Medway NHS Foundation Trust, Gillingham, United Kingdom.
East Kent Hospitals NHS University Foundation Trust, Ashford, United Kingdom.
Foot (Edinb). 2021 Jun;47:101805. doi: 10.1016/j.foot.2021.101805. Epub 2021 Apr 20.
There has been no consensus regarding the treatment of osteochondral lesions of the talus, there has been many attempts to formulate a treatment pathway, with multiple proposed modalities and adjuncts used.
The aim of this paper was to investigate the evidence published in the recent history, identify the relevant papers, review and summarize the findings, to help clarify the available operative treatment options and their respective efficacies based on the level of evidence provided.
STUDY DESIGN & METHODS: A literature search through electronic databases MEDLINE and EMBASE was done, these databases were screened for publications and papers form June 2004 to June 2019. Key words were utilised in the search 'talus, talar, tibia, cartilage, osteochondral, ankle, osteochondritis dissecans, articular cartilage'. Studies on adults aged 18-60 years were included. Exclusion criteria were studies with less than 10 patients, or no clear outcome was recorded. Papers were reviewed by the authors and data extracted as per a pre-defined proforma.
Following screening, 28 published articles were included and reviewed. Of these publications 5 were level I, 7 level II, 4 level III and 12 level IV. The total number of patients was 1061 patients. Treatment modalities included arthroscopic microfracture, drilling, hyaluronic acid injection, platelet rich plasma, osteochondral autologous transplantation (OAT), vascularised free bone graft among others. The most common functional measures used to assess efficacy were the Visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle (AOFAS) score. Follow up ranged from 26 weeks upto 4 years.
Despite the abundance of treatment options, high level evidence (level I) remains limited and does not conclude a definitive treatment modality as superior to others. Further research, in the form highly organised randomised clinical trials, is needed to help improve the efficacy and develop new treatment modalities in the future.
目前对于距骨骨软骨损伤的治疗尚未达成共识，许多人试图制定治疗路径，提出了多种治疗方法和辅助手段。
本文旨在研究近期发表的相关文献，识别相关文献，回顾和总结研究结果，以帮助明确现有的手术治疗方法及其各自的疗效，依据提供的证据水平。
通过电子数据库 MEDLINE 和 EMBASE 进行文献检索，对 2004 年 6 月至 2019 年 6 月期间的出版物和论文进行筛选。搜索关键词为“talus、talar、tibia、cartilage、osteochondral、ankle、osteochondritis dissecans、articular cartilage”。纳入年龄在 18-60 岁之间的成人研究。排除标准为患者少于 10 例或未记录明确的结局的研究。作者对论文进行了审查，并按照预先制定的方案提取数据。
经过筛选，共纳入并回顾了 28 篇已发表的文章。其中 5 篇为 I 级，7 篇为 II 级，4 篇为 III 级，12 篇为 IV 级。患者总数为 1061 例。治疗方法包括关节镜下微骨折术、钻孔、透明质酸注射、富血小板血浆、自体骨软骨移植术（OAT）、带血管游离骨移植术等。最常用的评估疗效的功能指标是视觉模拟评分（VAS）和美国矫形足踝协会（AOFAS）评分。随访时间从 26 周到 4 年不等。
尽管治疗方法众多，但高水平证据（I 级）仍然有限，无法确定哪种治疗方法优于其他方法。需要进一步研究，以组织良好的随机临床试验形式，有助于提高疗效，并为未来开发新的治疗方法。
