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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2018

Open Access 01-07-2018 | Ankle

No superior surgical treatment for secondary osteochondral defects of the talus

Authors: Kaj T. A. Lambers, Jari Dahmen, Mikel L. Reilingh, Christiaan J. A. van Bergen, Sjoerd A. S. Stufkens, Gino M. M. J. Kerkhoffs

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2018

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Abstract

Purpose

The purpose of this systematic review was to identify the most effective surgical treatment for talar osteochondral defects after failed primary surgery.

Methods

A literature search was conducted to find studies published from January 1996 till July 2016 using PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL. Two authors screened the search results separately and conducted quality assessment independently using the Newcastle–Ottawa scale. Weighted success rates were calculated. Studies eligible for pooling were combined.

Results

Twenty-one studies with a total of 299 patients with 301 talar OCDs that failed primary surgery were investigated. Eight studies were retrospective case series, twelve were prospective case series and there was one randomized controlled trial. Calculated success percentages varied widely and ranged from 17 to 100%. Because of the low level of evidence and the scarce number of patients, no methodologically proper meta-analysis could be performed. A simplified pooling method resulted in a calculated mean success rate of 90% [CI 82–95%] for the osteochondral autograft transfer procedure, 65% [CI 46–81%] for mosaicplasty and 55% [CI 40–70%] for the osteochondral allograft transfer procedure. There was no significant difference between classic autologous chondrocyte implantation (success rate of 59% [CI 39–77%]) and matrix-associated chondrocyte implantation (success rate of 73% [CI 56–85%]).

Conclusions

Multiple surgical treatments are used for talar OCDs after primary surgical failure. More invasive methods are administered in comparison with primary treatment. No methodologically proper meta-analysis could be performed because of the low level of evidence and the limited number of patients. It is therefore inappropriate to draw firm conclusions from the collected results. Besides an expected difference in outcome between the autograft transfer procedure and the more extensive procedures of mosaicplasty and the use of an allograft, neither a clear nor a significant difference between treatment options could be demonstrated. The need for sufficiently powered prospective investigations in a randomized comparative clinical setting remains high. This present systematic review can be used in order to inform patients about expected outcome of the different treatment methods used after failed primary surgery.

Level of evidence

IV.
Appendix
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Metadata
Title
No superior surgical treatment for secondary osteochondral defects of the talus
Authors
Kaj T. A. Lambers
Jari Dahmen
Mikel L. Reilingh
Christiaan J. A. van Bergen
Sjoerd A. S. Stufkens
Gino M. M. J. Kerkhoffs
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4629-0

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