TY - JOUR
T1 - Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation
AU - Dahmen, Jari
AU - Hurley, Eoghan T.
AU - Shimozono, Yoshiharu
AU - Murawski, Christopher D.
AU - Stufkens, Sjoerd A. S.
AU - Kerkhoffs, Gino M. M. J.
AU - Kennedy, John G.
N1 - Funding Information: The authors thank F.S. van Etten-Jamaludin, clinical librarian, for her help with the search. The authors also thank Dr. Mikel L. Reilingh for providing additional data. The author(s) received no financial support for the research, authorship, and/or publication of this article. Publisher Copyright: © The Author(s) 2021.
PY - 2021/12
Y1 - 2021/12
N2 - Objective: The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT). Design: A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate. Results: Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40). Conclusions: The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.
AB - Objective: The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT). Design: A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate. Results: Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40). Conclusions: The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.
KW - arthroscopy
KW - bone marrow stimulation
KW - failed surgery
KW - microfracture
KW - nonprimary
KW - osteochondral lesions
KW - revision
KW - talus
UR - http://www.scopus.com/inward/record.url?scp=85101684512&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/1947603521996023
DO - https://doi.org/10.1177/1947603521996023
M3 - Article
C2 - 33618537
SN - 1947-6035
VL - 13
SP - 1411S-1421S
JO - Cartilage
JF - Cartilage
IS - 1_suppl
ER -