SLR - August 2022 - Junaid M Khazi, DPM
Reference: Dahmen, J., Steman, J. A. H., Buck, T. M. F., Struijs, P. A. A., Stufkens, S. A. S., Van Bergen, C. J. A., & Kerkhoffs, G. M. M. J. (2022). Treatment of osteochondral lesions of the talus in the skeletally immature population: A systematic review. Journal of Pediatric Orthopaedics, https://doi.org/10.1097/bpo.0000000000002175Level of evidence: 4
Scientific Literature Review
Reviewed by: Junaid M Khazi, DPM
Residency Program: Mercy Health – St. Vincent’s Medical Center
Podiatric Relevance: The presence of osteochondral lesions of the talus (OLTs) are not well documented or are underreported. Treatment for this condition and clinical efficacy of different treatment options are not well researched. This study aims to investigate the efficacy of conservative and surgical treatment options in pediatric patients. Another aim of this study is to recognize and assess return to sports rate and radiological outcomes for different treatment options
Methods: From January 1996 to September 2021 an electronic literature search was performed to identify suitable studies for the review. There were 20 studies with a total of 381 OLTs. The search was carried on PubMed, EMBASE, Cochrane, CDSR, CENTRAL and DARE databases. Inclusion and exclusion criteria were defined specifically as children who had reported open growth plates or physis.The methodological index for non-randomized studies was used to assess the quality of the studies in this systemic review.They evaluated these articles for clinical, radiographic and sports performance outcomes for different treatment modalities.
Results:
The pooled success rate in the conservative group was 44 percent, the bone marrow stimulation (BMS) was 77 percent, in the retrograde drilling (RD) group was 95 percent, in the fixation group 79 percent and in the osteochondral autograft 67 percent.
Return to sports rates were reported on two groups; the bone marrow stimulation had an 86% return to sports rate while the retrograde drilling showed a return to sport rate of 100 percent.
A treatment strategy was considered radiologically successful when there were no remaining signs of lesion on either computed tomography (CT) scan or magnetic resonance imaging (MRI) scan.
Radiological success based on MRI were 29 percent in the conservative group, 81 percent in the bone marrow stimulation, 41 percent in the retrograde drilling group and 87 percent in the fixation group. There was no data on radiological success based on MRI for osteochondral autograft group.
Radiological success based on CT were 62 percent in the conservative group, 30 percent in the bone marrow stimulation and 57 percent in the retrograde drilling group. There was no data on radiological success based on CT for the fixation group and osteochondral autograft group.
Conclusions: There are different treatment options for a symptomatic osteochondral lesion of the talus for a skeletally immature patient. This study showed us that surgical treatments were found to be more successful than the conservative treatments like physiotherapy or immobilization. The fixation group based on clinical and radiological success. There is no validation of AOFAS score in skeletally immature patients so there is a chance for bias as overestimation or underestimation of the results. Treatments should be a tailored based on the characteristic of the lesion, patient and the parent’s preference. Ultimately it should always start conservatively for 4-6 weeks and if pain persists along with radiographic evidence; surgical approach should be considered.