Houston Methodist. Leading Medicine

Ankle FAQ

Question:

I'm checking to see what you know about a bone graft to the talus bone of the ankle. This is supposed to fill in a hole in the ankle bone where I had a major injury from spraining my ankle. I guess what I really want to know is whether or not I'll be able to play ball again. I'm not a professional athlete or anything like that. But I like to play all kinds of intramural and recreational sports. Am I looking at being sidelined for the rest of my life?

Answer:

Ankle sprains make up almost one-third of all sports-related injuries so you are not alone in this. About half of all ankle sprains have an associated injury, such as the defect you described. The hole you mentioned is likely called an osteochondral lesion, indicating that both cartilage and a layer of bone have pulled away from the talus. The talus is the major ankle bone located between the heel bone and the lower leg bone (shin). A recent study was done on 131 young, active adults engaged in recreational activities and sports. The goal was to see what kind of activity and level of activity these patients were able to return to after a procedure called osteochondral autologous transplantation (OAT). In this procedure, a piece of bone is harvested from the knee and moved to fill in the hole in the talus (or other damaged bone). In this study, (after the OAT procedure), everyone was followed for a minimum of two years (some were followed for as long as 12 years). The primary area of interest was the ability to return-to-sports. Pain, activity levels in general, and patient satisfaction were also measured. They found a significant change in activity type and level from before to after surgery. Patient satisfaction was not high, possibly due to the fact that these athletes expected more after this type of surgery. Many of them altered their activity level and started avoiding high-impact activities such as jumping and contact sports. It's likely (but not confirmed) that the athletes were afraid of injuring or reinjuring the ankle. By limiting the amount of time they played and the intensity of play, they may have believed that they could further prevent deterioration of the ankle joint. The authors did not test out this hypothesis but just offered their theories on the athletes' behaviors. The decreased patient satisfaction may be the result of athletes who were disappointed that they could no longer train or play at the high level they participated in sports before the injury and subsequent ankle surgery. Pain at the bone donor site (knee) may also adversely affect activity and sports play as well as attitude and level of satisfaction. As a result of these findings, the authors suggested surgeons advise young, active patients having osteochondral transplantation of the talus what to expect after surgery. There may be a risk that the outcomes won't be as expected. The patient may have to reduce activity level and possibly change type of sports participation. Having this kind of information will help you in talking with your surgeon. Be sure and bring up your question and see what you find. Each patient has some individual differences in age, body type, goals, and extent of injury that may impact treatment decisions and treatment results. Jochen Paul, MD, et al. Sports Activity After Osteochondral Transplantation of the Talus. In The American Journal of Sports Medicine. April 2012. Vol. 40. No. 4. Pp. 870-874.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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