Good clinical outcome after osteochondral autologous transplantation surgery for osteochondral lesions of the talus but at the cost of a high rate of complications: a systematic review

Importance Osteochondral autologous transplantation surgery (OATS) is one of many treatment modalities for osteochondral lesions of the talus (OLT). OATS uses bone-cartilage cylinder grafts from a non-weight bearing portion of another joint and transplants these on the site of the defect. This may cause complications of the donor site and the ankle. Overall, there is scarce knowledge concerning the clinical outcome and complication rate after OATS. Objective To determine the clinical outcome and complications of OATS for the treatment of OLT. Evidence review The data sources are PubMed and EMBASE. Studies were included if they were written in English and were level I-IV clinical studies. Excluded were level V publications, systematic reviews and the use of osteoperiosteal grafts. All participants of included studies were treated for their OLT using OATS. An electronic search was performed to find clinical studies published on OATS from 2005 until March 2016. All titles and abstracts were independently evaluated by 2 researchers. Full texts that met the inclusion criteria were subsequently assessed for quality using the Coleman Methodology score as modified by Kon. To analyse clinical outcome, from each article, demographic information, patient history, study design, clinical variables, patient-reported outcomes and complications were extracted. Findings The initial search identified 578 studies. A total of 24 articles were selected for the final analysis. Of 24 included articles, 1 was classified as level I, 3 as level III and 20 as level IV studies. The mean modified Coleman Methodology score for all trials was 40.9 (SD 11.0). The 24 studies included a total of 643 patients with a mean age ranging from 22 to 48 years. 11 studies, including a total of 310 patients, evaluated surgery outcome using the American Orthopaedic Foot and Ankle Society (AOFAS) both preoperatively and postoperatively, showing a mean improvement of 51.9-85.4 points. A total of 278 complications were reported including 173 ankle joint complications, 35 donor site-related complications and 70 general complications. Conclusions and relevance OATS provides good clinical outcome in patients with OLT as both primary and secondary surgical treatment. It is, however, associated with complications related to the ankle joint and donor site. Level of evidence Level IV, systematic review of level I-IV studies.