Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation

Abstract

Objective The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT). Design A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate. Results Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40). Conclusions The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.

Should Arthroscopic Bone Marrow Stimulation Be Used in the Management of Secondary Osteochondral Lesions of the Talus? A Systematic Review

“…Although a systematic review of arthroscopic bone marrow stimulation for secondary lesions has recently been performed [7], we believe there is sufficient justification for another review. The previous review pooled outcomes from five studies (one randomized controlled trial, one retrospective comparative study, and three case series studies), finding that the overall success proportion of arthroscopic bone marrow stimulation for nonprimary osteochondral lesions of the talus was 61%.…”

The effect of talus osteochondral defects of different area size on ankle joint stability: a finite element analysis

“…BMS can cause additional damage when minor defects in the talus cartilage do not affect the stability of the ankle joint [11]. The size of defects diameter that do not require repair is clinically controversial [12]. There is no clear quantitative indicator of the size of the area to guide the selection of conservative or surgical treatment.…”

Autologous matrix induced chondrogenesis (AMIC) as revision procedure for failed AMIC in recurrent symptomatic osteochondral defects of the talus

“…For primary osteochondral talar lesions, a variety of surgical treatments has been proposed 9 – 15 , but the superiority of any surgical technique has not been confirmed 16 . For lesions smaller than 1.5 cm 2 , bone marrow stimulation (BMS) techniques provide satisfactory long-term outcomes 17 , and a pooled success rate of 61% was reported for non-primary lesions 18 . For larger lesions, both matrix-induced autologous chondrocyte implantation (mACI) and autologous matrix-induced chondrogenesis (AMIC) have been proposed 19 .…”