Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation.

Jari Dahmen,Christopher D Murawski,Gino M M J Kerkhoffs,Eoghan T Hurley,Sjoerd A S Stufkens,John G Kennedy,Yoshiharu Shimozono

doi:10.1177/1947603521996023

Abstract

ObjectiveThe purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT).DesignA literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate.ResultsFive studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40).ConclusionsThe overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.

Highlights

Osteochondral lesions of the talus (OLT) are a common injury in athletes and often result from acute ankle sprains, fractures, or chronic ankle instability
It is assumed that bone marrow stimulation (BMS) for nonprimary lesions (i.e., osteochondral lesions that have had prior surgical intervention(s)) results in worse outcomes in comparison to primary arthroscopic treatment; there is a clear paucity of clinical data and limited knowledge on the efficacy of BMS for nonprimary OLTs
The most important finding of the present study is that the overall success rate of arthroscopic BMS for nonprimary OLTs was low at 61%, and the re-revision rate was high

Summary

Introduction

Osteochondral lesions of the talus (OLT) are a common injury in athletes and often result from acute ankle sprains, fractures, or chronic ankle instability. It is clear that the majority of the literature focuses on BMS for primary (i.e., osteochondral lesions that have not had prior surgery) OLTs.. It is assumed that BMS for nonprimary lesions (i.e., osteochondral lesions that have had prior surgical intervention(s)) results in worse outcomes in comparison to primary arthroscopic treatment; there is a clear paucity of clinical data and limited knowledge on the efficacy of BMS for nonprimary OLTs.. The purpose of this study is to systematically review the literature and to evaluate the outcomes following BMS for nonprimary OLTs. The hypothesis was that BMS in revision surgery would result in better outcomes than primary treatment due to the centralization of more complex cases.

Materials and Methods

Results

Discussion

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Acknowledgments and Funding