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

Abstract

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.

Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans

“…Apart from the aforementioned AMIC procedure, there are many scaffolds with different biochemical characteristics in use. In 2017, Shimozono et al 159 gave an interesting review on already used scaffold for treatment OLT. The authors sampled 897 cases/patients reviewing data from 30 different treatment groups/articles: (13 matrix-induced autologous chondrocyte transplantation (MACI), 9 bone marrow-derived cell transplantation (BMDCT/BMAC), 4 autologous matrix-induced chondrogenesis (AMIC), and 4 studies of other techniques.…”

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects

“… A preoperative CT scan is used to measure the bony dimensions of the osteochondral defect (anteroposterior diameter, mediolateral diameter and depth) The last part of the distal tibial osteotomy is done with a chisel to prevent thermal damage to the osteochondral unit Both the distal tibial osteotomy and iliac crest autograft transplantation can be customized for every patient In case a larger distal tibial osteotomy is indicated, an extra antiglide plate can be used to prevent rotation and proximal translation Press-fit autograft transplantation allows for quick rehabilitation without need for intra-articular screw removal Theoretically, an optimal graft to replace an osteochondral unit has the following characteristics: natural scaffold, good quality cells, and growth factors [ 36 , 41 , 42 , 48 , 53 ] …”

“…Theoretically, an optimal graft to replace an osteochondral unit has the following characteristics: natural scaffold, good quality cells, and growth factors [ 36 , 41 , 42 , 48 , 53 ]…”

Operative treatments for osteochondral lesions of the talus in adults

“…If the primary treatment failed to resolve smaller defects with excision, debridement, and bone marrow stimulation, the OAT procedure was considered. [ 44 ] The OLTs secondary to avascular necrosis have been shown to be at a higher risk of failure because of the decreased vascularity resulting in poor incorporation of the graft. [ 45 ] The PJCAT entailed the transplantation of fresh juvenile cartilage pieces containing live cells within their native extracellular matrix.…”