NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, USA.
National University Health System, Singapore, Singapore.
Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4238-4249. doi: 10.1007/s00167-022-07130-z. Epub 2022 Aug 27.
To evaluate the complication rates, continuous functional outcome scores, and return to play data following bone marrow stimulation (BMS) versus biologics ± BMS for the treatment of osteochondral lesion of the talus (OLT).
A systematic review was performed. The PubMed and Embase databases were searched using specific search terms and eligibility criteria according to the PRISMA guidelines. The level of evidence was assessed using published criteria by The Journal of Bone & Joint Surgery, and the quality of evidence using the Modified Coleman Methodology Score. Continuous variables were presented as mean ± standard deviation and categorical variables as frequencies (percentages).
BMS versus BMS + hyaluronic acid (HA): no complications in either treatment arm were reported. The mean American Orthopaedic Foot and Ankle Society score was 43.5 to 67.3 points and 44.0 to 72.4 points, respectively. The mean 10 mm Visual Analogue Scale pain score was 7.7 to 3.8 points and 7.5 to 2.5 points, respectively. BMS versus BMS + concentrated bone marrow aspirate (CBMA): the pooled overall complication rate was 17/64 (26.6%) versus 11/71 (15.5%), respectively (non-significant). The pool revision rate was 15/64 (23.4%) versus 6/71 (8.5%), respectively (p = 0.016). There has been a notable poor reporting of complication rates for the use of ADSC and PRP as adjuvant biological therapies to BMS for the treatment of OLT.
There was an overall limited comparative clinical evidence of adjuvant biologics with BMS versus BMS alone for the treatment of OLT. BMS + HA and BMS + CBMA can provide superior outcomes, albeit the currently limited evidence. Further studies are warranted to establish the true clinical superiority of the various biologics ± BMS versus BMS alone. These studies must also compare the various biologics against one another to determine, if any, the optimal biologic for OLT. Clinicians should counsel patients accordingly on these findings as required.
Level III.
评估骨髓刺激（BMS）与生物制剂联合 BMS 治疗距骨骨软骨病变（OLT）的并发症发生率、连续功能评分和重返赛场数据。
进行了系统评价。根据 PRISMA 指南，使用特定的搜索词和纳入标准在 PubMed 和 Embase 数据库中进行搜索。根据《骨与关节外科杂志》的出版标准评估证据水平，并使用改良 Coleman 方法学评分评估证据质量。连续变量以平均值±标准差表示，分类变量以频率（百分比）表示。
BMS 与 BMS+透明质酸（HA）：两种治疗方法均无并发症报告。美国矫形足踝协会评分的平均值分别为 43.5 至 67.3 分和 44.0 至 72.4 分。10mm 视觉模拟评分疼痛平均值分别为 7.7 至 3.8 分和 7.5 至 2.5 分。BMS 与 BMS+浓缩骨髓抽吸（CBMA）：总体并发症发生率分别为 17/64（26.6%）和 11/71（15.5%）（无统计学意义）。联合 BMS 治疗 OLT 时，联合使用 ADSC 和 PRP 作为辅助生物治疗的翻修率分别为 15/64（23.4%）和 6/71（8.5%）（p=0.016）。在使用 ADSC 和 PRP 作为 BMS 治疗 OLT 的辅助生物治疗时，并发症发生率的报告明显较差。
对于 BMS 联合 BMS 治疗 OLT，目前仅有有限的比较临床证据表明辅助生物制剂具有总体优势。BMS+HA 和 BMS+CBMA 可以提供更好的结果，但目前的证据有限。需要进一步的研究来确定各种生物制剂联合 BMS 与单独使用 BMS 相比的真正临床优势。这些研究还必须相互比较各种生物制剂，以确定是否有任何生物制剂最适合 OLT。临床医生应根据这些发现为患者提供相应的咨询。
III 级。
