Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2017; 8(10): 798-808
Published online Oct 18, 2017. doi: 10.5312/wjo.v8.i10.798
Scaffolds based therapy for osteochondral lesions of the talus: A systematic review
Yoshiharu Shimozono, Youichi Yasui, Andrew W Ross, Wataru Miyamoto, John G Kennedy
Yoshiharu Shimozono, Youichi Yasui, Andrew W Ross, John G Kennedy, Hospital for Special Surgery, New York, NY 10021, United States
Yoshiharu Shimozono, Youichi Yasui, Wataru Miyamoto, Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
Yoshiharu Shimozono, Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: Kennedy JG is a consultant for Arteriocyte, Inc.; has received research support from the Ohnell Family Foundation, Mr. and Mrs. Michael J Levitt, and Arteriocyte Inc.; is a board member for the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy, International Society for Cartilage Repair of the Ankle, American Orthopaedic Foot and Ankle Society Awards and Scholarships Committee, International Cartilage Repair Society finance board.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: John G Kennedy, MD, MCh, MMSc, FRCS (Orth), Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY 10021, United States. kennedyj@hss.edu
Telephone: +1-646-7978880 Fax: +1-646-7978966
Received: March 26, 2017
Peer-review started: March 28, 2017
First decision: April 17, 2017
Revised: July 19, 2017
Accepted: August 2, 2017
Article in press: August 3, 2017
Published online: October 18, 2017
Abstract
AIM

To clarify the effectiveness of scaffold-based therapy for osteochondral lesions of the talus (OLT).

METHODS

A systematic search of MEDLINE and EMBASE databases was performed during August 2016 and updated in January 2017. Included studies were evaluated with regard to the level of evidence (LOE) and quality of evidence (QOE) using the Modified Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and the percentage of patients who returned to sport at previous level were also evaluated.

RESULTS

Twenty-eight studies for a total of 897 ankles were included; 96% were either LOE III or IV. Studies were designated as either of poor or fair quality. There were 30 treatment groups reporting six different scaffold repair techniques: 13 matrix-induced autologous chondrocyte transplantation (MACT), nine bone marrow derived cell transplantation (BMDCT), four autologous matrix-induced chondrogeneis (AMIC), and four studies of other techniques. The categories of general demographics (93%) and patient-reported outcome data (85%) were well reported. Study design (73%), imaging data (73%), clinical variables (49%), and patient history (30%) were also included. The weighted mean American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up was: 86.7 in MACT, 88.2 in BMDCT, and 82.3 in AMIC. Eight studies reported that a weighted mean of 68.3% of patients returned to a previous level of sport activity.

CONCLUSION

Scaffold-based therapy for OLT may produce favorable clinical outcomes, but low LOE, poor QOE, and variability of the data have confounded the effectiveness of this treatment.

Keywords: Scaffold, Ankle, Talar osteochondral lesion, Systematic review, Cartilage

Core tip: This systematic review demonstrated that scaffold-based therapy for lesions of the talus (OLT) may produce favorable clinical outcomes. However, 96% of included studies were classified into the category of poor level of evidence and no papers were of good methodological quality. Therefore, careful attention should be paid when evaluating scaffold-based therapy for OLT. In addition, large variability and underreporting of clinical data between studies made it difficult to reliably compare the results. Further well-designed studies are necessary to determine the effectiveness of scaffold-based therapy for OLT, especially when compared to the available traditional treatments.