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Abstract

Objective

The primary aim was to determine and compare the complication rate of different surgical treatment options for osteochondral lesions of the talus (OLTs). The secondary aim was to analyze and compare the severity and types of complications.

Design

A literature search was performed in MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane Library. Methodological quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Primary outcome was the complication rate per surgical treatment option. Secondary outcomes included the severity (using the Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery) and types of complications. The primary outcome, the severity, and the sub-analyses were analyzed using a random effects model. A moderator test for subgroup-analysis was used to determine differences. The types of complications were presented as rates.

Results

In all, 178 articles from the literature search were included for analysis, comprising 6,962 OLTs with a pooled mean age of 35.5 years and follow-up of 46.3 months. Methodological quality was fair. The overall complication rate was 5% (4%-6%; treatment group effect, P = 0.0015). Analysis resulted in rates from 3% (2%-4%) for matrix-assisted bone marrow stimulation to 15% (5%-35%) for metal implants. Nerve injury was the most observed complication.

Conclusions

In 1 out of 20 patients treated surgically for an OLT, a complication occurs. Metal implants have a significantly higher complication rate compared with other treatment modalities. No life-threatening complications were reported.

Keywords

osteochondral defect osteochondral lesion surgery surgical treatment complication

Introduction

Osteochondral lesions of the talus (OLTs) are lesions that affect the articular cartilage and the subchondral bone. Often, this arises after a traumatic event, such as an ankle sprain or fracture.^1,2 Symptomatic OLTs often have a severe impact on the quality of life (QoL) of patients.³ To improve QoL, patients are treated, either non-operatively or surgically. In a stepped care treatment protocol, non-operative treatment is the first step, which has been shown being somewhat effective.^4
-8 However, if this is not successful, then surgical treatment may be considered necessary. The optimal surgical treatment is determined on the patients’ preferences, lesion nature, localization, size, morphology, and fixability of a fragment.⁹ A wide variety of surgical treatment options exist, including bone marrow stimulation (BMS) therapies, retrograde drilling, fixation, matrix-assisted BMS, cartilage implantation, osteo(chondral) autograft transplantation therapies, osteo(chondral) allograft transplantation therapies, and metal implants.^10
-17 In small lesions (defect size < 10 mm in any of the dimensions), fixation and BMS are the primary treatment options.⁹ For larger lesions, retrograde drilling and osteo(chondral) transplantation therapies are more often used.⁹

Every different surgical procedure comes with its own risks and complications. Complication characteristics are an important factor in the evidence-based shared decision-making process.¹⁸ Besides complications, the efficacy and costs of a treatment are also of importance. Recent research has shown that no superior treatment for primary and secondary lesions exists.^19,20 Increased insight into the occurrence, severity, and types of complications in surgical treatment of OLTs is therefore of importance in future patients’ treatment decisions.

The primary aim of this study is to determine and compare the complication rate per surgical treatment option for OLTs. The secondary purpose is to analyze and compare the severity of complications and to analyze the types of complications per treatment option. The hypothesis of the present study is that surgical treatment of OLTs yields a low complication rate.

Materials and Methods

The protocol of the present study was registered prospectively in the international prospective registry for systematic reviews PROSPERO²¹ (registration number CRD42018081490). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed as a guideline for this study.²²

Search Strategy

Studies from 1996 until September 2021 from MEDLINE (PubMed), EMBASE (Ovid), and the Cochrane Library were identified. The publication filter from 1996 was applied due to the emerging of arthroscopy in the ankle. The full search strategy can be found in the Supplementary Appendix. Backward citation chaining was performed to find any additional eligible articles.

Eligibility Criteria and Study Selection

All clinical studies that investigated surgical treatment of OLTs were eligible for inclusion. The full text needed to be available in English, French, Spanish, German, or Dutch. No restrictions regarding patient demographics were applied. A study needed to analyze a minimum of 5 OLTs on a minimum follow-up of 6 months. Review, cadaver, and animal studies were excluded. In case there was overlap between studies, the study with the highest number of patients was included. If multiple treatment modalities were used in an eligible study, the authors of the present study needed to be able to extract the data per treatment option to include the study. The title and abstract was screened by two researchers (J.H. and J.D.). This was performed using the Rayyan web-tool, which makes it more convenient for researchers to screen articles.²³

Methodological Quality

Methodological quality was assessed by two independent reviewers (J.H. and J.D.) using the Methodological Index for Non-Randomized Studies (MINORS).²⁴

Data Extraction

Data extraction was performed by two reviewers (J.H. and J.D.) using a standardized extraction form, specially designed for the present study, and tested before use. Data on study and patient characteristics were collected. Study characteristics include author, title, year of publication, level of evidence, treatments used, and follow-up duration. Patient characteristics are gender, age, laterality, and complications.

