Operative treatments for osteochondral lesions of the talus in adults

Abstract

Purpose: This systematic review aimed to identify the available evidence regarding the comparative effectiveness and safety of various operative treatments in adult patients with osteochondral lesions of the talus (OLT). Materials and methods: The PubMed, Embase, ISI Web of Knowledge, and the Cochrane Controlled Trial Register of Controlled Trials were searched from their inception date to September 2019. Two reviewers selected the randomized controlled trials (RCTs) and non-RCTs assessing the comparative effectiveness and safety of various operative treatments for OLT. The meta-analysis was performed using Revman 5.3. Results: Eight studies (1 RCT and 7 non-RCTs) with 375 patients were included in this review. The difference in the American Orthopaedic Foot and Ankle Society (AOFAS) score between the cartilage repair and replacement was not significant. The cartilage regeneration with or without cartilage repair had significant superiority in improving the AOFAS score compared with the cartilage repair. The difference in the magnetic resonance observation of cartilage repair tissue score between the cartilage repair and replacement and between cartilage repair and cartilage repair plus regeneration was significant. Conclusions: Cartilage regeneration and cartilage repair plus regeneration had significant superiority in improving the ankle function and radiological evaluation of OLT, although the trials included did not have high-level evidence. Moreover, which treatment between the 2 was safer could not be addressed in this review as most of the trials did not report the safety outcome. Further studies are needed to define the best surgical option for treating OLT.

Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group ‘clinical tissue regeneration’ of the German Society of Orthopedics and Traumatology (DGOU)

“…They concluded that augmented microfracture is superior to microfracture alone in treating talar OLTs based on the AOFAS, MOCART, VAS score, complication rate, and revision ratio. Tan et al(66) confirmed the results with a similar methodologic approach.There are also discussions on the best BMS technique. Kraeutler et al(67) concluded after a systematic review and meta-analyses that there is still limited basic science available, whether deep drilling or microfracture leads to better clinical results.…”

“…In smaller lesions, the additional scaffolds did not change the clinical outcome. However, patients benefit from biological support (65,66).…”

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

“…Osteochondral lesions of the talus (OLT) are frequently seen in orthopedic practice, with the majority of lesions occurring following a traumatic event, such as an ankle sprain or ankle fracture [1][2][3][4][5][6]. A consensus statement by international experts suggested that a lesion to both the cartilage and underlying subchondral bone of the talus should be referred to as an OLT [6].…”