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

Abstract

Osteochondral lesions of the talus (OLT) are common following ankle trauma. Operative treatment is often required, with osteochondral autografting frequently performed for large or cystic lesions, or following failed primary surgery. The aim of this systematic review was to evaluate the current evidence for osteochondral autograft transfer system (OATS) in the management of OLT. A systematic search of the PubMed, EMBASE, Scopus, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Study quality was assessed using the modified Coleman Methodology Score (CMS). Meta-analysis was carried out using RevMan, version 5.4 (The Cochrane Collaboration, 2020). A total of 23 studies were included. The mean modified CMS was 48.1±7.47. Fourteen studies reported preoperative and postoperative Visual Analog Scale (VAS) and American Orthopaedic Foot & Ankle Score (AOFAS). The aggregate mean preoperative and postoperative VAS score across 14 studies was 6.47±1.35 and 1.98±1.18, respectively. Meta-analysis of seven studies on 210 patients found that OATS resulted in a significant reduction in VAS score compared to baseline (Mean Difference {MD} -4.22, 95% Confidence Interval {CI} -4.54 to -3.90, P < 0.0001). The aggregate mean preoperative and postoperative AOFAS scores across 14 studies were 56.41±8.52 and 87.14±4.8, respectively. Based on eight studies on 224 patients, OATS resulted in a significant improvement in AOFAS score compared to baseline (MD 29.70, 95% CI 25.68 to 33.73, P = < 0.0001). Donor site pain occurred in 9% of cases. Current evidence from low-quality studies suggests that OATS is a safe and effective treatment option for OLT, though it is associated with a risk of donor site morbidity.

Current Concepts in Clinical Treatment of Osteochondral Lesions of the Talus

“…Cartilage replacement surgery include AOT and OAT, which are recommend for larger OLTs. Pain relieve and high rate of sports recovery were reported to demonstrated the effect of AOT [17,18]. However, donor-site morbidity might lead surgical failure and has been a major concern of AOT.…”

“…Conventional surgical procedures involve lesion exposure, debridement, and graft implantation, and malleolus osteotomy was always needed in treating some OLTs patients. A systematic review in 2022 showed a significant reduction in the level of clinical pain in patients after AOT [17]. In addition, a recent meta-analysis also found high rate of sports recovery in athletes after osteochondral autografts transplantation in 2021 [18].…”

Particulated juvenile cartilage allograft for the treatment of osteochondral lesions of the talus is associated with a high complication rate and a high failure rate at short‐term follow‐up: A systematic review

“…Smaller OLTs (<100 mm 2 or <10 mm in diameter) are treated with reparative procedures such as arthroscopic debridement, bone marrow stimulation (BMS) and augmentation with biological adjuvants such as platelet-rich plasma (PRP) or concentrated bone marrow aspirate (cBMA) [3,20,33,36]. Larger lesions (>100 mm 2 or >10 mm in diameter) entail replacement procedures, including autologous osteochondral transplantation (AOT), osteochondral allograft transplantation, autologous chondrocyte implantation and matrixinduced chondrocyte implantation [13,17,19,23].…”

Enhancing precision in osteochondral lesions of the talus measurements and improving agreement in surgical decision‐making using weight‐bearing computed tomography and distance mapping

“…Over the last decades, advancements in imaging modalities, arthroscopic techniques and biologicalbased treatment have brooded surgical indications for osteochondral lesion of the talus (OLTs) [1,5,13,16,23,25]. The outcome of OLT surgery depends on the ability to tailor a surgical solution to the lesion's size, depth and location [20,[22][23][24].…”