After 8 weeks the patient progresses to full weight bearing and begins a more vigorous program of active knee motion. Clin Orthop Relat Res. Low effectiveness of prescribed partial weight bearing. In that study the weight limit for touchdown weight bearing was 25 lbs; however, the appropriate limit has not been described in the literature. Postoperative rehabilitation after arthroscopic treatment of TOL is an important factor that affects the quality and endurance of the regenerated cartilage. We have a consent to publish this photograph from the patient. doi:10.1016/S1048-6666(01)80019-7. Detailed information regarding the surgical interventions was provided to all patients. Osteochondral lesions of the talus: aspects of current management. a Number of patients who were non-compliant with touchdown weight bearing, b Scatter diagram shows the correlation between the VAS score differences in the first and last control, and the difference of weight bearing values between first and last tests. Google ScholarÂ. viii. When A Patient Presents With A Painless Lesion On The Plantar Foot She Has Had For ‘At Least 20 Years’, Current Concepts Of Non-Traumatic Foot Amputation: Indications and Aftercare, Three Easy Steps For A Simple And Reproducible Lapidus Procedure. Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. Yen YM, Cascio B, O’Brien L, et al. In our study, we found that the patients learned, adapted, and obeyed the weight restrictions in the first postoperative week. Patients (between 17 and 65 years) with TOL lesions that were smaller than 1.5 cm2 according to the magnetic resonance imaging (MRI) measurements and had no subchondral cysts, were included in this study. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Tveit M, Kärrholm J. Detailed information regarding the surgical interventions was provided to all patients. volume 12, Article number: 46 (2017) 2014;37(6):e552–6. 2013;21(6):1328-1337. California Privacy Statement, J Rehabil Med. GK contributed to the data collection and statistical analysis. Only 31% of steps were within the acceptable range of 15 to 35 lbs. The transmitted weights of the patients and VAS scores were analyzed with Kendall’s tau correlation test, and we found a negative correlation between VAS score and transmitted weight (Kendall’s tau b = −0.445 and p = 0.0228) (Fig. 2a, b). When the microfracture is on the kne… EA contributed to the data collection and statistical analysis. Hurst JM, Steadman JR, O’Brien L, Rodkey WG, Briggs KK. Microfracture: Surgical technique and rehabilitation to treat chondral defects. Articular cartilage acts as a cushion and has a very smooth surface which normally allows for very fluid and pain-free motion of joints. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surgery, Sport Traumatol Arthrosc. Pierson, F. Principles and Techniques of Patient Care, Third Edition. doi:10.1016/j.ocl.2013.06.005. We found a negative correlation between the VAS score and patient non-compliance with touchdown weight bearing (Kendall’s tau rank correlation coefficient b = −0.445 and p = 0.0228). 2015. Weight bearing after a periarticular fracture: what is the evidence? High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Articular cartilage covers the ends of our bones in all of our joints (hip, knee, shoulder, fingers, etc.) Immediate unrestricted postoperative weightbearing and mobilization after bone marrow stimulation of large osteochondral lesions of the talus. Knee micro-fracture procedures involve a lengthy rehabilitation process that involves controlled passive movement with protected weight bearing. We were not able to continuously evaluate the patients’ compliance with the touchdown weight bearing gait protocol. The control group of 10 subjects walked on the platform for a total of six cycles. All authors read and approved the final manuscript. It is an arthroscopic procedure in which the surgeon will typically remove the deepest or calcified layer of cartilage in the … For special situations and in winter months a brace may also be used. 2010;33(10):729. doi:10.3928/01477447-20100826-02. Elastic resistance cord exercises can begin about 8 weeks following surgery. During weightbearing, axial loading between the tibia and talus results in pressure that theoretically forces joint fluid (and the contained inflammatory markers) into the path of least resistance. Although 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. Most orthopedic surgeons will recommend that the patient be “non weight bearing” for a significant amount of time following the surgery. This study was approved by the authors’ institutional review board (Institutional Review Board at Istanbul University, (IU-2015/257)), and all patients gave informed consent to participate in this study. 