Treatment of osteochondral lesions of the talus: a systematic review

Abstract

The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from January 1966 to December 2006 were systematically screened. The proportion of the patient population treated successfully was noted, and percentages were calculated. For each treatment strategy, study size weighted success rates were calculated. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. One randomized clinical trial was identified. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Retrograde drilling and fixation scored 88 and 89%, respectively. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus.

Modern Cartilage Imaging of the Ankle

“…This can be accomplished, on the one hand, by fibrocartilaginous repair tissue, e. g. after micro-fracturing or retrograde drilling of osteochondral lesions, or via transplant, using osteochondral autograft transfer (OATS) or the matrix-induced autologous chondrocyte transplantation (MACT) [27,44]. In addition, micro-fracturing can be combined with matrix implantation as part of autologous matrix-induced chondrogenesis (AMIC) at the ankle joint; [19] provides a current overview of this.…”

“…They have a singular age distribution between 15 and 35 years, and 63 % of the patients are male [27]. The osteochondral lesions occur predominantly in the talus with a ratio of occurrences in the tibial plateau to the talar dome of 1 to 20.…”

Osteochondral lesions of the talus in the athlete: up to date review

“…The treatment traditionally consists of one or more regimens, which include rest, restriction of activities, immobilization, and non-steroidal anti-inflammatory drugs (NSAIDs). A systematic review by Zengerink et al [4] reported that 45% of patients had successful outcomes when conservatively treated with a weightbearing as tolerated protocol. The authors also demonstrated that 53% of patients who underwent cast immobilization for a duration of 3 weeks to 4 months reported successful clinical outcomes.…”

“…This procedure is low cost, technically undemanding, and minimally invasive. Several clinical studies have shown that approximately 85% of patients that underwent BMS reported good-toexcellent clinical results at short-and mid-term outcomes [1,4,13]. Two studies have shown the long-term results of BMS.…”

“…Recent clinical evidence has suggested that operative treatment of OLT provides good-to-excellent clinical outcomes in up to 85% of cases [4]. However, concerns regarding longterm outcomes and biologic deterioration of the repair still remain.…”