Summary
High rate of return to play can be achieved with careful management of osteochondral lesions.
Abstract
Management of Osteochondral Lesions in Elite Athletes
Background
Osteochondral lesions can be career ending for elite athletes. While small, stable lesions can be treated conservatively, larger, and unstable lesions may require intervention.
Restoration of native hyaline cartilage with fixation / repair of the lesion should be the goal if possible. In small unrepairable lesions a microfracture procedure may be indicated. If there is a large osteochondral defect, an osteochondral graft may be indicated. Although good outcomes have been reported in both adult and paediatric populations there is very little evidence available for elite athletes.
We report the return to play (RTP), career longevity and re-surgery rates from our retrospective reviews of athletes following microfracture and ORIFs. We also report the case of an elite player who had osteochondral reconstruction of the MFC.
Results
Microfracture results
50 professional athletes underwent microfracture. 94% returned to professional sport and of these 91.5% were still playing at 2 years and 61.5% were still playing at 5 years. The size of the lesion significantly affected the ability to RTP (p=0.048) and to still be playing at 5 years (p=0.037).
Further microfracture was required for one case, one had microfracture to a new lesion and one case was revised to a mosaicplasty at 6 months.
ORIF results
21 elite athletes underwent ORIF of the osteochondral fragment.
18 (85.7%) RTP, 2(9.5%) did not RTP and information was unavailable for one academy rugby player. Of those that RTP 15 (79.0%) were still playing at 2 years and information was unavailable for 4 (21.0%) academy players. 17 players were more than 5 years post op and of those that RTP 11 (64.7%) were still playing, 2 (11.8%) had retired and information was unavailable for 4 (23.5%) academy players.
13 (61.9%) required further surgery. 7 required removal of implants and 2 had further microfracture. 4 had arthroscopies and chondroplasties due to synovitis but the implants were retained.
OCA result
One football player presented with a very large defect in the MFC. This was reconstructed using OCA. Healing was confirmed on imaging and at planned repeat arthroscopy to remove the metal screws. The player successfully RTP and continues to play over 2 years from surgery.
Conclusion
Osteochondral lesions are career threatening in elite sport.
A high RTP rate and good career longevity can be achieved with careful management.
OCA is a useful salvage procedure when there is significant bone and cartilage loss.