Comparison of Early Versus Delayed Weightbearing Outcomes After Microfracture for Small to Midsized Osteochondral Lesions of the Talus

Lee, Dong Hoon; Lee, Keun Bae; Jung, Sung Taek; Seon, Jong Keun; Kim, Myung Sun; Sung, Il Hoon

doi:10.1177/0363546512455316

Cited by 63 publications

(68 citation statements)

References 26 publications

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“…To our knowledge there have been no studies on early PWB and its complications during rehabilitation from (peri)-or intra-articular fractures of the pelvis and lower extremities treated with internal fixation. Recent literature has reported composite postoperative complication rates of up to 37% (range 0.7-37%) (21)(22)(23)(24)(25)(26)(27)(28)(29)(30). A comparison of our complication data with published data based on applying the current guidelines shows comparable rates of complication for all our groups treated with the PWB protocol (21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

Section: Discussionsupporting

confidence: 53%

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Meys¹,

Kalmet²,

Sanduleanu³

et al. 2019

J Rehabil Med

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Aftercare in surgically treated trauma patients with fractures of the pelvis and lower extremities has remained largely unchanged during the past 60 years. To optimize rapid clinical recovery and the restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regime, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on both the time to full weight-bearing and the number of complications in patients with surgically treated fractures of the pelvis and lower extremities who undergo permissive weight-bearing. Objective: To optimize rapid clinical recovery and restoration of function and functionality, permissive weight-bearing has been designed as a new aftercare mobilization regimen, within the upper boundary of the therapeutic bandwidth, yet safe enough to avoid overloading. The aim of the present paper is to describe a comprehensive protocol for permissive weight-bearing during allied health therapy and to report on the time to full weight-bearing, as well as the number of complications, in patients with surgically treated fractures of the pelvis and lower extremities undergoing permissive weight-bearing. Patients and methods: This study included surgically treated trauma patients with (peri)-or intra-articular fractures of the pelvis and lower extremities. A standardized permissive weight-bearing protocol was used for all patients. Time to full weight-bearing and number of complications were recorded. Results: This study included 150 patients, 69% male, with a median age of 48 years (interquartile range (IQR) 33.0, 57.0). The median time to full weight bearing was 12.0 weeks (IQR 6.8, 19.2). The complication rate during rehabilitation was 10%. Conclusion: The permissive weight-bearing protocol, as described, might be beneficial and has potential to be implemented in trauma patients with surgically treated (peri)-or intra-articular fractures of the pelvis and lower extremities.

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Section: Discussionsupporting

confidence: 53%

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Meys¹,

Kalmet²,

Sanduleanu³

et al. 2019

J Rehabil Med

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“…Periods of non-weight-bearing ranging from one week to three months have been suggested, to protect the repair tissue. 28 A recent study by Lee et al 29 compared early (two weeks) with delayed (eight weeks) weight-bearing after microfracture for small to mid-sized OCLs of the talus (mean 1.0 cm 2 (0.6 cm 2 to 1.8 cm 2 )) and found no difference in functional outcomes at a mean follow-up of 37 months (24 to 76). This suggests that smaller lesions may not require delayed weight-bearing, but larger lesions with greater edge loading may need to be protected for longer.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Osteochondral lesions of the talus

Hannon

Smyth

Murawski

et al. 2014

The Bone & Joint Journal

136

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Osteochondral lesions (OCLs) occur in up to 70% of sprains and fractures involving the ankle. Atraumatic aetiologies have also been described. Techniques such as microfracture, and replacement strategies such as autologous osteochondral transplantation, or autologous chondrocyte implantation are the major forms of surgical treatment. Current literature suggests that microfracture is indicated for lesions up to 15 mm in diameter, with replacement strategies indicated for larger or cystic lesions. Short- and medium-term results have been reported, where concerns over potential deterioration of fibrocartilage leads to a need for long-term evaluation. Biological augmentation may also be used in the treatment of OCLs, as they potentially enhance the biological environment for a natural healing response. Further research is required to establish the critical size of defect, beyond which replacement strategies should be used, as well as the most appropriate use of biological augmentation. This paper reviews the current evidence for surgical management and use of biological adjuncts for treatment of osteochondral lesions of the talus.

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“…Although there are controversies regarding the best postoperative rehabilitation program for microfracture patients, most authors prefer the implementation of a non-weight or touchdown weight bearing postoperative period to allow for the formation and maturation of the hyaline-like fibrocartilage tissue at the defect site [7–9, 15]. There are few publications on this issue, and some authors reported confusion regarding the use of weight bearing rehabilitation methods and issues with providing sufficient information to patients to ensure compliance with postoperative rehabilitation protocols [16, 17].…”

Section: Discussionmentioning

confidence: 99%

Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions

et al. 2017

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BackgroundThe aim of this study was to prospectively evaluate the compliance of our patients with a touchdown weight bearing (without supporting any weight on the affected side by only touching the plantar aspect of the foot to the ground to maintain balance to protect the affected side from mechanical loading) postoperative rehabilitation protocol after treatment of talar osteochondral lesion (TOL).MethodsFourteen patients, who had been treated with arthroscopic debridement and microfracture, were followed prospectively. The patients were evaluated for weight bearing compliance with using a stationary gait analysis and feedback system at the postoperative first day, first week, third week, and sixth week.ResultsThe mean visual analog scale (VAS) scores of the patients at the preoperative, postoperative first day, first week, third week, and sixth weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. The decrease in VAS scores were statistically significant (p < 0.0001). First postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8 (one non-compliant patient). The mean value was 4.34% ±0.8 at the first postoperative week (two non-compliant patients), 6.95% ±2.3 at the third postoperative week (eight non-compliant patients), and 10.8% ±4.8 at the sixth postoperative week (11 non-compliant patients). In the analysis of data, we found a negative correlation between VAS scores and transmitted weight (Kendall’s tau b = −0.445 and p = 0.0228).ConclusionsAlthough patients were able to learn and adjust to the touchdown weight bearing gait protocol during the early postoperative period, most patients became non-compliant when their pain was relieved. To prevent this situation of non-compliance, patients should be warned to obey the weight bearing restrictions, and patients should be called for a follow-up at the third postoperative week.

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Comparison of Early Versus Delayed Weightbearing Outcomes After Microfracture for Small to Midsized Osteochondral Lesions of the Talus

Cited by 63 publications

References 26 publications

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

A protocol for permissive weight-bearing during allied health therapy in surgically treated fractures of the pelvis and lower extremities

Osteochondral lesions of the talus

Patient compliance with touchdown weight bearing after microfracture treatment of talar osteochondral lesions

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