Return To Sports After Talar OsteoPeriostic Grafting From the Iliac Crest for Large Osteochondral Lesions of the Talus

Background: The Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure shows successful clinical outcomes up to 2-year follow-up for large osteochondral lesions of the talus (OLTs). However, sports outcomes remain unknown. Purpose/Hypothesis: The purpose of this study was to prospectively evaluate sport outcomes for patients with large OLTs treated with the TOPIC procedure. It was hypothesized that the TOPIC procedure would result in adequate (return to/participation in) sports outcomes and improvements of pain scores during running at 1 and 2 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 61 patients who underwent the TOPIC procedure for a symptomatic OLT were prospectively included with ≥24-month follow-up. Using digital questionnaires and an in-depth qualitative telephone interview, participation in desired level of sport at 1 and 2 years (primary outcome) was assessed. Secondary outcomes included different levels of return to and participation in sports rates, as well as the Numeric Rating Scale (NRS) for pain during running and the Ankle Activity Score (AAS) at 1 and 2 years postoperatively. Results: Of the total patients, 59% and 82% participated at their desired level of sport at 1 and 2 years after TOPIC, respectively. Furthermore, at 2 years postoperatively, the return to any level of sports was 98%, the return to preoperative level of sports was 93%, and the return to preinjury level of sports was 59%. The AAS significantly increased from 2 (IQR, 2-3) preoperatively to 5 (IQR, 5-6.5), 2 years postoperatively (P < .01). The NRS for pain during running improved significantly from 9 (IQR, 8-10) points preoperatively to 5 (IQR, 1-8) points at 2 years postoperatively (P < .01). At 2-year follow-up, the reoperation rate was 38%. Conclusion: Almost all patients returned to sports, and 8 out of 10 returned to their desired level of sport 2 years after the TOPIC procedure. Ankle activity significantly improved, and pain during running significantly decreased. Moderate symptoms, mostly unrelated to the graft, persisted in some patients, and 1 in 3 required reoperation.