No superior surgical treatment for secondary osteochondral defects of the talus

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

Research output: Contribution to journalReview articleAcademicpeer-review

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.
Original languageEnglish
Pages (from-to)2158-2170
JournalKnee Surgery, Sports Traumatology, Arthroscopy
Volume26
Issue number7
DOIs
Publication statusPublished - 2018

Cite this

Lambers, K. T. A., Dahmen, J., Reilingh, M. L., van Bergen, C. J. A., Stufkens, S. A. S., & Kerkhoffs, G. M. M. J. (2018). No superior surgical treatment for secondary osteochondral defects of the talus. Knee Surgery, Sports Traumatology, Arthroscopy, 26(7), 2158-2170. https://doi.org/10.1007/s00167-017-4629-0
Lambers, Kaj T. A. ; Dahmen, Jari ; Reilingh, Mikel L. ; van Bergen, Christiaan J. A. ; Stufkens, Sjoerd A. S. ; Kerkhoffs, Gino M. M. J. / No superior surgical treatment for secondary osteochondral defects of the talus. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2018 ; Vol. 26, No. 7. pp. 2158-2170.
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title = "No superior surgical treatment for secondary osteochondral defects of the talus",
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.",
author = "Lambers, {Kaj T. A.} and Jari Dahmen and Reilingh, {Mikel L.} and {van Bergen}, {Christiaan J. A.} and Stufkens, {Sjoerd A. S.} and Kerkhoffs, {Gino M. M. J.}",
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Lambers, KTA, Dahmen, J, Reilingh, ML, van Bergen, CJA, Stufkens, SAS & Kerkhoffs, GMMJ 2018, 'No superior surgical treatment for secondary osteochondral defects of the talus' Knee Surgery, Sports Traumatology, Arthroscopy, vol. 26, no. 7, pp. 2158-2170. https://doi.org/10.1007/s00167-017-4629-0

No superior surgical treatment for secondary osteochondral defects of the talus. / Lambers, Kaj T. A.; Dahmen, Jari; Reilingh, Mikel L.; van Bergen, Christiaan J. A.; Stufkens, Sjoerd A. S.; Kerkhoffs, Gino M. M. J.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 26, No. 7, 2018, p. 2158-2170.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - No superior surgical treatment for secondary osteochondral defects of the talus

AU - Lambers, Kaj T. A.

AU - Dahmen, Jari

AU - Reilingh, Mikel L.

AU - van Bergen, Christiaan J. A.

AU - Stufkens, Sjoerd A. S.

AU - Kerkhoffs, Gino M. M. J.

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/28687862

U2 - 10.1007/s00167-017-4629-0

DO - 10.1007/s00167-017-4629-0

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JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 0942-2056

IS - 7

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