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01-02-2021 | Osteoarthrosis | Review Article

Evidence on ankle injections for osteochondral lesions and osteoarthritis: a systematic review and meta-analysis

Authors: Angelo Boffa, Davide Previtali, Giorgio Di Laura Frattura, Francesca Vannini, Christian Candrian, Giuseppe Filardo

Published in: International Orthopaedics | Issue 2/2021

Abstract

Purpose

To evaluate the evidence supporting safety and effectiveness of intra-articular injective treatments for ankle lesions ranging from osteochondral lesions of the talus (OLT) to osteoarthritis (OA).

Methods

A systematic review and a meta-analysis were performed on PubMed, Embase, and Cochrane Library in March 2020. Safety was evaluated through the reported side effects and effectiveness through the scores used. The quality of the studies was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool and the Downs and Black checklist. For each outcome, the quality of evidence was graded according to GRADE guidelines.

Results

Twenty-four studies (21 for OA, 3 for OLT) were included on hyaluronic acid (HA), platelet-rich plasma (PRP), saline, methylprednisolone, botulinum toxin type A (BoNT-A), mesenchymal stem cells (MSCs), and prolotherapy. No severe adverse events were reported. For OLT, a comparison was possible between HA and PRP showing no significant difference. For ankle OA, a significant difference favouring HA versus saline was documented at six months (p < 0.001). The GRADE level of evidence was very low.

Conclusion

This meta-analysis supports the safety of intra-articular treatment for ankle OA and OLT, while only a very low evidence supports the efficacy of HA in terms of better results versus placebo for the treatment of ankle OA, and other conclusions are hindered by the scarcity of the available literature. This urges further and stronger trials to specifically investigate potential and limitations of these different injective approaches for the treatment of OLT and ankle OA.

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Title: Evidence on ankle injections for osteochondral lesions and osteoarthritis: a systematic review and meta-analysis
Authors: Angelo Boffa
Davide Previtali
Giorgio Di Laura Frattura
Francesca Vannini
Christian Candrian
Giuseppe Filardo
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Osteoarthrosis
Published in: International Orthopaedics / Issue 2/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-020-04689-5

At a glance: The STEP trials

Springer Medicine

Evidence on ankle injections for osteochondral lesions and osteoarthritis: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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