No superior treatment for primary osteochondral defects of the talus

Abstract

Purpose: The purpose of this systematic literature review is to detect the most effective treatment option for primary talar osteochondral defects in adults.

Methods: A literature search was performed to identify studies published from January 1996 to February 2017 using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. Two authors separately and independently screened the search results and conducted the quality assessment using the Newcastle-Ottawa Scale. Subsequently, success rates per separate study were calculated. Studies methodologically eligible for a simplified pooling method were combined.

Results: Fifty-two studies with 1236 primary talar osteochondral defects were included of which forty-one studies were retrospective and eleven prospective. Two randomised controlled trials (RCTs) were identified. Heterogeneity concerning methodological nature was observed, and there was variety in reported success rates. A simplified pooling method performed for eleven retrospective case series including 317 ankles in the bone marrow stimulation group yielded a success rate of 82% [CI 78-86%]. For seven retrospective case series investigating an osteochondral autograft transfer system or an osteoperiosteal cylinder graft insertion with in total 78 included ankles the pooled success rate was calculated to be 77% [CI 66-85%].

Conclusions: For primary talar osteochondral defects, none of the treatment options showed any superiority over others.

Level of evidence: IV.

Keywords: Ankle; Arthroscopy; Articular cartilage; Defect; Osteochondral lesion; Success rate; Systematic review; Talus.

Fig. 1

Literature selection algorithm—preferred reporting items for systematic reviews and meta-analyses (PRISMA)

Fig. 2

Flow chart of study inclusion and treatment of talar OCDs between 1996 and 2017. ACI autologous chondrocyte implantation, ACIC autologous collagen-induced chondrogenesis, AMIC autologous matrix-induced chondrogenesis, RD retrograde drilling, BMS bone marrow stimulation, MACI matrix-associated chondrocyte implantation, OATS osteochondral autograft transfer system, HA hyaluronic acid, PEMF pulsed electromagnetic fields, ECD endoscopic core decompression

Fig. 3

Forest plot of all included studies with the success rates and the corresponding 95% confidence interval per separate study (sorted on treatment strategy group, methodological quality and alphabetical order accompanied by number of ankles and mean follow-up duration; the size of the diamond representing the success rate is adjusted for the number of ankles included in the publications)

Fig. 4

Forest plot of the pooled success rates of different treatment strategies with the corresponding 95% confidence intervals (accompanied by the total number of ankles and total number of studies included in the pooled group, and the corresponding methodological quality; the size of the diamond representing the pooled success rate is adjusted for the number of ankles included)