677 - Mid- to Long-Term Outcomes of Osteochondral Lesions of the Talus Repair: A Systematic Review

Osteochondral lesions of the talus (OLTs) involve damage to the articular cartilage and underlying bone, posing a therapeutic challenge due to cartilage's limited intrinsic healing capacity. This review aims to provide mid- to long-term follow-ups for joint preservation procedures for OLTs through analysis of patient-reported outcomes (PROs), rates of return to activity/sport, and survival rates.

Design:

The guidelines by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed to perform this systematic review across three databases: PubMed, Embase, and Cochrane Library for studies evaluating surgical treatment for OLTs at a minimum 5-year follow-up. Quality and risk of bias assessment was completed using the Methodological Index for Non-Randomized Studies criteria. 

Results:

31 studies with a total of 1793 patients with an age range of 23.9 to 47.3 years, defect size of 0.9 to 29.1 cm2, and follow-up of 5 to 13.9 years were included. Survival rates, defined as no revision surgeries, at the latest follow-up, for Bone marrow stimulation (7 studies), autologous chondrocyte implantation (5 studies), matrix-associated chondrocyte implantation (3 studies), autologous matrix-induced chondrogenesis (AMIC) (2 studies), and osteochondral autologous/allograft transfer system (2 studies) were 92.7%, 89.73%, 88.89%, 84.21%, and 95.9%, respectively. Survival rates for the other techniques, reported in separate studies, were biphasic bioresorbable scaffold (100%), matrix-induced stem cell transplantation (100%), AMIC plus peripheral blood concentrate (96.9%), microfracture plus platelet-rich plasma and hyaluronic acid (91.23%), bone marrow aspirate concentrate (90.09%), autologous tibia osteoperiosteal graft (86.67%), arthroscopic lift-drill-fill-fix (66.7%), and particulates juvenile allograft cartilage implantation (53.5%). 29/31 (93.5%) studies, including PROs, demonstrated significant improvements at the latest follow-up. 

Conclusions:

BMS remained the most commonly used technique and produced survival rates comparable to all other techniques included in this study. Most patients across all the techniques analyzed in this study had significant PRO improvements at the latest follow-up.