Back in the Game, But Maybe Not at the Top: Mid-term Sports Ability After Microfracturing For Juvenile Osteochondral Lesions Of The Talus.

INTRODUCTION: Juvenile osteochondral lesions of the talus (OLT) occur more frequently in children and adolescents who are physically active, although no clear causality can be established. For the frequently used, stage-adapted microfracture procedure, evidence remains insufficient regarding medium-term sports participation and sport-specific performance levels in this population with a view to competitive youth sports.

OBJECTIVE: The primary objective of this study was to evaluate the rate of medium-term sports participation (in accordance with the IOC Consensus Statement on the continuum of return to sports) and sport-specific performance in adolescents following microfracture treatment of a juvenile OLT in the context of potentially persistent limitations. Secondly, the study aimed to evaluate the everyday functionality and pain levels of the patients.

MATERIALS AND METHODS: A retrospective clinical longitudinal study was conducted on first-line therapy following microfracture treatment of OLT stage 3 according to Dipaola in a consecutive cohort of systematically physically active children and adolescents, recorded at a single centre. PROMS included the modified Heidelberg Sports Activity Score (HAS) to assess the rate of medium-term sports participation and sport-specific performance, as well as the Visual Analogue Scale Foot and Ankle (VAS FA) and the modified Foot and Ankle Outcome Score (FAOS) to assess the development of functionality and pain intensity immediately before the injury and at follow-up.

RESULTS: A total of 35 patients were included in the study, with a loss to follow-up of 18.6%. Mean age at surgery was 14.6 years, and the mean follow-up period was 49.8 months. There was a significant improvement in the VAS FA and the modified FAOS compared with the preoperative status regarding everyday functionality and pain levels. Return to participation in sports was 97.1%. A significant medium-term reduction in overall athletic performance compared with the pre-injury level was observed in the modified HAS (p < 0.017) from 58.8 to 43.1 median points, although this reduction was not consistent across all sports. Only three of eleven sports analysed (running/jogging, cycling, ball sports) showed a significant decline in sport-specific performance (p < 0.017), whereas performance in eight sports remained unchanged. Functional, pain-related impairments of the operated-on ankle were most frequently reported in ball sports, racket sports, dancing and running/jogging in the medium term. During the return-to-sport phase within the return-to-sport continuum, participants rarely switched to lower-impact sports to a comparable extent or intensity (n=3). Persistent impairments led to a higher number of sport attrition (n=19).

CONCLUSION: Stage-adapted microfracture treatment in juvenile OLT shows very good results with respect to pain-free everyday resilience. A high likelihood of return to sports participation can be expected. In the medium term, however, painful progression can limit performance levels, especially in high-impact sports (ball sports, racket sports), but also in dancing and running/jogging. Persistent painful impairments at the threshold of return to sports participation in these three sports had the greatest prognostic value and impact on sport-specific performance levels in the medium term. In contrast to adults, children and adolescents in this study were less likely to transition to lower-impact sports. Consequently, this resulted in a higher number of sport attrition.