Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus: A Systematic Review

Pereira, Greg F.; Steele, John R.; Fletcher, Amanda N.; Clement, Ryan D.; Arasa, Miguel A.; Adams, Samuel B.

doi:10.1053/j.jfas.2021.02.001

Cited by 22 publications

(18 citation statements)

References 24 publications

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“…This review touted an aggregate graft survival rate of 86.6% with significant improvements in PROMs reported (AOFAS ankle/hindfoot score in 6 studies; VAS score in 5 studies) over an 18-year period (2000-2018). 29 This review provides the most comprehensive summary of complications and reoperation following allograft transplantation. A total of 21.6% of patients required minor subsequent procedures, most commonly arthroscopic debridement and removal of hardware.…”

Section: Discussionmentioning

confidence: 99%

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

et al. 2022

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Background: In cases of large osteochondral lesions of the talus (OLTs), fresh structural or bulk osteochondral allograft transplantation has yielded favorable outcomes in several retrospective and few prospective case series. The purpose of this study was to prospectively evaluate patients who received fresh structural allograft transplantation of the talar shoulder. Methods: A prospective evaluation of patients who received a fresh structural allograft of an OLT was performed. Preoperative imaging included magnetic resonance imaging (MRI) and/or computed tomography (CT) with plain radiographs. The following patient-reported outcomes questionnaires were administered preoperatively and yearly after surgery: 36-Item Short-Form Health Survey (SF-36), visual analog scale (VAS) for pain, and the Short Musculoskeletal Functional Assessment (SMFA). Preoperative and postoperative imaging were evaluated for allograft assimilation, evidence of arthritic changes, or functional range of motion abnormalities. Results: Thirty-one patients with a mean age of 41.4 years (±14.1, range 18-69) underwent structural fresh osteochondral allograft transplantation to the talar shoulder and were included in this study. The mean follow-up was 56.2 months (±36.1, range 24-142). The majority of patients were female (n=17, 54.8%), reported some history of prior ankle trauma (n=21, 67.7%), and underwent prior ankle surgery (n=23, 74.2%). The mean lesion size on CT scan was 1879 mm3 (n = 27) compared to the mean lesion size of 3877 mm3 (n = 21) on MRI. There was a significant improvement in the mean preoperative VAS score ( P < .0001), SF-36 score ( P < .0005), SMFA bother index ( P < .0015), and the SMFA function index ( P < .0001) at final follow-up. A total of 15 (48.4%) patients underwent an additional surgery following their osteochondral allograft transplant, most commonly arthroscopic debridement or removal of hardware, performed at an average of 25.2 (±13.0) from their index procedure. There was one failure that required a total ankle replacement. The overall graft survival rate was 96.8%. Conclusion: Fresh, structural allograft transplantation resulted in significant improvement in patient-reported postoperative pain and function in patients suffering from OLTs. The graft survival rate was 96.8% at a mean of 56.2 months follow-up, with half of patients requiring a second procedure. Level of Evidence: Level IV, prospective case series.

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Section: Discussionmentioning

confidence: 99%

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

et al. 2022

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“…For allografts, the pooled clinical success rate was found to be 55% in secondary lesions and ranged from 20 to 100% for primary lesions in a systematic review ( 45 ). In another recent systematic review, the mean preoperative AOFAS score of six studies was 50 and increased to 80 at follow-up ( 46 ). The VAS pain score improved from 7.3 preoperatively to 2.6 at follow-up in five studies.…”

Section: Therapy Of Osteochondral Lesion Of the Talusmentioning

confidence: 99%

Osteochondral lesion of the talus: still a problem?

Krause

Anwander

2022

EFORT Open Reviews

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Osteochondral lesion of the talus (OLT) often occurs after ankle trauma or repetitive micro-traumata, whereas the actual etiology remains unclear. The most common symptoms are local pain deep in the medial or lateral ankle that increases with weight-bearing and activity, accompanied by tenderness and swelling. Eventually, most patients with symptomatic or unstable OLT require surgery. Many reasonable operative techniques have been described, whereas most lead to similar and satisfactory results. They can be divided into cartilage repair, cartilage regeneration and cartilage replacement techniques. The OLT size and morphology in the first place but also surgeon and individual patient aspects are considered when it comes to surgery. For high postoperative success and low recurrence rates, underlying causes, for example, ligamentous instability and hindfoot malalignment should also be addressed during surgery.

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“…The modified version of the original CMS [ 31 ] was created to specifically assess the quality of studies on cartilage repair. The score uses 10 specific criteria to formally assess study quality and has been used in a number of similar studies [ 11 , 30 , 32 , 33 ]. Each study is given a score for each section, with a final score ranging between 0 (worst quality) and 100 (highest quality).…”

Section: Reviewmentioning

confidence: 99%

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

Feeney¹

2022

Cureus

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Osteochondral lesions of the talus (OLT) are common following ankle trauma. Operative treatment is often required, with osteochondral autografting frequently performed for large or cystic lesions, or following failed primary surgery. The aim of this systematic review was to evaluate the current evidence for osteochondral autograft transfer system (OATS) in the management of OLT. A systematic search of the PubMed, EMBASE, Scopus, and Cochrane Library databases was performed based on the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Study quality was assessed using the modified Coleman Methodology Score (CMS). Meta-analysis was carried out using RevMan, version 5.4 (The Cochrane Collaboration, 2020). A total of 23 studies were included. The mean modified CMS was 48.1±7.47. Fourteen studies reported preoperative and postoperative Visual Analog Scale (VAS) and American Orthopaedic Foot & Ankle Score (AOFAS). The aggregate mean preoperative and postoperative VAS score across 14 studies was 6.47±1.35 and 1.98±1.18, respectively. Meta-analysis of seven studies on 210 patients found that OATS resulted in a significant reduction in VAS score compared to baseline (Mean Difference {MD} -4.22, 95% Confidence Interval {CI} -4.54 to -3.90, P < 0.0001). The aggregate mean preoperative and postoperative AOFAS scores across 14 studies were 56.41±8.52 and 87.14±4.8, respectively. Based on eight studies on 224 patients, OATS resulted in a significant improvement in AOFAS score compared to baseline (MD 29.70, 95% CI 25.68 to 33.73, P = < 0.0001). Donor site pain occurred in 9% of cases. Current evidence from low-quality studies suggests that OATS is a safe and effective treatment option for OLT, though it is associated with a risk of donor site morbidity.

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Fresh Osteochondral Allograft Transplantation for Osteochondral Lesions of the Talus: A Systematic Review

Cited by 22 publications

References 24 publications

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

Midterm Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder

Osteochondral lesion of the talus: still a problem?

The Effectiveness of Osteochondral Autograft Transfer in the Management of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

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