The definition of a complication, used in this study, is derived from the definition of Sokol and Wilson,²⁵ and is as follows: “any undesirable, unintended, and direct result of an operation affecting the patient.” Any complication related to the success rate of the treatment, for example, graft non-union or other graft-related failures, was excluded from the analysis. In addition, secondary surgical procedures were also not scored as a complication. This was done to prevent the double-counting of complications for which subsequent surgical treatment was needed (e.g., complication and subsequent needed surgery counts one complication).²⁶ Also hardware removal was not considered a complication.^27
-29

The severity of the complications was assessed with the help of the Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery ( Table 1 ).³⁰ This classification was used to avoid subjective terms as “major” and “minor” and to improve the interrater and intrarater reliability.³⁰ To compare the different surgical treatment options, treatment groups based on treatment modalities were defined. The treatment modalities are BMS therapies, retrograde drilling, fixation, matrix-assisted BMS, cartilage implantation, osteo(chondral) autograft transplantation therapies, osteo(chondral) allograft transplantation therapies, and metal implants ( Table 2 ). The different types of complications were also extracted, to assess which type of complications occurs per treatment option.

Table 1.

Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery.

Grade	Definition
I	A complication that does not result in deviation from routine follow-up in the postoperative period and has minimal clinical relevance and requires minimal treatment (e.g., antiemetics, antipyretics, analgesics, diuretics, electrolytes, antibiotics, and physiotherapy) or no treatment.
II	A deviation from the normal postoperative course (including unplanned clinic/office visits) that requires outpatient treatment, either pharmacological or close monitoring as an outpatient.
III	A complication that is treatable but requires surgical, endoscopic, or interventional radiology procedure(s), or an unplanned hospital readmission.
IVa	A complication that is life- or limb-threatening, and/or requires ICU admission, a complication with potential for permanent disability but treatable, a complication that may require organ/joint resection/replacement. No long-term disability.
IVb	A complication that is life- or limb-threatening, and/or requires ICU admission, a complication that is not treatable, a complication that requires organ/joint resection/replacement or salvage surgery. With long-term disability.
V	Death.

Adopted from Dodwell et al.³⁰

ICU = intensive care unit.

Table 2.

Treatment Modalities.

Treatment Option	Examples
Bone marrow stimulation therapies	Bone marrow stimulation, debridement, microfracture
Retrograde drilling	Retrograde drilling
Fixation	Lift, drill, fill, fix
Matrix-assisted bone marrow stimulation	Autologous chondrocyte inducing chondrogenesis, matrix-associated stem cell transplantation, autologous matrix-induced chondrogenesis, bone marrow–derived stem cell transplantation
Cartilage implantation	Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, particulated juvenile cartilage allograft transplantation
Osteo(chondral) autograft transplantation therapies	Osteochondral autograft transfer system, autologous osteochondral transplantation
Osteo(chondral) allograft transplantation therapies	Allogenic osteochondral transplantation
Metal implants	Implant therapies

Statistical Analysis

The primary outcome is the complication rate, which is defined as the proportion of complications to the total number of lesions. This was then pooled per surgical treatment option (i.e., BMS therapies, retrograde drilling, fixation, matrix-assisted BMS, cartilage implantation, osteo(chondral) autograft transplantation therapies, osteo(chondral) allograft transplantation therapies, and metal implants) with a random effects model, weighted by inverse variance. T², a measure of heterogeneity, was determined with the use of the DerSimonian and Laird³¹ estimator, and the corresponding confidence interval (CI) was calculated using the Jackson and Bowden³² method. A logit transformation was applied. The 95% CIs for individual studies were calculated using the Clopper-Pearson³³ interval method. Difference in complication rates within treatment modalities were compared using a moderator test for subgroup-analysis with α = 0.05.³⁴ If a significant effect among all treatments was found, post hoc moderator tests were used to assess difference between single treatment modalities.

The distribution of grades per treatment option and the types of complications were presented as a rate which is the proportion of the total complications per treatment option. The different types of complications were presented by means of a top 5 per treatment option.

