Amsterdam UMC location University of Amsterdam, Department of Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands.
Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2023 Aug;31(8):3517-3527. doi: 10.1007/s00167-023-07408-w. Epub 2023 Apr 16.
The purpose of the present study was to assess the overall clinical success rate of non-operative management for osteochondral lesions of the talus (OLT).
A literature search was conducted in the PubMed (MEDLINE), COCHRANE and EMBASE (Ovid) databases. Clinical success rates per separate study were calculated at the latest moment of follow-up and were defined as successful when a good or excellent clinical result at follow-up was reported in a qualitative manner or when a post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score at or above 80 was reached. When clinical outcomes were based on other clinical scoring systems, outcomes reported as good or excellent were considered as clinical success. Studies methodologically eligible for a simplified pooling method were combined to calculate an overall pooled clinical success rate. Radiological changes over the course of conservative treatment were assessed either considering local OLT changes and/or overall ankle joint changes.
Thirty articles were included, including an overall of 868 patients. The median follow-up of the included studies was 37 months (range: 3-288 months). A simplified pooling method was possible among 16 studies and yielded an overall pooled clinical success rate of 45% (95% CI 40-50%). As assessed with plain radiographs, progression of ankle joint osteoarthritis was observed in of 9% (95% CI 6-14%) of the patients. As assessed through a Computed Tomography (CT) scan, focal OLT deterioration was observed in 11% (95% CI 7-18%) of the patients. As assessed with a Magnetic Resonance Imaging (MRI) scan, focal OLT deterioration was observed in 12% (95% CI 6-24%) of the patients. An unchanged lesion was detected on plain radiographs in 53% (48/91; CI 43-63%), 76% (99/131; 95% CI 68-82%) on a CT scan and on MRI in 84% (42/50; 95% CI 71-92%) of the patients.
The current literature on non-operative management of OLTs is scarce and heterogeneous on indication and type of treatment. Promising clinical results are presented but need to interpreted with caution due to the heterogeneity in indication, duration and type of treatment. Further studies need to focus on specific types on conservative management, indications and its results.
Systematic review, Level IV.
本研究旨在评估距骨骨软骨病变（OLT）非手术治疗的总体临床成功率。
在 PubMed（MEDLINE）、COCHRANE 和 EMBASE（Ovid）数据库中进行文献检索。分别在随访的最后时间点计算每个研究的临床成功率，并将随访时报告良好或优秀临床结果的定性方式定义为成功，或者达到术后美国矫形足踝协会（AOFAS）评分 80 分或以上。当临床结果基于其他临床评分系统时，将报告为良好或优秀的结果视为临床成功。对于符合简化汇总方法的研究进行合并，以计算总体汇总的临床成功率。通过保守治疗的放射学变化来评估局部 OLT 变化和/或整个踝关节变化。
共纳入 30 篇文章，共纳入 868 例患者。纳入研究的中位随访时间为 37 个月（范围：3-288 个月）。16 项研究可采用简化汇总方法，总体汇总的临床成功率为 45%（95%CI 40-50%）。通过 X 线平片评估，9%（95%CI 6-14%）的患者出现踝关节骨关节炎进展。通过 CT 扫描评估，11%（95%CI 7-18%）的患者出现局灶性 OLT 恶化。通过 MRI 扫描评估，12%（95%CI 6-24%）的患者出现局灶性 OLT 恶化。在 X 线平片上未发现病变进展的患者占 53%（48/91；95%CI 43-63%），在 CT 扫描和 MRI 上未发现病变进展的患者占 76%（99/131；95%CI 68-82%）和 84%（42/50；95%CI 71-92%）。
目前关于 OLT 非手术治疗的文献很少，并且在适应证和治疗类型方面存在异质性。尽管存在异质性，但提供了有前途的临床结果，但需要谨慎解释，因为适应证、治疗持续时间和类型存在差异。需要进一步研究重点关注特定类型的保守治疗、适应证及其结果。
系统评价，IV 级。
