Summary

This prospective study assessed the return to sport outcomes after treatment (conservative and surgical) for osteochondral lesions of the talus in elite-level athletes.

Abstract

Purpose

The aim of this study is to assess the return to sport rate to pre-injury level of sport for all treatment options of osteochondral lesions of the talus in elite level athletes. Secondly, the return to any level of sport, return to performance (RTP), the time to RTS at any level, pre-injury level and RTP time will be assessed. Lastly, patient reported outcome measures (PROMs) were assessed.

Methods

This study concerns a cross-sectional database between January 1989 and August 2022 consisting of more than 1900 consecutive patients with osteochondral lesions to the ankle. Elite level athletes that have been treated for an osteochondral lesion of the talus were selected from this database and subsequently underwent prospective follow-up. Data was collected by means of online questionnaires (CASTOR portal), electronic patient records and an in-depth telephone interview. The primary outcome of this study was the return to sports rate at pre-injury level. Secondary outcomes were: rate of return to performance, rate of return to any level of sport, return to sport times for return to pre-injury level, return to performance and return to any level of sport. PROMs regarding NRS, SF-36 and FAOS were collected.

Results

A total of 26 patients were included in this study. Mean age of the included patients was 27 years (SD ± 5.3, range 16 – 38) and mean follow-up time was 57 months (SD ± 37.3, range 9 – 170). A total of seven patients (27%) underwent conservative treatment and 19 patient (73%) operative treatment.
Overall return to pre-injury level of sport was 69%, return to any level of sport 96% and return to performance 62%. For conservative treatment, the rate of return to pre-injury level was 57%, the rate of return to any level of sport 86% and the rate of return to performance 57%. Operative treatment showed a rate of return to pre-injury level of 74%, a rate of return to any level of 100% and a rate of return to performance of 63% - without significant differences between operative care and conservative management.
Mean time to return to any level, to pre-injury level and to performance for the conservative treatment was 18, 23, and 25 weeks, respectively. Mean time to return to any level, to pre-injury level and to performance for the conservative treatment was 17, 40, and 51 weeks, respectively. At latest follow-up 11 patients (42%) were still active at an elite level of sport. Mean NRS rate was 2.1 during running and 0.3 in rest. The mean FAOS score was 83.

Conclusion

Conservative treatment for osteochondral lesions of the talus resulted in a rate of return to pre-injury level of 57%, a rate of return to any level of sport of 86%, and a rate of return to performance of 57%. Operative treatment for OLTs showed a rate of return to pre-injury level of 74%, a rate of return to any level of 100% and a rate of return to performance of 63% - without significant differences between the operative care and conservative management.