All analyses were performed in STATA 15 (StateCorp LP, College Station, TX) and R version 4.0.2 (RStudio, Boston, MA) with meta package.³⁵

Results

Article Selection

The literature search yielded 3,949 articles, of which 333 met the inclusion criteria ( Fig. 1 ). A total of 155 studies comprising 6,261 lesions could not be included in the analysis as they did not (well) report complications. The distribution of the lesions among the 155 studies can be viewed in Table 3 . In all, 178 studies remained for analysis in the present study.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of study selection.

Table 3.

Characteristics Excluded Studies Due to Underreporting/Unclear Reporting of Complications.

Treatment Option	Lesionsn
Overall	6,261
Bone marrow stimulation therapies	2,916
Retrograde drilling	253
Fixation	181
Matrix-assisted bone marrow stimulation	1,031
Cartilage implantation	493
Osteo(chondral) autograft transplantation therapies	1,068
Osteo(chondral) allograft transplantation therapies	236
Metal implants	41
Other	42

Evaluation of the Characteristics of Included Studies

Overall, the 178 studies included 6,921 patients with 6,962 lesions (41 bilateral patients [0.6% of all patients]). The pooled mean age was 35.5 years (range of means: 10.4-58), and the pooled mean follow-up was 46.3 months (range of means: 6-411.6 months).

Methodological Quality

Scoring the methodological quality of the 134 non-comparative studies resulted in an average score of 10.1 (range: 5-13) out of 16 points.^{11,14,15,17,27
-29,36
-162} The 44 comparative studies had an average score of 17.8 (range: 13-22) out of 24 points.^163
-206 The MINORS scores per individual study can be found in the Supplementary Appendix.

Primary Outcome

In total, 225 complications were reported. The overall complication rate was 5% (95% CI: 4%-6%; treatment group effect Q = 25.05, P = 0.0015), ranging per treatment option from 3% (95% CI: 2%-4%) for matrix-assisted BMS to 15% (95% CI: 5%-35%) for metal implants. The moderator test for subgroup-analysis between all treatment modalities showed a significant effect of treatment option (Q = 25.05, P = 0.015). Metal implants have a higher complication rate compared with BMS therapies (Q = 5.27, P = 0.0217), compared with retrograde drilling (Q = 3.86, P = 0.0493), compared with fixation (Q = 4.56, P = 0.0328), compared with matrix-assisted BMS (Q = 9.29, P = 0.0023), and compared with cartilage implantation (Q = 3.95, P = 0.0468). In addition, differences between matrix-assisted BMS and osteo(chondral) autograft transplantation therapies (3% [95% CI: 2%-5%] versus 7% [95% CI: 5%-10%], Q = 16.86, P ≤ 0.0001) and between matrix-assisted BMS and osteo(chondral) allograft transplantation therapies (3% [95% CI: 2%-5%] versus 8% [95% CI: 4%-16%], Q = 7.66, P = 0.0056) were found. The overall complication rate and the complication rate per treatment option can be viewed in Table 4 .

Table 4.

Overall Complication Rate per Treatment Option.

Treatment Option	Studiesn	Lesionsn	Pooled Mean Age (Years)	Pooled Mean Follow-Up (Months)	Complication Rate% (95% Confidence Interval)
Overall	178	6,962	35.5	46.3	5 (4-6)
Bone marrow stimulation therapies^a	67	2,926	36.7	48.7	4 (3-6)^a
Retrograde drilling^b	14	289	32.6	39.2	5 (3-8)^b
Fixation^c	8	179	22.3	35.5	3 (1-8)^c
Matrix-assisted bone marrow stimulation^d	31	1,072	16.8	14.7	3 (2-4)^d
Cartilage implantation^e	22	479	32.8	47.5	5 (3-8)^e
Osteo(chondral) autograft transplantation therapies^f	61	1,639	34.7	54.2	8 (6-10)^f
Osteo(chondral) allograft transplantation therapies^g	15	288	43.1	30.8	8 (4-14)^g
Metal implants^h	3	80	41.7	54.4	15 (5-35)^h
Otherⁱ	1	10	43.3	12	5 (0-45)ⁱ

Significantly different from osteo(chondral) autograft transplantation therapies (Q = 7.55, P = 0.0060) and metal implants (Q = 5.27, P = 0.0217).^{43,52,59,61
-63,66,81,92,93,109,113,117,121,123,125,131,135,141,143,146,149,150,153,158,164,165,167,168,171,173,176,177,179
-183,187,190,192,195
-200,202,204
-206}

