Systematic review of bone marrow stimulation for osteochondral lesion of talus - evaluation for level and quality of clinical studies

Table 1 Modified Coleman Methodology Score[6]

Section	No. or factor	Score
Part A: Only one score to be given for each section
1 Study size - number of patients
	> 60	10
	41-60	7
	20-40	4
	< 20, not stated	0
2 Mean follow up (mo)
	> 24	5
	12-24	2
	< 12, not stated or unclear	0
3 Number of different surgical procedures included in each reported outcome. More than one surgical technique may beassessed but separate outcomes should be reported
	One surgical procedure	10
	More than one surgical procedure, but > 90% of subjects undergoing the one procedure	7
	Not stated, unclear, or < 90% of subjects undergoing the one procedure	0
4 Type of study
	Randomized controlled trial	15
	Prospective cohort study	10
	Retrospective cohort study	0
5 Diagnostic certainty (MRI)
	In all	5
	In > 80%	3
	In < 80%	0
6 Description of surgical procedure given
	Adequate (technique stated and necessary details of that type of procedure given)	5
	Fair (technique only stated without elaboration)	3
	Inadequate, not stated, or unclear	0
7 Description of postoperative rehabilitation
	Well described (ROM, WB and sport)	10
	Not adequately described (2 items between ROM and WB and sport)	5
	Protocol not reported	0
Part B: Scores may be given for each option in each of the three sections if applicable
1 Outcome criteria
	Outcome measures clearly defined	2
	Timing of outcome assessment clearly stated (e.g., at best outcome after surgery or follow-up)	2
	Objective, subjective and imaging criteria	6
	2 items between objective, subjective and imaging criteria	4
	Objective or subjective or radiological criteria	2
2 Procedure for assessing outcomes
	Subjects recruited (results not taken from surgeons files)	5
	Investigator independent of surgeon	4
	Written assessment	3
	Completion of assessment by subjects themselves with minimal investigator assistance	3
3 Description of subject selection process
	Selection criteria reported and unbiased	5
	Recruitment rate reported
	> 80% or	5
	< 80%	3
	Eligible subjects not included in the study satisfactorily accounted for, or 100% recruitment	5

MRI: Magnetic resonance imaging; ROM: Range of motion; WB: Weight bearing.

Table 2 Studies included and demographic datas

Ref.	Year	No. of ankles	No. of males	No. of females	Follow -up (mo)	Lesion area (mm2)	Lesion diameter (mm)	Prognostic factors	LOE	MCMS (points)
[23]	2013	50	20	30	35.5	61.7	8.8	Lesion size	III	58
[29]	2015	15	7	8	94.8	87		Lesion size	IV	50
[5]	2009	120	80	37	35.6	111.7	11.4	Lesion size	III	56
[3]	2013	399			74	111.3		Lesion size, contained	III	61
[32]	2015	90	68	22	38.3	100		Lesion size	III	67
[24]	2013	298	184	114	52	98.5		Lesion size	III	57
[19]	2012	173	121	52	70.3	95.4		Lesion size	III	54
[4]	2008	105	73	32	31.6		8.84	Lesion size	IV	57
[16]	2000	17	13	4	84	85.2		Lesion size	III	33
[13]	2006	10	6	4	53	450		Lesion size	III	61
[18]	2011	22	16	6	32	76		Lesion size	IV	45
[30]	2014	50	28	22	27.1			Lesion size	III	69
[20]	2012	22	12	10	24			Lesion size	IV	56
[21]	2012	81	64	17	37.4	100		Lesion size	III	89
[17]	2010	35	27	8	33	90		Lesion size	IV	50
[31]	2014	58	37	21	35	124		Lesion size	IV	65
[25]	2013	50	30	20	141		8.8	Lesion size	IV	62
[26]	2013	38	23	15	52.8	100		Lesion size	IV	52
[27]	2013	50	22	28	36.3	62		Lesion size	IV	66
[28]	2015	41	17	24	42.5	67		Lesion size	IV	56
[22]	2012	25	19	5	32	110		Lesion size	IV	48
[7]	2011	130	64	66	37.2	84		Lesion size, contained	IV	50

LOE: Level of evidence; MCMS: Modified coleman methodology score.

Table 3 Outcome of modified Coleman methodology scores

Ref.	Part A							Part B			Total
	1 Study size - number of patients	2 Mean follow-up (mo)	3 No. of different surgical procedures included in each reported outcome	4 Type of study	5 Diagnostic certainty (MRI)	6 Description of surgical procedure given	7 Description of postoperative rehabilitation	1 Outcome criteria	2 Procedure for assessing outcomes	3 Description of subject selection process
[23]	7	5	10	0	5	3	10	8	5	5	58
[29]	0	5	10	0	0	5	10	10	5	5	50
[5]	10	5	10	0	5	5	10	8	5	0	58
[3]	10	5	10	0	5	5	10	8	8	0	61
[32]	10	5	10	0	5	5	5	6	3	8	57
[24]	10	5	10	0	5	5	10	10	9	3	67
[18]	10	5	10	0	5	5	10	8	3	0	56
[4]	10	5	10	0	5	3	10	6	8	0	57
[16]	4	5	10	0	0	3	0	8	5	3	38
[13]	4	5	0	10	5	5	10	10	9	3	61
[18]	4	5	10	0	5	5	5	6	5	0	45
[30]	7	5	10	0	5	5	10	10	9	8	69
[20]	4	2	10	0	5	3	5	10	9	8	56
[21]	10	5	10	15	5	5	10	10	9	10	89
[17]	4	5	10	0	5	5	5	8	5	3	50
[31]	7	5	10	0	5	5	10	10	5	8	65
[25]	7	5	10	0	0	3	5	10	12	5	57
[26]	4	5	10	0	5	3	10	10	5	0	52
[27]	7	5	10	0	5	3	10	8	8	10	66
[28]	7	5	10	0	5	3	10	8	5	3	56
[22]	4	2	10	0	5	5	5	8	9	0	48
[7]	10	5	0	0	5	0	10	10	5	5	50
mean	6.8	4.7	9.1	1.1	4.3	4	8.2	8.6	6.6	4	57.5
SD	3	0.9	2.9	3.8	1.8	1.3	2.9	1.4	2.4	3.5	10.2

MRI: Magnetic resonance imaging.