Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus

Shimozono, Yoshiharu; Dankert, John F.; Deyer, Timothy; Mercer, Nathaniel P.; Kennedy, John G.

doi:10.1016/j.jcjp.2021.100008

Cited by 3 publications

(1 citation statement)

References 31 publications

(34 reference statements)

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“…Only one study [44] demonstrated an association between any patient-related or clinical factor and treatment outcome, with that study reporting poorer outcomes in patients with larger lesions. Most research investigating factors associated with outcomes focused on primary lesions, and found an association between poorer outcomes and an increased lesion size, patient BMI, patient age, presence of cysts, deep lesions, uncontained lesions, the presence of a medial lesion uncovered by the medial malleolus, and syndesmosis widening [26,28,37,38,45]. Although primary and secondary lesions may share common prognostic factors, this is yet to be supported by comprehensive evidence.…”

Section: Factors Associated With Better Patient-reported Outcomesmentioning

confidence: 99%

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

Arshad

Aslam

Iqbal

et al. 2022

Clin Orthop Relat Res

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Background Osteochondral lesions of the talus are common, particularly after trauma. Arthroscopic bone marrow stimulation has emerged as the first-choice surgical treatment for small primary lesions less than 100 mm 2 . Individual studies on the topic are small and heterogeneous, and they have differed in their main findings; for this reason, systematically reviewing the available evidence seems important. Questions/purposes In this systematic review, we asked:(1) What patient-reported outcomes and pain scores have been observed after arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus? (2) What complications were reported? (3) What demographic and clinical factors were reported to be associated with better patient-reported outcome scores? Methods We performed a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using Embase, EmCare, PubMed, CINAHL, and Scopus (databases last searched June 23, 2021). A two-stage title/abstract and full-text screening process was performed independently by two reviewers. Randomized control trials, cohort studies, and observational studies published in English that evaluated the outcome of arthroscopic bone marrow stimulation for secondary osteochondral lesions of the talus were included. Case reports, review articles, commentaries, abstracts, and letters to the editor were excluded. A total of 12 articles (10 case series and two retrospective comparative studies) involving 446 patients were included. Of these, 111 patients with a mean age of 33 years (range 20 to 49) received arthroscopic bone marrow stimulation for a secondary osteochondral lesion of the talus. The Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess the methodologic quality of included studies. The MINORS is a numerical score ranging from 0 to 16 for studies with no comparison group and 0 to 24 for comparative studies, with higher quality studies receiving higher scores. Of the 10 noncomparative case series, the highest score was 10 of 16, with a median (range) score of 7.5 (4 to 10), while the two comparative studies scored 22 of 24 and 19 of 24, respectively. Results Studies varied widely in terms of patient-reported outcome measures such as the American Orthopaedic Foot and Ankle Society score (AOFAS), with inconsistent reporting across studies regarding whether or how much patients improved; there was variation in some effect sizes Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was not sought.

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