Quinten G H Rikken, Jari Dahmen, Sjoerd A S Stufkens, Tomoyuki Nakasa, Gino M M J Kerkhoffs
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The methodological quality of the included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. The primary outcome the clinical success rate following fixation was pooled using a random effects model with 95% confidence interval (95%-CI). Success was predefined based on cut-off values for commonly used patient- or physician-reported outcome measures. Secondary outcomes concerned the union rate, complication rate, and revision rate.</p><p><strong>Findings: </strong>A total of 10 studies with 241 ankles were included at a mean follow-up of 40 months. 88% of lesions were chronic in nature, and 12% acute. In total, 9 non-comparative studies had a mean MINRORS score of 10.3 (range: 6 - 14) out of 16 points and 1 comparative study had and a MINRORS score of 20 of 24 points. The pooled clinical success rate was 91% [95%-CI: 81% - 96%]. The pooled union rate was 91% [95%-CI: 87% - 94%]. The addition of biological adjuncts in the form of autologous bone-grafting did not show a statistically superior success rate. The pooled complication and revision rate were 1% [95%-CI: 0 - 4] and 6% [95%-CI: 0% - 4%], respectively.</p><p><strong>Conclusion and relevance: </strong>Fixation for osteochondral lesions of the talus leads to successful clinical outcomes in 9 out of 10 patients. Moreover, fragment union is achieved in 9 out of 10 patients, with a low reported complication rate. 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引用次数: 0
摘要
重要性：距骨骨软骨病变（OLT）伴骨软骨碎片可修复固定。固定的目的是在保留原有软骨的同时稳定骨软骨碎片。虽然固定治疗OLT是一种很有前途的治疗方法，但没有关于其疗效和安全性的系统文献综述。目的：本研究的主要目的是评估OLT固定的临床成功率。次要结局涉及愈合率和不良事件。证据回顾：对PubMed、Embase （Ovid）和Cochrane Library进行系统文献检索，截止到2023年12月。采用非随机研究方法学指数（methodology Index for non - random studies，未成年人）工具评价纳入研究的方法学质量。使用随机效应模型（95%可信区间）汇总固定后的主要终点临床成功率。成功与否是预先确定的，基于常用的病人或医生报告的结果测量的临界值。次要结果包括愈合率、并发症率和翻修率。结果：共纳入10项研究，涉及241个踝关节，平均随访时间为40个月。88%的病变是慢性的，12%是急性的。总共有9项非比较研究的平均MINRORS评分为10.3分（范围：6 - 14分），满分为16分；1项比较研究的MINRORS评分为20分（满分为24分）。合并临床成功率为91% [95%-CI: 81% - 96%]。合并愈合率为91% [95%-CI: 87% - 94%]。以自体骨移植的形式添加生物辅助物并没有显示出统计学上优越的成功率。合并并发症和翻修率分别为1% [95%-CI: 0 - 4]和6% [95%-CI: 0% - 4%]。结论及意义：距骨软骨病变固定治疗10例患者中有9例临床效果良好。此外，10例患者中有9例实现碎片愈合，并发症发生率低。这些发现表明，当有症状的OLT可以固定时，医生应该考虑固定。证据等级：四级。
Fixation for Osteochondral Lesions of the Talus Leads to Successful Clinical Outcomes in 9 out of 10 Patients: a Systematic Review.
Importance: Osteochondral lesions of the talus (OLT) with an osteochondral fragment are amendable for fixation. Fixation aims to stabilize the osteochondral fragment while retaining the native cartilage. Though fixation for OLT is a promising treatment, no systematic overview of the literature on its efficacy and safety exists.
Aim: The primary aim of the present study is to assess the clinical success rate of fixation for OLT. The secondary outcomes concern the union rate and adverse events.
Evidence review: A systematic literature search of PubMed, Embase (Ovid), and Cochrane Library was performed up to December 2023. The methodological quality of the included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. The primary outcome the clinical success rate following fixation was pooled using a random effects model with 95% confidence interval (95%-CI). Success was predefined based on cut-off values for commonly used patient- or physician-reported outcome measures. Secondary outcomes concerned the union rate, complication rate, and revision rate.
Findings: A total of 10 studies with 241 ankles were included at a mean follow-up of 40 months. 88% of lesions were chronic in nature, and 12% acute. In total, 9 non-comparative studies had a mean MINRORS score of 10.3 (range: 6 - 14) out of 16 points and 1 comparative study had and a MINRORS score of 20 of 24 points. The pooled clinical success rate was 91% [95%-CI: 81% - 96%]. The pooled union rate was 91% [95%-CI: 87% - 94%]. The addition of biological adjuncts in the form of autologous bone-grafting did not show a statistically superior success rate. The pooled complication and revision rate were 1% [95%-CI: 0 - 4] and 6% [95%-CI: 0% - 4%], respectively.
Conclusion and relevance: Fixation for osteochondral lesions of the talus leads to successful clinical outcomes in 9 out of 10 patients. Moreover, fragment union is achieved in 9 out of 10 patients, with a low reported complication rate. These findings show that when a symptomatic OLT is fixable physicians should consider fixation.
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