Hong Choon Chiet, Chua Chen Xi Kasia, Betzler Brjan Kaiji, Lim Sheng Yang, Sharon Tan Si Heng, Pearce Christopher Jon
Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
Arthroscopy. 2025 Jul;41(7):2506-2521.e21. doi: 10.1016/j.arthro.2024.10.045. Epub 2024 Nov 8.
To provide a comprehensive systematic review to determine the impact of early weight-bearing compared with late weight-bearing on the clinical outcomes of patients who underwent osteochondral lesion of the talus (OLT) and were treated with autologous osteochondral transplantation (AOT) and to review the rate of return to sports and/or activities, patient satisfaction, and complications.
A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Publications were divided into group A, in which patients were allowed early weight-bearing within the first 6 weeks, whereas group B consisted of patients who were only allowed weight-bearing after 6 weeks. Unweighted estimates were calculated instead of quantitative random-effects meta-analysis due to the high heterogeneity and low level of evidence of the included studies.
In total, 44 studies with 1,838 ankles were included. There were 25 studies in group A and 19 studies in group B. Both the American Orthopaedic Foot and Ankle Society and visual analog scale scores were not affected by early weight-bearing after AOT for OLT. There were similar rates of return to sports and/or activities (71.4%-100% vs 71.4%-100%) and patient satisfaction (71.4%-100% vs 65.7%-100%). Notably, late weight-bearers had lower rates of postoperative knee symptoms (0-30% vs 0-39.1%) despite more late weight-bearers presenting with complication rates >20% compared with early weight-bearers (20% vs 14.3%) respectively. Late weight-bearers also had greater rates of repeat surgery (0-26% vs 0-18.2%) compared with early weight-bearers, with the most common cause for repeat surgery being arthroscopic debridement for postoperative impingement pain.
Protocols allowing for early weight-bearing after AOT for OLT yielded similarly good outcomes in terms of American Orthopaedic Foot and Ankle Society, visual analog scale for pain score, return to sports and/or daily activities, and patient satisfaction when compared with late weight-bearing. Although the differences in ranges for postoperative complications were not exceedingly different, late weight-bearers have slightly lower rates of postoperative knee symptoms and marginally greater rates of repeat surgery, with the most common cause for repeat surgery being arthroscopic debridement for postoperative impingement pain, similar to the studies with a low level of evidence appraised. The strength of these conclusions is limited because of the high level of heterogeneity, low level of evidence and high risk of bias in the literature reviewed.
Level IV, systematic review of Level I to Level IV studies with predominantly Level IV studies.
进行一项全面的系统评价，以确定与延迟负重相比，早期负重对接受距骨骨软骨损伤（OLT）并接受自体骨软骨移植（AOT）治疗的患者临床结局的影响，并评估恢复运动和/或活动的比率、患者满意度及并发症情况。
根据系统评价和Meta分析的首选报告项目指南，对PubMed、Embase和Cochrane图书馆数据库进行系统评价。出版物分为A组，即患者在术后6周内被允许早期负重；B组则是仅在6周后才被允许负重的患者。由于纳入研究的异质性高且证据水平低，因此计算未加权估计值而非进行定量随机效应Meta分析。
共纳入44项研究，涉及1838例踝关节。A组有25项研究，B组有19项研究。美国矫形足踝协会评分和视觉模拟量表评分在OLT的AOT术后均不受早期负重的影响。恢复运动和/或活动的比率（71.4%-100%对71.4%-100%）以及患者满意度（71.4%-100%对65.7%-100%）相似。值得注意的是，延迟负重者术后膝关节症状发生率较低（0-30%对0-39.1%），尽管与早期负重者相比，延迟负重者出现并发症率>20%的情况更多（分别为20%对14.3%）。与早期负重者相比，延迟负重者再次手术的比率也更高（0-26%对0-18.2%），再次手术最常见的原因是因术后撞击痛进行关节镜清创。
与延迟负重相比，OLT的AOT术后允许早期负重的方案在美 国矫形足踝协会评分、疼痛视觉模拟量表评分、恢复运动和/或日常活动以及患者满意度方面产生了同样良好的结果。尽管术后并发症发生率范围的差异并非极为显著，但延迟负重者术后膝关节症状发生率略低，再次手术比率略高，再次手术最常见的原因是因术后撞击痛进行关节镜清创，这与证据水平低的研究结果相似。由于所综述文献的异质性高、证据水平低且偏倚风险高，这些结论的力度有限。
IV级，对I级至IV级研究的系统评价，主要为IV级研究。
