Editorial Commentary: Early Weightbearing in a Cast After Osteochondral Autograft Transplantation for Osteochondral Lesions of the Talus Is Feasible.

Abstract

Osteochondral lesions of the talus (OLTs) should initially be treated nonoperatively. In case of failure of a large, irreparable (nonprimary) OLT, osteochondral transplantation techniques may be recommended. Harvesting an osteochondral graft from the ipsilateral knee is most commonly used. Several other donor sites of transplantation grafts have also been described, such as the iliac crest (osteoperiosteal graft). Moreover, allografts may also be used. In the case of medial OLTs, a medial malleolar osteotomy is often needed to access the joint. Postoperatively, patients are placed in a nonweightbearing cast to ensure both incorporation of the graft and union of the osteotomy. While consensus exists on the need to immobilize patients postoperatively, protocols for weightbearing differ significantly. Based on our clinical experience, early weightbearing may be used but should be carefully monitored. Patient characteristics, such as compliance to the protocol, should be included, and thus rehabilitation protocols should be individualized.