Significantly different from metal implants (Q = 3.86, P = 0.0493).^{11,42,53,56,59,116,118,137,170,177,194,196}

Significantly different from metal implants (Q = 4.56, P = 0.0328).^{85,102,104,119,134,138,185,186}

Significantly different from osteo(chondral) autograft transplantation therapies (Q = 16.86, P < 0.0001), osteo(chondral) allograft transplantation therapies (Q = 7.66, P = 0.0056), and metal implants (Q = 9.29, P = 0.0023).^{29,38,40,49,58,65,72,77,82,94,98,101,130,139,140,142,144,145,155,157,162,166,169,181,189,192,195,201,204}

Significantly different from metal implants (Q = 3.95, P = 0.0468).^{14,41,45,46,51,64,76,78
-80,86,99,103,107,112,114,115,124,133,147,179}

Multiple studies: ^{15,36,39,47,48,50,60,68,70,71,74,75,83,84,87
-90,95
-97,100,105,106,108,110,120,126,128,129,132,136,138,148,151,152,154,156,159
-161,163,171
-175,178,184,188,191,193,194,197,203}.

Multiple studies: ^{17,37,44,54,55,57,67,73,91,111,122,152,163,191,206}.

Multiple studies: ^27,28,69.

Study: ¹²⁷.

Secondary Outcomes

Severity of complications

No Grade IV and Grade V complications were found. Most of the complications were Grade I complications with an overall rate of 4% (95% CI: 3%-4%; difference between all treatment options, Q = 13.51, P = 0.0955). The rates for Grade II and Grade III are 3% (95% CI: 3%-4%; difference between all treatment options, Q = 12.88, P = 0.1160) and 3% (95% CI: 2%-3%; difference between all treatment options, Q = 8.44, P = 0.3917), respectively. The distribution of the severity of the complications that arise per treatment option can be seen in Table 5 . The proportion of Grade I and Grade II (complications without the need of a hospital readmission or intervention) of all complications is 84%.

Table 5.

Overall Complication Rate Separated in Severity.

Treatment Option	Grade I^a		Grade II^a		Grade III^a
Treatment Option	% (95% CI)	Proportion	% (95% CI)	Proportion	% (95% CI)	Proportion
Overall	4 (3-4)	51	3 (3-4)	33	3 (2-3)	16
Bone marrow stimulation therapies	3 (2-4)	48	2 (2-3)	30	2 (2-3)	22
Retrograde drilling	4 (2-7)	50	3 (2-7)	33	3 (1-6)	17
Fixation	3 (1-7)	50	3 (1-7)	N/A	3 (1-8)	50
Matrix-assisted bone marrow stimulation	2(1-3)	22	2 (1-3)	67	2 (1-3)	11
Cartilage implantation	4 (2-6)	44	3 (2-6)	44	3 (1-5)	11
Osteo(chondral) autograft transplantation therapies	6 (4-8)	62	4 (3-5)	28	3 (2-4)	10
Osteo(chondral) allograft transplantation therapies	3 (2-7)	13	6 (3-11)	47	5 (3-9)	40
Metal implants	7 (2-28)	50	7 (3-15)	42	3 (1-13)	8
Other	5 (0-45)	N/A	5 (0-45)	N/A	5 (0-45)	N/A

CI = confidence interval; N/A = not applicable.

Severity based on the grades of Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery. Rates presented as percentage of the overall complication rate of the respective treatment option, and the proportion of the grade of all complications overall and per treatment option. No significant differences were found.

Type of complications

The proportions of all complications for the most occurring complications per treatment option can be viewed in Table 6 . In 5 treatment modalities (i.e., BMS therapies, retrograde drilling, fixation, cartilage implantation, and metal implants), nerve injury, either temporary or duration unknown, was the most frequently reported complication (range of the proportions of the total complications per treatment option: 22%-50%). For matrix-assisted BMS, superficial infection was the most occurring type of complication (56%), for osteochondral autograft transplantation therapies, it is donor site morbidity (41%), and deep venous thrombosis (DVT) for osteo(chondral) allograft transfer (27%).

Table 6.

Most Occurring Complications per Treatment Option.

