Effectiveness of Autograft and Allograft Transplants in Treating Athletic Patients With Osteochondral Lesions of the Talus

Osteochondral lesions of the talus (OLTs) represent 50% of ankle sprains and are most common in athletes who play competitive sports or are on active military duty. OLTs can cause significant physical damage if left untreated and may inflict financial burdens and mental health issues. Over the years, replacement surgeries, mainly autologous osteochondral transplantation (AOT) and osteochondral allograft transplantation (OAT), have become instrumental in treating OLTs. However, these procedures' effectiveness in returning to full fitness to resume competitive sports or active duty has not been well-established. This systematic review attempts to help this population cohort better understand OLTs and highlight the existing clinical evidence on AOT and OAT effectiveness in treating such patients. We performed a literature search between March 2022 through September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Of eligible studies evaluating surgical outcomes of AOT and OAT in sportspeople and active-duty military personnel, 86% of patients who received AOT returned to competitive sports or active duty compared to 61% who received OAT. Additionally, on average, patients who underwent AOT returned to full fitness in five months rather than in 16 months for those who underwent OAT. As highlighted in this review, the limited evidence indicates that AOT may lead sportspeople and active-duty military personnel to return to pre-injury levels and resume athletic activities sooner. It is challenging to assume the same for OAT, given the limited studies in athletic cohorts with OLTs. Nevertheless, AOT and OAT are crucial surgical options that can significantly benefit competitive sportspeople and military personnel in resuming their careers.