Second-Look Arthroscopy after Surgery for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis

CATEGORY: Ankle INTRODUCTION/PURPOSE: The primary aim was to assess and compare cartilage quality after different surgical interventions evaluated by second-look arthroscopy (SLA). Secondary aims were to report concomitant diagnoses found during SLA, and to correlate the cartilage quality with clinical- and radiological outcomes. METHODS: A literature search was performed through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the difference of cartilage quality as assessed with SLA between different surgical interventions. The Moderator analysis was used to calculate differences between treatment groups. Associated 95% confidence intervals (CI) were calculated with the Clopper- Pearson interval. Additionally, correlations between the cartilage quality and clinical- or radiological outcomes were calculated and percentages of concomitant diagnoses per treatment group were reported. RESULTS: Nineteen studies comprising 447 ankles having undergone SLA 14 months after the initial surgery were included. The cartilage quality success rate for bone marrow stimulation (BMS) was 53% (95% CI 38-68%), for Retrograde Drilling (RD) 100% (95% CI 66-100%, for fixation (FIX) 92% (95% CI 70-89%), for Osteochondral Transplantation (OCT) 94% (95% CI 69-99%) and Chondrogenesis-Inducing Techniques (CT) this was 81% (95% CI 70-89%). The success rate of BMS was significantly lower than FIX, OCT and CIT. There were no significant differences in success rates between the other treatment options. The incidence of concomitant diagnoses found during second-look arthroscopy differed among different treatment strategies. For BMS, a positive correlation was found between the International Cartilage Repair Society score (ICRS) and AOFAS-scores (rc =.67, p <0.01). For OCT, no significant correlation was found between the MOCART score and the ICRS (rc =.36, p =.23). CONCLUSION: Bone marrow stimulation yields inferior cartilage quality as assessed with SLA in comparison to fixation, osteo(chondral) transplantation and cartilage implementation. The role of the quality of the subchondral bone and its repair must be highlighted concerning correlation with clinical outcomes and long-term success as well as prevention of development of osteo- arthritis.