Treatment Option	Most Occurring		Second Most Occurring		Third Most Occurring		Fourth Most Occurring		Fifth Most Occurring
Treatment Option	Complication	%	Complication	%	Complication	%	Complication	%	Complication	%
Bone marrow stimulation therapies	Nerve injury (dur. unk.)	22	Superficial infection	12	DVT	12	Nerve injury (temporary)	10	Hematoma	7
Retrograde drilling	Nerve injury (dur. unk.)	50	Arterial bleeding	17	Delayed wound healing	17	Extensor hallucis longus weakness	17	N/A
Fixation	Nerve injury (temporary)	50	Screw loosening	50	N/A		N/A		N/A
Matrix-assisted bone marrow stimulation	Superficial infection	56	Arthrofibrosis	11	Delayed union of osteotomy site	11	Nerve injury (temporary)	11	Donor site morbidity	11
Cartilage implantation	Nerve injury (temporary)	44	Delayed union of osteotomy site	22	Non-union of osteotomy site	11	Skin necrosis	11	Superficial infection	11
Osteo(chondral) autograft transplantation therapies	Donor site morbidity	41	Superficial infection	13	Nerve injury (temporary)	6	Nerve injury (dur. unk.)	3	Delayed union of osteotomy site	3
Osteo(chondral) allograft transplantation therapies^a	DVT	27	Delayed union of osteotomy site	20	Plantar fasciitis	13	Arthrofibrosis	7	Cellulitis	7
Metal implants	Nerve injury (dur. unk.)	50	Wound dehiscence	25	Superficial infection	17	DVT	8	N/A
Other	N/A		N/A		N/A		N/A		N/A

Rates are the proportions from the total amount complications per treatment option. DVT = deep venous thrombosis; N/A = not applicable; dur. unk. = duration unknown.

Nerve injury (duration unknown) and non-union both also have rates of 7% in this treatment option.

Discussion

The main finding of the present study is that there is a 5% risk of a complication with surgical treatment of an OLT. Significant differences between treatment modalities exist, with metal implants having a significantly higher complication rate than BMS therapies, retrograde drilling, fixation, matrix-assisted BMS, and cartilage implantation. BMS therapies have a significantly lower complication than osteo(chondral) autograft transplantation therapies, and it has also been shown that matrix-assisted BMS results in significantly lower complication rates than osteo(chondral) autograft- and allograft transplantation therapies.

Primary Outcome

There are multiple factors reported in the literature that affect the complication rate of OLT surgeries, such as operative time and the experience of the surgeon.^207,208 The latter is of interest in the context of the present study as ankle arthroscopy is regarded as a challenging procedure.²⁰⁹ Accordingly, this is of importance regarding the possible complications, considering damaging the peroneal nerve near the lateral portal in anterior ankle arthroscopy.^210,211

Metal implants have a significantly higher complication rate compared with retrograde drilling, fixation, matrix-assisted BMS, and cartilage implantation. This may be due to several reasons. First, for the implantation of a metal implant, an open procedure with an osteotomy is often needed. This primarily, already, introduces a higher risk for potential infections, nerve injury, and other types of complications. This is because a longer incision is often needed which could damage nerve branches and introduce a greater porte d’entrée. This clarifies why in the analysis of the type of complications, the present study also found nerve damage and superficial infections to be more frequent in metal implants. Second, implantation of a metal resurfacing inlay implant may cause degenerative changes to the distal tibia.²⁷ The literature has found rates from 10% to 60%.^16,69 Third, the learning curve of this procedure is fairly long.^69,212 This is due in part to the fact that the depth of the implantation is of importance, due to the deformity of the talar cartilage during load.^213,214 As mentioned above, the experience of a surgeon is of vast importance for the complication rate. Given the potential limited experience with these implants, may cause higher complication rates. In addition, it must be noted that metal implantation often is used as a salvage procedure and that may influence the complication rate. There is, however, an intrinsic relationship between the indication and the treatment technique and the other treatment groups also include a subset of secondary patients.

Secondary Outcomes

The severity of the complications was assessed with the use of the Modified Clavien-Dindo-Sink Complication Classification System for Orthopedic Surgery.³⁰ No Grade IV (a and b) and V complications were found. Grade I, II, and III complications have overall rates of 4%, 3%, and 3%, respectively. No significant difference was found for either grade.

