Abstract
Although results of bone marrow stimulation in osteochondral defects of the talus
(OCLT) have been satisfactory, the technique performance has not yet been subjected
to review as a prognostic factor. The aim of this systematic review is to determine
whether variation within technique influences outcome of bone marrow stimulation for
OCLT. Electronic databases were searched for articles on OCLT treated with bone marrow
stimulation techniques, providing a technique description. Six articles on microfracture
were included (198 patients). Lesion size averaged 0.9 cm2 to 4.5 cm2, and follow-up varied from 2 to 6 years. Key elements were removal of unstable cartilage,
hole depth variation between 2 and 4 mm until bleeding or fat droplets occurred, and
a distance between the created holes of 3 to 4 mm. The success rate (excellent/good
results by any clinical outcome score) was 81%. There is a vast similarity in the
technique with similar outcomes as in previous general reviews; therefore variation
in technique as currently described in the literature does not seem to influence the
outcome of bone marrow stimulation for OCLT. Whether the instruments used or the hole
depth and geometry influence clinical outcome remains to be determined. Microfracture
is safe and effective for OCLTs smaller than 15 mm. However, in this review, only
81% of patients obtained satisfactory results. Larger clinical trials are needed with
clearly defined patient groups, technique descriptions, and reproducible outcome measures
to provide insight in the specific indications and the preferred technique of bone
marrow stimulation.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 24, 2012
Footnotes
Financial Disclosure: This investigation was supported by the Ministry of Economic Affairs of The Netherlands, and the Marti-Keunig Eckhart Foundation, Lunteren, The Netherlands.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