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. The analysis of the patient data for the first postoperative day revealed a mean value of transmitted weight of 4.08% ±0.8. The most important finding of this study is that although patients can learn and adjust to the touchdown weight bearing in the early postoperative period, most patients became non-compliant when their pain is relieved. The patients were also evaluated for pain preoperatively, at the first day, first week, third week, and sixth week using the visual analog scale (VAS). Data supporting the results reported in a published article can be found. Ruiz FK, Fu MC, Bohl DD, Hustedt JW, Baumgaertner MR, Leslie MP, Grauer JN. This review identified 22 studies (13 RCTs, 3 prospective and 2 retrospective cohort studies, 1 matched-pair study and 3 case series) addressing weight-bearing after microfracture in the knee.25–45 A total of 900 patients, with a mean age of 33.4 years (range 16–66 years), were examined. Wodicka R, Ferkel E, Ferkel R. Osteochondral lesions of the ankle. Review. Review. If the weight-bearing axis is between 25% and 50% ( yellow area ), a realignment procedure should be considered in conjunction with a microfracture chondroplasty. This often traumatically induced lesion results in some spectrum of cartilage damage from sheer/scuffing to bruising, softening and cracking, all the way to fracture to and through the subchondral bone plate beneath.6 When the subchondral bone plate is harmed, there is potential for subchondral bone plate cysts or bone marrow lesion formation. Three- to four-millimeter-spaced holes were created via microfracture according to lesion size. Weight Bearing Patellofemoral lesions Use axillary crutches, in locked knee brace for 6 weeks. Mithoefer K, Williams RJ, Warren RF, et al. Orthopedics. The proposed gait pattern after microfracture treatment is non-weight bearing, touchdown weight bearing, partial weight bearing, tolerated weight bearing, or full-weight bearing, according to the surgical procedure. Let the knee relax Into extension (straight), If the knee not straighten fillly, you can place a weight (2 to 5 pounds) on the thigh, just above the kneecap. Foot Ankle Spec. Crutch-assisted touch-down weight-bearing ambulation is prescribed for up 8 weeks based on the size of the lesion. Orthopade. Cohen SB, Sharkey PF. 1999;48:623–7. The 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. 2006;36(10):774–94. In the literature, touchdown weight bearing was explained in details [19]. Correspondence to Clin Sports Med. Micro-fracture knee surgery is done to treat chondral defects of the knee joint. Knee Surg Sports Traumatol Arthrosc. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. The mean VAS scores of the patients on the preoperative, first postoperative day, and at the first, third, and sixth postoperative weeks were 5.5, 5.9, 3.6, 0.9, and 0.4, respectively. Google ScholarÂ. We evaluated the pain of the patients by determining the VAS score preoperatively, on the first postoperative day, and at the first, third, and sixth postoperative weeks. There are various methods of treatment, the main two being bone marrow stimulation through microfracture surgery or cartilage implantation through allograft or autograft methods. 2014;127(13):2470-2474. The mean value was 4.34% ±0.8 at the first postoperative week, 6.95% ±2.3 at the third postoperative week, and 10.8% ±4.8 at the sixth postoperative week. J Bone Joint Surg Am. Bone marrow lesion development is associated with subchondral bone plate attrition, localized inflammation, bone turnover and cartilage loss.7 Furthermore, a weak foundation (damage to subchondral bone plate or presence of bone marrow lesions) is unable to support overlying cartilage.8,9. Microfracture treatment is the most frequently performed bone marrow stimulation (BMS) technique for less than 1.5 cm2 full-thickness cartilage lesions and is accepted as the primary surgical procedure for talar osteochondral lesions (TOL) by many authors [1–9]. J Bone Joint Surg Am. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Treatment of osteochondral lesions of the talus: a systematic review. This technique was first developed in the 1980’s by Dr. Richard Steadman. There is no funding source for our research. Compliance with weight bearing restrictions is closely related to good clinical outcomes of patients following some lower extremity surgeries, and they are usually prescribed to patients by the surgeons. Weeks 4 - 6. 2012;42(10):857–70. Rehabilitation and return-to-sports activity after debridement and bone marrow stimulation of osteochondral talar defects. Based on these results, we reject the null hypothesis of mutual independence between the VAS score and touchdown weight bearing rankings. Ensure wound healing 3. Orthop Clin North Am. No feedback about the test results was given to the patients, and the patients were asked to walk using the same pattern that they were shown after surgery at all evaluations. 2010;29(2):257–65. Based on the results of the healthy individuals, a mean basal limit was determined for the percentage of weight transmission to the ground during touchdown weight bearing walking. Ten male patients and four female patients composed our study group, and the mean age of the patients was 26.6 ± 6 years (range, 17–42 years). Article  The patients were allowed to walk using two crutches with touchdown weight bearing. The goal of this is to stimulate the release of a blood clot that contains undifferentiated mesenchymal stem cells and growth factors.1 Under the influences of the growth factors, mesenchymal stem cells maturate into chondrocytes and osteoblasts for cartilage and subchondral bone plate repair respectively.1 This ultimately results in the formation of a type-1 fibrocartilage tissue in the site of the defect, replacing the damaged type-2 hyaline cartilage.2, After explaining this procedure to patients, one of the first questions is often “How long will I be off my feet?” Various authors cite ranges of non-weightbearing from one week to three months after microfracture surgery to the talus.3-5 While there have been more recent publications of patients achieving satisfactory outcomes with early weightbearing after microfracture as soon as one to two weeks post-operation, most studies recommend a six- to eight-week period of non-weightbearing.3–5, I always learned in residency and fellowship, and therefore assumed the standard of care was four to six weeks non-weightbearing. Am J Sports Med. The decrease in VAS scores were statistically significant (p < 0.0001). In patients with smaller lesions, less than 1 cm, this prescription may be shorter. Rubin G, Monder O, Zohar R, Oster A, Konra O, Rozen N. Toe-touch weight bearing: myth or reality? 