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

Abstract

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.

High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus

“…Fifty‐seven clinical studies reporting return to play and/or rehabilitation guidelines with 3072 ankles were included (LOE I: 4, LOE II: 6, LOE III: 9, LOE IV: 38) [2–5, 7–12, 14–29, 32–43, 45, 47, 50, 52, 53, 55, 56, 59–64, 66–70, 72, 73]. There were 1858 males and 1125 females, with a mean weighted age of 36.9 years (range 23–56.8) followed up at a mean of 46.0 months (range 1.5–141).…”

“…The range of motion protocol was reported in 39 studies [2, 4–9, 12, 14, 19–23, 25, 28, 29, 32–37, 40, 41, 43, 45, 47, 50, 52, 53, 55, 56, 59, 63, 66, 68, 70, 72, 73]. The most commonly reported time of commencing range of motion was within the first week (46.2%), followed by 1 week postoperatively (23.1%) and 2 weeks postoperatively (23.1%).…”

“…3, 4, 5. The time to partial weight‐bearing was reported in 49 studies [2–5, 7–12, 14, 15, 17, 19–29, 32–43, 45, 47, 50, 52, 53, 56, 59, 63, 66, 67, 70, 72, 73]. The most commonly reported time of commencing partial weight‐bearing was the first week (38.8%), followed by 6 week postoperatively (14.3%), and 2/3/4 weeks postoperatively (all 12.2%).…”

“…The most commonly reported time of commencing partial weight‐bearing was the first week (38.8%), followed by 6 week postoperatively (14.3%), and 2/3/4 weeks postoperatively (all 12.2%). The time to complete weight‐bearing was reported in 52 studies [2–5, 7–12, 14, 15, 17–27, 29, 32–34, 37–43, 45, 47, 50, 52, 53, 56, 59, 63, 64, 66, 67, 70, 72, 73]. The most commonly reported time of commencing full weight‐bearing was 6 weeks postoperatively (28.8%), followed by 8 weeks postoperatively (21.1%), and 2 weeks postoperatively (13.5%).…”

Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus

“…On a practical note, research has also shown that patients often do not comply with prescribed weightbearing precautions, despite clear instructions. 14 There are also drawbacks with the assistive devices necessary to maintain a partial or NWB status. While crutches or scooters allow for the weight to be redistributed to the contralateral side, they can require excessive strength, balance, and metabolic demands that could result in injury even in younger patients.…”