Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

James Toale; Yoshiharu Shimozono; Conor Mulvin; Jari Dahmen; Gino M M J Kerkhoffs; John G Kennedy

doi:10.1177/2325967119879127

Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

Orthop J Sports Med. 2019 Oct 30;7(10):2325967119879127. doi: 10.1177/2325967119879127. eCollection 2019 Oct.

Authors

James Toale^{1

2}, Yoshiharu Shimozono³, Conor Mulvin^{1

2}, Jari Dahmen^{4

5

6}, Gino M M J Kerkhoffs^{4

5

6}, John G Kennedy³

Affiliations

¹ Hospital for Special Surgery, New York, New York, USA.
² Royal College of Surgeons in Ireland, Dublin, Ireland.
³ Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.
⁴ Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, The Netherlands.
⁵ Academic Center for Evidence-Based Sports Medicine (ACES), Amsterdam, The Netherlands.
⁶ Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC, Amsterdam, The Netherlands.

Abstract

Background: Bone marrow stimulation (BMS) is a common surgical intervention in the treatment of small osteochondral lesions of the talus (OLTs). Evidence has shown good clinical outcomes after BMS in the short term, but several studies have shown less favorable results at midterm and long-term follow-up because of fibrocartilaginous repair tissue degeneration.

Purpose: To evaluate the clinical and radiological outcomes of BMS in the treatment of primary OLTs at midterm and long-term follow-up and to investigate reported data in these studies.

Study design: Systematic review; Level of evidence, 4.

Methods: A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Clinical and radiological outcomes as well as reported data were evaluated.

Results: A total of 15 studies comprising 853 patients (858 ankles) were included at a weighted mean follow-up time of 71.9 months. There were 9 studies that used the American Orthopaedic Foot & Ankle Society (AOFAS) score, with a weighted mean postoperative score of 89.9. There were 3 studies that measured postoperative magnetic resonance imaging results in the midterm using the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system and showed 48% of patients with complete filling, 74% with complete integration, and 76% with surface damage. There was a complication rate of 3.4% and a reoperation rate of 6.0% after BMS in the midterm.

Conclusion: This systematic review found good clinical outcomes after BMS at midterm follow-up for primary OLTs. Radiological outcomes showed repair tissue surface damage in the majority of patients, which may be a harbinger for long-term problems. Data were variable, and numerous data were underreported. Further high-quality studies, a validated outcome scoring system, and further radiological reports at midterm follow-up are required to accurately assess the success of BMS in the midterm.

Keywords: bone marrow stimulation; osteochondral; systematic review; talus.

Publication types

Review