Microfracture for Osteochondral Lesions of the Talus

Hannon, Charles P.; Murawski, Christopher D.; Fansa, Ashraf M.; Smyth, Niall A.; Do, Huong; Kennedy, John G.

doi:10.1177/0363546512458218

Cited by 46 publications

(19 citation statements)

References 63 publications

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“…Of those clinical studies “Procedure for assessing outcomes” and “Description of subject selection process” in Part B (primarily evaluates outcome criteria and recruitment rates) were significantly low. These findings are consistent with the outcomes found by a recent systematic review that analyzed the outcome data following microfracture for OLT in 24 clinical studies[ 36 ]. The authors found that approximately half of included studies did not have a patient history or patient-reported outcome data, despite the presence of well described general demographics and study design.…”

Section: Discussionsupporting

confidence: 90%

Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies

Yasui¹,

Ramponi²,

Seow³

et al. 2017

WJO

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AIMTo clarify the quality of the studies indicating lesion size and/or containment as prognostic indicators of bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT).METHODSTwo reviewers searched the PubMed/MEDLINE and EMBASE databases using specific terms on March 2015 in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Predetermined variables were extracted for all the included studies. Level of evidence (LOE) was determined using previously published criteria by the Journal of Bone and Joint Surgery and methodological quality of evidence (MQOE) was evaluated using the Modified Coleman Methodology Score.RESULTSThis review included 22 studies. Overall, 21 of the 22 (95.5%) included studies were level IV or level III evidences. The remaining study was a level II evidence. MQOE analysis revealed 14 of the 22 (63.6%) included studies having fair quality, 7 (31.8%) studies having poor quality and only 1 study having excellent quality.CONCLUSIONThe evidence supporting the use of lesion size and containment as prognostic indicators of BMS for OLTs has been shown to be of low quality.

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Section: Discussionsupporting

confidence: 90%

Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies

Yasui¹,

Ramponi²,

Seow³

et al. 2017

WJO

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“…Conservative therapy typically is used for Hepple modified magnetic resonance imaging (MRI) type I and milder type II injuries, which involve a smaller lesion area, stable exfoliated bone mass, and non-displaced talus cartilage [ 14 ], whereas surgery is require for Hepple type III to V injuries with severe symptoms, when conservative treatment for 3 to 6 months for talus cartilage injury with acute separation and displacement is ineffective, or the area of injury is large [ 15 , 16 ]. Reports in the literature underscore the fact that the area of the talus cartilage defect is an important influencing factor [ 17 – 19 ], and that a lesion range of 15 mm, lack of fracture displacement, and locaton of injury in the anterolateral talus [ 20 , 21 ] often suggest a better prognosis. In contrast, the prognosis is poor when the range is larger than 15 mm, the lesion is located on the medial side, and there is subchondral cystic degeneration and intra-articular osteophyte formation [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability

Wei

2020

Med Sci Monit

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Background Talus cartilage injury leads to changes in biomechanics of the ankle joint and ultimately affects ankle joint function, but which talus cartilage defects require surgery is still uncertain. This research used a finite element method to simulate the effect of different depth of talus cartilage defects on the stress and stability of the ankle joint in a certain area. Material/Methods A three-dimensional finite element model with different depths of osteochondral defects was created to simulate and calculate joint stress and displacement of the articular surface of the distal tibia and the proximal talus while the ankle joint was in the push-off, midstance, and heel-strike phases. Results The equivalent stress of the proximal talus did not change significantly at a defect depth of 1 mm, whereas the equivalent stress of the upper talus increased significantly at a defect depth of ≥3 mm or more, reaching a maximum value at a defect depth of 10 mm. The equivalent stress of the tibial cartilage and the equivalent stress and displacement in the corresponding forces in the midstance phase and heel-strike phase were significantly different from those in the normal group, but the difference in stress in each defect group was not obvious. Conclusions The effect of cartilage defects of the talus on biomechanics of the ankle is clear, especially in the midstance and push-off phases. When the defect reaches the subchondral bone (at a depth of 3 mm), the most obvious change in ankle joint stability occurs, and it does not increase linearly with the increase in depth of the defect.

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“…These inconsistencies and general underreporting of data make it difficult to pool data, which furthermore makes it difficult to draw conclusions about effectiveness of the use of scaffold in the treatment for OLT. As Hannon et al[ 15 ] described, adequate reporting of data in the studies of the treatment for OLT should be required to perform high quality studies, and investigators should be encouraged to implement data collection both before and after surgery according to recommended list described by Hannon et al[ 15 ] in this review, the categories of imaging data were reported in 73% of included studies. Compared with reporting of outcome data on microfracture for OLT in the systematic review by Hannon et al[ 15 ], imaging data was reported in only 39% among the studies.…”

Section: Discussionmentioning

confidence: 99%

“…Two reviewers independently extracted data from each study and assessed variable reporting of outcome data using parameters of previously published criteria[ 15 ]. In addition, clinical outcomes and the percentage of patients who returned to sport at previous level were evaluated.…”

Section: Methodsmentioning

confidence: 99%

Scaffolds based therapy for osteochondral lesions of the talus: A systematic review

Shimozono

Yasui

Ross

et al. 2017

WJO

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AIMTo clarify the effectiveness of scaffold-based therapy for osteochondral lesions of the talus (OLT).METHODSA systematic search of MEDLINE and EMBASE databases was performed during August 2016 and updated in January 2017. Included studies were evaluated with regard to the level of evidence (LOE) and quality of evidence (QOE) using the Modified Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and the percentage of patients who returned to sport at previous level were also evaluated.RESULTSTwenty-eight studies for a total of 897 ankles were included; 96% were either LOE III or IV. Studies were designated as either of poor or fair quality. There were 30 treatment groups reporting six different scaffold repair techniques: 13 matrix-induced autologous chondrocyte transplantation (MACT), nine bone marrow derived cell transplantation (BMDCT), four autologous matrix-induced chondrogeneis (AMIC), and four studies of other techniques. The categories of general demographics (93%) and patient-reported outcome data (85%) were well reported. Study design (73%), imaging data (73%), clinical variables (49%), and patient history (30%) were also included. The weighted mean American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up was: 86.7 in MACT, 88.2 in BMDCT, and 82.3 in AMIC. Eight studies reported that a weighted mean of 68.3% of patients returned to a previous level of sport activity.CONCLUSIONScaffold-based therapy for OLT may produce favorable clinical outcomes, but low LOE, poor QOE, and variability of the data have confounded the effectiveness of this treatment.

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Microfracture for Osteochondral Lesions of the Talus

Cited by 46 publications

References 63 publications

Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies

Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies

Finite Element Analysis of the Effect of Talar Osteochondral Defects of Different Depths on Ankle Joint Stability

Scaffolds based therapy for osteochondral lesions of the talus: A systematic review

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