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Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

BACKGROUND: Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. PURPOSE: To summarize RTS times and rates for talar OCDs treated by...

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Autores principales: Steman, Jason A.H., Dahmen, Jari, Lambers, Kaj T.A., Kerkhoffs, Gino M.M.J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806124/
https://www.ncbi.nlm.nih.gov/pubmed/31673563
http://dx.doi.org/10.1177/2325967119876238
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author Steman, Jason A.H.
Dahmen, Jari
Lambers, Kaj T.A.
Kerkhoffs, Gino M.M.J.
author_facet Steman, Jason A.H.
Dahmen, Jari
Lambers, Kaj T.A.
Kerkhoffs, Gino M.M.J.
author_sort Steman, Jason A.H.
collection PubMed
description BACKGROUND: Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. PURPOSE: To summarize RTS times and rates for talar OCDs treated by different surgical techniques. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. RESULTS: A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. CONCLUSION: Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients’ return to preinjury levels versus return at any level.
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spelling pubmed-68061242019-10-31 Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases Steman, Jason A.H. Dahmen, Jari Lambers, Kaj T.A. Kerkhoffs, Gino M.M.J. Orthop J Sports Med Article BACKGROUND: Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. PURPOSE: To summarize RTS times and rates for talar OCDs treated by different surgical techniques. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. RESULTS: A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. CONCLUSION: Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients’ return to preinjury levels versus return at any level. SAGE Publications 2019-10-22 /pmc/articles/PMC6806124/ /pubmed/31673563 http://dx.doi.org/10.1177/2325967119876238 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Steman, Jason A.H.
Dahmen, Jari
Lambers, Kaj T.A.
Kerkhoffs, Gino M.M.J.
Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases
title Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases
title_full Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases
title_fullStr Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases
title_full_unstemmed Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases
title_short Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases
title_sort return to sports after surgical treatment of osteochondral defects of the talus: a systematic review of 2347 cases
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806124/
https://www.ncbi.nlm.nih.gov/pubmed/31673563
http://dx.doi.org/10.1177/2325967119876238
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