Evidence for operative treatment of talar osteochondral lesions: a systematic review

Abstract

Purpose Operative treatment of talar osteochondral lesions is challenging with various treatment options. The aims were (i) to compare patient populations between the different treatment options in terms of demographic data and lesion size and (ii) to correlate the outcome with demographic parameters and preoperative scores. Methods A systemic review was conducted according to the PRISMA guidelines. The electronic databases Pubmed (MEDLINE) and Embase were screened for reports with the following inclusion criteria: minimum 2-year follow-up after operative treatment of a talar osteochondral lesion in at least ten adult patients and published between 2000 and 2020. Results Forty-five papers were included. Small lesions were treated using BMS, while large lesions with ACI. There was no difference in age between the treatment groups. There was a correlation between preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and change in AOFAS score (R = −0.849, P < 0.001) as well as AOFAS score at follow-up (R = 0.421, P = 0.008). Preoperative size of the cartilage lesion correlates with preoperative AOFAS scores (R= −0.634, P = 0.001) and with change in AOFAS score (R = 0.656, P < 0.001) but not with AOFAS score at follow-up. Due to the heterogeneity of the studies, a comparison of the outcome between the different operative techniques was not possible. Conclusion Patient groups with bigger lesions and inferior preoperative scores did improve the most after surgery. Level of evidence IV.

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].…”

Hyaluronic scaffold transplantation with bone marrow concentrate for the treatment of osteochondral lesions of the talus: durable results up to a minimum of 10 years

“…6 to 12 months after the initial trauma, or a consequence of chronic ankle instability, with an incidence reported in 16 to 54% of cases of ankle instabilities [5][6][7][8]. Conservative treatments, including weight loss, limitations in sports activities, rehabilitation programs, and physical therapies are often inefective, and their use is controversial due to the low success rates and the risk of further cartilage degeneration [9,10]. In this light, surgical treatments have been developed to restore the articular cartilage, with several surgical approaches being proposed and used over the years from reconstructive techniques to the more recent regenerative strategies [11].…”