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Review
. 2021 Nov;29(11):3525-3533.
doi: 10.1007/s00167-021-06630-8. Epub 2021 Jun 29.

Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

Quinten G H Rikken  1   2   3 , Jari Dahmen  1   2   3 , Sjoerd A S Stufkens  1   2   3 , Gino M M J Kerkhoffs  4   5   6
Affiliations
Review

Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

Quinten G H Rikken et al. Knee Surg Sports Traumatol Arthrosc. 2021 Nov.

Abstract

Purpose: The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up.

Methods: A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures.

Results: Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5-13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6-9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6-84.1). 78% (95% CI 69.5-86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1-9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4-3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3-33.2) of ankles.

Conclusion: Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS.

Level of evidence: Level IV.

Keywords: Bone marrow stimulation; Long-term; OLT; Osteochondral; Talus.

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Conflict of interest statement

All the authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flowchart of the study selection
See this image and copyright information in PMC

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References

    1. Rikken QGH, Kerkhoffs GMMJ. Osteochondral lesions of the talus: an individualized treatment paradigm from the Amsterdam perspective. Foot Ankle Clin. 2021;26(1):121–136. doi: 10.1016/j.fcl.2020.10.002. - DOI - PubMed
    1. Zengerink M, Struijs PAA, Tol JL, van Dijk CN. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sport Traumatol Arthrosc. 2010;18:238–246. doi: 10.1007/s00167-009-0942-6. - DOI - PMC - PubMed
    1. Hannon CP, Bayer S, Murawski CD, Canata GL, Clanton TO, Haverkamp D, et al. Debridement, curettage, and bone marrow stimulation: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int. 2018;39:16S–22S. doi: 10.1177/1071100718779392. - DOI - PubMed
    1. Dahmen J, Lambers KTA, Reilingh ML, Van Bergen CJA, Stufkens SAS, Kerkhoffs GMMJ. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sport Traumatol Arthrosc. 2018;26:2142–2157. doi: 10.1007/s00167-017-4616-5. - DOI - PMC - PubMed
    1. Ramponi L, Yasui Y, Murawski CD, Ferkel RD, Digiovanni CW, Kerkhoffs GMMJ, et al. Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med. 2017;45(7):1698–1705. doi: 10.1177/0363546516668292. - DOI - PubMed