Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group ‘clinical tissue regeneration’ of the German Society of Orthopedics and Traumatology (DGOU)

Walther, Markus; Gottschalk, Oliver; Aurich, Matthias

doi:10.1530/eor-23-0075

Cited by 6 publications

(1 citation statement)

References 127 publications

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“…For surgical treatment of OLT > 1 cm 2 , the International Consensus Group on Cartilage Repair agreed that implanting scaffolds would yield superior and more reliable outcomes [ 57 ]. In 2024, the latest guidelines issued by the German Society of Orthopedics and Traumatology (DGOU) stated that the long-term benefits of scaffolds were proportional to the size of the lesion; in other words, larger areas exhibited more significant effects [ 58 ]. Therefore, based on existing research [ 23 , 27 ], DGOU recommended adding additional scaffolds when OLT > 1 cm 2 (instead of 1.5 cm 2 ).…”

Section: Discussionmentioning

confidence: 99%

The efficacy of autologous matrix-induced chondrogenesis (AMIC) for osteochondral lesions of the talus in the mid-long term: a systematic review and meta-analysis

Jiang,

Li,

Wang

et al. 2024

J Orthop Surg Res

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Purpose The objective of this study was to provide a comprehensive review of the existing literature regarding the treatment of osteochondral lesions of the talus (OLT) using autologous matrix-induced chondrogenesis (AMIC), while also discussing the mid-long term functional outcomes, complications, and surgical failure rate. Methods We searched Embase, PubMed, and Web of Science for studies on OLT treated with AMIC with an average follow-up of at least 2 years. Publication information, patient data, functional scores, surgical failure rate, and complications were extracted. Results A total of 15 studies were screened and included, with 12 case series selected for meta-analysis and 3 non-randomized controlled studies chosen for descriptive analysis. The improvements in the Visual Analog Scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot, and Tegner scores at the last follow-up were (SMD = − 2.825, 95% CI − 3.343 to − 2.306, P < 0.001), (SMD = 2.73, 95% CI 1.60 to 3.86, P < 0.001), (SMD = 0.85, 95% CI 0.5 to 1.2, P < 0.001) respectively compared to preoperative values. The surgery failure rate was 11% (95% CI 8–15%), with a total of 12 patients experiencing complications. Conclusion The use of AMIC demonstrates a positive impact on pain management, functional improvement, and mobility enhancement in patients with OLT. It is worth noting that the choice of stent for AMIC, patient age, and OLT size can influence the ultimate clinical outcomes. This study provides evidences supporting the safety and efficacy of AMIC as a viable treatment option in real-world medical practice.

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Section: Discussionmentioning

confidence: 99%

The efficacy of autologous matrix-induced chondrogenesis (AMIC) for osteochondral lesions of the talus in the mid-long term: a systematic review and meta-analysis

Jiang,

Li,

Wang

et al. 2024

J Orthop Surg Res

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Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized

Cao,

Ding,

Zan

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral lesions of the talus (OLT).MethodsThe clinical data of patients with single cystic OLT undergoing autologous osteoperiosteal transplantation at the Department of Foot and Ankle Surgery of our hospital between 2018 and 2022, including complete follow‐up, were retrospectively analyzed. Imaging data from each patient were imported into Mimics software to measure the surface area, volume and depth of the lesions. Then, the talus nine‐compartment partitioning method was used to partition the injury site. Preoperative and final follow‐up assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for pain and 36‐item Short‐Form Health Survey (SF‐36) to evaluate treatment efficacy and analyze prognostic factors.ResultsOf the 31 patients with single cystic OLT with a complete set of follow‐up data, there were 17 males and 14 females, with a mean age of 43.3 ± 13.6 years, a mean follow‐up time of 30.1 ± 14.0 months and a mean illness duration of 30.4 ± 20.0 months. The postoperative final follow‐up AOFAS score was 90.7 ± 5.5; this represented significant improvement when compared to the preoperative score of 57.0 ± 8.5 (P < 0.001). The final postoperative follow‐up VAS score was 18.5 ± 8.3; this was significantly better than the preoperative score of 57.8 ± 8.7 (P < 0.001). The physical component summary (PCS) score and mental component summary (MCS) score on the SF‐36 scale showed significant improvement at the final postoperative follow‐up when compared to preoperative scores (p < 0.001). No other complications were observed during follow‐up, such as wound infection or pain at the donor site. One of the patients showed less improvement, which may be related to premature weight‐bearing or re‐sprained ankle after surgery. There was no significant correlation between the duration of illness, gender and the location, depth, surface area and volume of the OLT and the postoperative scores. However, patient age showed a significant negative correlation with the postoperative SF‐36 PCS and MCS scores.ConclusionAutologous osteoperiosteal transplantation for single cystic OLT demonstrated good clinical efficacy with a low incidence of complications. Furthermore, age represents an important factor influencing prognosis.Level of EvidenceLevel II.

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Surgical treatment for medium‐sized cystic osteochondral lesions of the talus: Autologous osteoperiosteal transplantation provides better clinical outcomes than bone marrow stimulation when cysts are deeper than 6 mm

Yang,

Shao,

Zhu

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo compare clinical outcomes of autologous osteoperiosteal transplantation versus bone marrow stimulation (BMS) for medium‐sized (100–150 mm2) cystic osteochondral lesions of the talus (OLTs) and assess the correlation between patient demographics and outcomes. It was hypothesised that autologous osteoperiosteal transplantation would provide better clinical outcomes than BMS for medium‐sized cystic OLTs.MethodsPatients who underwent autologous osteoperiosteal transplantation or BMS for medium‐sized cystic OLTs between 2014 and 2019 were retrospectively evaluated. According to their characteristics, a 1:1 propensity‐score matching was performed and 33 pairs of patients were matched. The visual analogue scale, American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot Ankle Outcome Score (FAOS) and Ankle Activity Score were collected preoperatively and at the last follow‐up. In addition, a general linear model analysis was performed between patient demographics and clinical outcomes in two groups separately to detect potential risk factors.ResultsFinally, 28 patients in the grafted group and 27 patients in the BMS group completed the follow‐up and were enrolled with a mean follow‐up period of 63.5 ± 13.9 months. Both groups showed significant improvement in all patient‐reported outcomes (p < 0.01). At the final follow‐up, no significant differences between groups were found in all postoperative scores except FAOS Pain (p = 0.02). Correlation analysis showed a moderate correlation between cyst depth and the postoperative AOFAS score in the BMS group (r = −0.48, p = 0.01). Based on the regression line, the patients in the BMS group with a cyst deeper than 6 mm showed a lower AOFAS score than the mean score (88.7 ± 9.5) of the grafted group.ConclusionAutologous osteoperiosteal transplantation and BMS are both safe and effective for medium‐sized cystic OLTs. However, autologous osteoperiosteal transplantation is expected to provide better clinical outcomes than BMS when the cysts are deeper than 6 mm.Level of EvidenceLevel III.

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Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group ‘clinical tissue regeneration’ of the German Society of Orthopedics and Traumatology (DGOU)

Cited by 6 publications

References 127 publications

The efficacy of autologous matrix-induced chondrogenesis (AMIC) for osteochondral lesions of the talus in the mid-long term: a systematic review and meta-analysis

The efficacy of autologous matrix-induced chondrogenesis (AMIC) for osteochondral lesions of the talus in the mid-long term: a systematic review and meta-analysis

Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized

Surgical treatment for medium‐sized cystic osteochondral lesions of the talus: Autologous osteoperiosteal transplantation provides better clinical outcomes than bone marrow stimulation when cysts are deeper than 6 mm

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