Second-Look Arthroscopy Shows Inferior Cartilage after Bone Marrow Stimulation Compared with Other Operative Techniques for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.

IF 2.7 4区医学 Q1 ORTHOPEDICS CARTILAGE Pub Date : 2024-02-07 DOI:10.1177/19476035241227332

Jelmer T Vreeken, Jari Dahmen, Tobias Stornebrink, Kaj S Emanuel, Alex B Walinga, Sjoerd A S Stufkens, Gino M M J Kerkhoffs

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Abstract

Objective: To compare cartilage quality after different surgical interventions for osteochondral lesions of the talus (OLT), evaluated by second-look arthroscopy. Secondary aims were to report concomitant diagnoses, and to correlate cartilage quality with clinical and radiological outcomes. This review hypothesizes that the cartilage repair after bone marrow stimulation (BMS) is inferior to the other available treatment options.

Methods: PROSPERO ID: CRD42022311489. Studies were retrieved through PubMed, EMBASE (Ovid), and Cochrane Library. Studies were included if they reported cartilage quality after second-look investigation after surgical treatment of OLT. The primary outcome measure was the cartilage quality success and failure rates (%) per surgical intervention group. Correlations between the cartilage quality and clinical or radiological outcomes were calculated.

Results: Twenty-nine studies were included, comprising 586 ankles that had undergone second-look arthroscopy on average 16 months after initial surgery. The success rate for BMS was 57% (95% confidence interval [CI] = 48%-65%), for fixation (FIX) 86% (95% CI = 70%-94%), for osteo(chondral) transplantation (OCT) 91% (95% CI = 80%-96%), for cartilage implementation techniques (CITs) 80% (95% CI = 69%-88%), and for retrograde drilling 100% (95% CI = 66%-100%). The success rate of BMS was significantly lower than FIX, OCT, and CIT (P < 0.01). There were no significant differences between other treatment groups. A moderate positive significant correlation between the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and the International Cartilage Repair Society score (ICRS) was found (ρ = 0.51, P < 0.001).

Conclusions: Successful restoration of cartilage quality was found in the majority of surgically treated OLTs. However, BMS yields inferior cartilage quality compared with FIX, OCT, and CIT. Study Design. Systematic review and meta-analysis. Level of evidence. Level IV, systematic review and meta-analysis.

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与其他治疗距骨骨软骨损伤的手术技术相比，第二眼关节镜检查显示骨髓刺激术后软骨较差：系统回顾与元分析。

目的通过关节镜二视图评估，比较不同手术干预治疗距骨软骨损伤（OLT）后的软骨质量。次要目的是报告伴随诊断，并将软骨质量与临床和放射学结果相关联。本综述假设骨髓刺激（BMS）后的软骨修复效果不如其他可用的治疗方案：PROSPERO ID：CRD42022311489。通过 PubMed、EMBASE (Ovid) 和 Cochrane Library 检索研究。如果研究报告了OLT手术治疗后进行二诊检查后的软骨质量，则纳入该研究。主要结果指标是每个手术干预组的软骨质量成功率和失败率（%）。计算软骨质量与临床或放射学结果之间的相关性：共纳入29项研究，包括586个脚踝，这些脚踝在初次手术后平均16个月接受了二次关节镜检查。BMS的成功率为57%（95%置信区间[CI] = 48%-65%），固定术（FIX）的成功率为86%（95% CI = 70%-94%），骨（软骨）移植术（OCT）的成功率为91%（95% CI = 80%-96%），软骨植入技术（CIT）的成功率为80%（95% CI = 69%-88%），逆行钻孔术的成功率为100%（95% CI = 66%-100%）。BMS的成功率明显低于FIX、OCT和CIT（P < 0.01）。其他治疗组之间无明显差异。结论：软骨修复组织磁共振观察（MOCART）评分与国际软骨修复协会评分（ICRS）呈中度正相关（ρ = 0.51，P < 0.001）：结论：大多数经手术治疗的 OLT 都能成功恢复软骨质量。然而，与 FIX、OCT 和 CIT 相比，BMS 的软骨质量较差。研究设计。系统回顾和荟萃分析。证据级别。IV级，系统回顾和荟萃分析。

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来源期刊

CARTILAGE ORTHOPEDICS-

CiteScore

6.90

自引率

7.10%

发文量

期刊介绍： CARTILAGE publishes articles related to the musculoskeletal system with particular attention to cartilage repair, development, function, degeneration, transplantation, and rehabilitation. The journal is a forum for the exchange of ideas for the many types of researchers and clinicians involved in cartilage biology and repair. A primary objective of CARTILAGE is to foster the cross-fertilization of the findings between clinical and basic sciences throughout the various disciplines involved in cartilage repair. The journal publishes full length original manuscripts on all types of cartilage including articular, nasal, auricular, tracheal/bronchial, and intervertebral disc fibrocartilage. Manuscripts on clinical and laboratory research are welcome. Review articles, editorials, and letters are also encouraged. The ICRS envisages CARTILAGE as a forum for the exchange of knowledge among clinicians, scientists, patients, and researchers. The International Cartilage Repair Society (ICRS) is dedicated to promotion, encouragement, and distribution of fundamental and applied research of cartilage in order to permit a better knowledge of function and dysfunction of articular cartilage and its repair.