PMID- 35130190
OWN - NLM
STAT- MEDLINE
DCOM- 20220523
LR  - 20230815
IS  - 1528-1132 (Electronic)
IS  - 0009-921X (Print)
IS  - 0009-921X (Linking)
VI  - 480
IP  - 6
DP  - 2022 Jun 1
TI  - Should Arthroscopic Bone Marrow Stimulation Be Used in the Management of 
      Secondary Osteochondral Lesions of the Talus? A Systematic Review.
PG  - 1112-1125
LID - 10.1097/CORR.0000000000002134 [doi]
AB  - BACKGROUND: Osteochondral lesions of the talus are common, particularly after 
      trauma. Arthroscopic bone marrow stimulation has emerged as the first-choice 
      surgical treatment for small primary lesions less than 100 mm2. Individual 
      studies on the topic are small and heterogeneous, and they have differed in their 
      main findings; for this reason, systematically reviewing the available evidence 
      seems important. QUESTIONS/PURPOSES: In this systematic review, we asked: (1) 
      What patient-reported outcomes and pain scores have been observed after 
      arthroscopic bone marrow stimulation for secondary osteochondral lesions of the 
      talus? (2) What complications were reported? (3) What demographic and clinical 
      factors were reported to be associated with better patient-reported outcome 
      scores? METHODS: We performed a systematic review according to Preferred 
      Reporting Items for Systematic Reviews and Meta-Analyses guidelines using Embase, 
      EmCare, PubMed, CINAHL, and Scopus (databases last searched June 23, 2021). A 
      two-stage title/abstract and full-text screening process was performed 
      independently by two reviewers. Randomized control trials, cohort studies, and 
      observational studies published in English that evaluated the outcome of 
      arthroscopic bone marrow stimulation for secondary osteochondral lesions of the 
      talus were included. Case reports, review articles, commentaries, abstracts, and 
      letters to the editor were excluded. A total of 12 articles (10 case series and 
      two retrospective comparative studies) involving 446 patients were included. Of 
      these, 111 patients with a mean age of 33 years (range 20 to 49) received 
      arthroscopic bone marrow stimulation for a secondary osteochondral lesion of the 
      talus. The Methodological Index for Non-randomized Studies (MINORS) criteria were 
      used to assess the methodologic quality of included studies. The MINORS is a 
      numerical score ranging from 0 to 16 for studies with no comparison group and 0 
      to 24 for comparative studies, with higher quality studies receiving higher 
      scores. Of the 10 noncomparative case series, the highest score was 10 of 16, 
      with a median (range) score of 7.5 (4 to 10), while the two comparative studies 
      scored 22 of 24 and 19 of 24, respectively. RESULTS: Studies varied widely in 
      terms of patient-reported outcome measures such as the American Orthopaedic Foot 
      and Ankle Society score (AOFAS), with inconsistent reporting across studies 
      regarding whether or how much patients improved; there was variation in some 
      effect sizes with regard to improvement seeming close to or below the minimum 
      clinically important difference (MCID). Although no perioperative complications 
      were reported in any included studies, 34% (26 of 77, in seven studies that 
      reported on this endpoint) of patients who underwent a revision procedure. One 
      study found a negative association between lesion size and AOFAS and VAS score. 
      No other studies reported on factors associated with patient-reported outcome 
      scores, and most studies were far too small to explore relationships of this 
      sort. CONCLUSION: We found that arthroscopic bone marrow stimulation for 
      secondary osteochondral lesions of the talus yielded inconsistent and often small 
      improvements in patient-reported outcomes, with approximately one in three 
      patients undergoing a revision procedure. Reported outcomes likely represent a 
      best-case scenario, inflated by low-level study designs and major sources of bias 
      that are known to make treatment effects seem larger than they are. Therefore, 
      the use of arthroscopic bone marrow stimulation in such patients cannot be 
      recommended, unless we are able to refine selection criteria to effectively 
      identify patients who show a substantial clinical benefit. LEVEL OF EVIDENCE: 
      Level IV, therapeutic study.
CI  - Copyright (c) 2022 by the Association of Bone and Joint Surgeons.
FAU - Arshad, Zaki
AU  - Arshad Z
AUID- ORCID: 0000-0002-2143-7792
AD  - School of Clinical Medicine, University of Cambridge, Cambridge, UK.
FAU - Aslam, Aiman
AU  - Aslam A
AD  - School of Clinical Medicine, University of Cambridge, Cambridge, UK.
FAU - Iqbal, Adil M
AU  - Iqbal AM
AD  - School of Clinical Medicine, University of Cambridge, Cambridge, UK.
FAU - Bhatia, Maneesh
AU  - Bhatia M
AD  - Department of Trauma and Orthopaedic Surgery, University Hospitals of Leicester 
      NHS Trust, Leicester, UK.
LA  - eng
PT  - Journal Article
PT  - Systematic Review
DEP - 20220207
PL  - United States
TA  - Clin Orthop Relat Res
JT  - Clinical orthopaedics and related research
JID - 0075674
SB  - IM
CIN - Clin Orthop Relat Res. 2022 Jun 1;480(6):1126-1128. PMID: 35348551
MH  - Adult
MH  - Arthroscopy/adverse effects
MH  - Bone Marrow
MH  - *Cartilage, Articular/diagnostic imaging/injuries/surgery
MH  - Humans
MH  - *Intra-Articular Fractures
MH  - Middle Aged
MH  - Retrospective Studies
MH  - *Talus/diagnostic imaging/surgery
MH  - Treatment Outcome
MH  - Young Adult
PMC - PMC9263474
COIS- Each author certifies that there are no funding or commercial associations 
      (consultancies, stock ownership, equity interest, patent/licensing arrangements, 
      etc.) that might pose a conflict of interest in connection with the submitted 
      article related to the author or any immediate family members. All ICMJE Conflict 
      of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) 
      editors and board members are on file with the publication and can be viewed on 
      request.
EDAT- 2022/02/08 06:00
MHDA- 2022/05/24 06:00
PMCR- 2023/06/01
CRDT- 2022/02/07 17:12
PHST- 2021/11/03 00:00 [received]
PHST- 2022/01/19 00:00 [accepted]
PHST- 2022/02/08 06:00 [pubmed]
PHST- 2022/05/24 06:00 [medline]
PHST- 2022/02/07 17:12 [entrez]
PHST- 2023/06/01 00:00 [pmc-release]
AID - 00003086-202206000-00015 [pii]
AID - CORR-D-21-01538 [pii]
AID - 10.1097/CORR.0000000000002134 [doi]
PST - ppublish
SO  - Clin Orthop Relat Res. 2022 Jun 1;480(6):1112-1125. doi: 
      10.1097/CORR.0000000000002134. Epub 2022 Feb 7.