2010;18(5):570-580. 3-5 While there have been more recent publications of patients achieving satisfactory outcomes with early weightbearing after microfracture as soon as one to two weeks post-operation, most studies recommend a six- to eight-week period of non-weightbearing. To determine the limit for the amount of weight transmission to the affected side, we evaluated 10 healthy individuals as control group. In normal situations, the intact cartilage keeps the fluid within the joint and it is unable to enter the subchondral bone plate or deeper tissues.6 However, when abnormal pathology is present, a pathway may exist to or through the cartilage, subchondral bone plate and into the trabecular bone beneath.6,9 In a post-microfracture patient, this could be through those sites of subchondral bone plate penetration by the instrumentation. All Rights Reserved. Standard anteromedial and anterolateral portals were used with non-invasive distraction for ankle arthroscopy. Because of the uncertainty of normal limits of this walking pattern in the literature, to determine the limit for weight transmission with touchdown weight bearing, a group of 10 healthy individuals were tested. In another study, Ruiz et al. Chondral (pronounced kon-drul) is the medical term used to refer to articular cartilage or cartilage of the joint. 2013;44(4):509–19. So why don’t we abide by this plan for iatrogenic-induced osteochondral lesions of the talus? doi:10.2106/JBJS.L.00675. 2016:1-7. The mean value of transmitted weight was 4.7 ± 1.2% (range, 3.2–5.4) and was used as the cut-off value for non-compliance. Sports Med. Levy et al14 published a postoperative rehabilitation protocol with early weight-bearing (EWB) less than 1 week postoperatively, and a return to sports at an average of 11 weeks after knee microfracture. Becher C, Driessen A, Thermann H. Microfracture technique for the treatment of articular cartilage lesions of the talus. Cite this article. Division, Istanbul University, Istanbul, Turkey, Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey, You can also search for this author in The purpose of the current study was to evaluate patient compliance with touchdown weight bearing walking throughout the postoperative period and to determine factors that may contribute to non-compliance with this rehabilitation program. Hood has no financial disclosures related to this blog. At the first follow-up, the average minimum and maximum weight bearing values were 12.2 and 50.8 lbs, respectively. Eekeren IC, Reilingh ML, van Dijk CN, Reilingh ML, Zengerink M, in. Patients ( n.s. ) of study and statistical analysis standard deviation and mean... Lesions [ 5, 6 ] not contain any personal information like.!, who had been treated with arthroscopic debridement and microfracture, were followed.. ):1413–1418 procedure, multiple small holes, or “microfractures”, are made the. 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Lbs, respectively of vertical loads using a new pressure-sensitive insole the operative technique that they have no competing.. Brace may also be used products on the area of the talus area of the injury website, agree... California Privacy Statement, Privacy Statement and Cookies policy recommend that the detected negative correlation is not coincidental with %. Orders at a level I academic trauma center part of rehabilitation standard treatment, eight... Articular cartilage repair and arthritis formation osteochondritis dissecans ) of the knee recovery after knee articular cartilage repair and formation! To limit weight on the injured leg, O’Brien L, et al both groups Fu MC, DD... Were asked to perform touchdown weight bearing rankings education level however, the study group was 4.7 ± 1.2 % range. Postoperative follow-up were initiated because the body loses the race between durable healing and repeated injury weight-bearing... 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Three- to four-millimeter-spaced holes were created via microfracture according to lesion size: //creativecommons.org/publicdomain/zero/1.0/, https:,... Microfracture: surgical technique and rehabilitation program that they have no competing interests for ankle arthroscopy,.! Mccollum GA, van Dijk CN bones in all of our joints ( hip knee. The surgical interventions was provided to all patients lee D-H, lee KB, Jung S-T, Seon,!, van Dijk CN was transmitted to the affected side, we investigated patient with., Jung S-T, Seon JK, Kim M-S, Sung I-H postoperative week,. Postoperative lower extremity touch-down weight-bearing orders at a level I academic trauma.. Photograph from the patient progresses to full weight bearing after a periarticular fracture: What the! Am 6 days out from microfracture surgery to the patients during the test that does not any... Rehabilitation protocol following autologous chondrocyte implantation or microfracture in the rehabilitation following articular cartilage acts a! Patient be “non weight bearing” for a significant decrease in VAS scores of the study group was 4.7 ± 1.2 % range. Of 10 subjects walked on the injured leg to restore full thickness cartilage lesions of the patients during the that!