In 5 treatment modalities (i.e., BMS therapies, retrograde drilling, fixation, cartilage implantation, and metal implants), nerve injury (temporary and duration unknown) was the most occurring complication. In the other treatment modalities, superficial infection (matrix-assisted BMS), donor site morbidity (osteo(chondral) autograft transplantation therapies) and DVT (osteo(chondral) allograft transplantation therapies) occurred the most times. All types of complications found in the present study are treatable and not life-threatening. It should be mentioned that the term nerve injury comprises complications from dysesthesia, neuralgia, paraesthesia, and altered sensation.

Defining the Term “Complication”

It is of critical importance in the analysis of complications to determine the definition of the term “complication.” Unfortunately, there is currently no widely accepted uniform definition for this term available, resulting in high heterogeneity in the reporting of complications in the literature. Factors related to the treatment failure were explicitly not considered as complications by the authors. This includes graft-related complications, such as failure to incorporate and reject a graft, as well as issues like persistent pain and no improvement of function. The removal of possible implanted hardware was also not included. Many studies removed screws from an osteotomy (reported rates of 17%-48% in 9 studies) which could also be for reasons other than, for example, irritation over the screw head.^{15,27
-29,83,87,122,133,179} As a result of the high heterogeneity in the definition of a complication, some studies report possible purely radiological findings, such as bone marrow edema and subchondral cyst formation, as a complication.^112,176 These findings were not counted as a complication in the present study, as they may not have any clinical consequences.

To improve this troublesome situation, the present study recommends that a proper definition should be established for complications in the treatment of OLTs. A definition could be drafted on a consensus meeting.

Methodological Considerations

The methodological quality of the included articles can be considered fair, as shown by the MINORS score. Many studies were of a non-comparative design and only 7 randomized controlled trials (RCTs) were included. This may be of influence for the results, as a higher methodological quality is possibly closer to the actual complication rate of procedure. Although it was our intention to perform a sub-analysis on the complication rate and severity of primary OLTs versus non-primary OLTs, it must be stated that this was not possible due to the heterogeneous patient groups and limited reporting.

In the literature search, only articles from 1996 were searched. This filter was applied because the technique of ankle arthroscopy only really emerged since this year. It became more and more normal to use this surgical technique. This is due to technological advances and increased clarity about (the applicability of) the technique.^215
-217

In the methodology of the present study, it was decided not to contact authors of articles in case of any doubt. There are, however, a high number of articles included, and therefore, the authors expect that this will have little impact on the results. In all, 137 studies (46% of the included articles) were excluded for the analysis because the complications were not (clearly) described.

Among the included studies, some were of retrospective nature, which may affect the complication rates. In effect, there may be underreporting due to selection, detection, and recall biases. Therefore, the complication rates found in the present study may be in reality higher. A 2-fold difference has been found in the literature.²¹⁸

Clinical Relevance and Future Perspectives

This study presents the complication rate per treatment option for OLTs and significant differences between treatment modalities. The complication rate and severity, in combination with the clinical efficacy and the costs, are one of the most important factors in the treatment selection. The clinical efficacy has already been recently reviewed, finding no clearly superior treatment for either primary or secondary lesions.^19,20 Thus, to justify the treatment choice, mere complication and cost factors remain. The insight of this study that surgical treatment of OLTs can be considered safe and that there are differences between treatment modalities may be of importance in the consulting room. It can, thus, help clinicians and patients in the evidence-based shared decision-making process and can also manage postoperative expectations of clinicians and patients.

The present study was not able to analyze the surgery duration. This was often not reported and in the case of reporting, then it was not clear. For example, it was often not known to which treatment group it applied and what the start and end points of the measurement were. Surgery duration, however, has been identified as an independent risk factor for postoperative complications in orthopedic surgery.^219
-226 Further research on risk factors, specific for this type of surgery, needs to be done in the future.

Conclusion

In 1 out of 20 patients treated surgically for an OLT, a complication occurs. Metal implants have a significantly higher complication rate than BMS therapies, retrograde drilling, fixation, matrix-assisted BMS, and cartilage implantation. BMS and matrix-assisted BMS have significantly lower complication rates compared with osteo(chondral) autograft transplantation therapies. In addition, matrix-assisted BMS is also significantly lower than osteo(chondral) allograft transplantation therapies. No life-threatening complications were reported. Nerve injuries were the most frequently observed type of complications for BMS therapies, retrograde drilling, fixation, cartilage implantation, and metal implants.

Supplemental Material

sj-docx-1-car-10.1177_19476035231154746 – Supplemental material for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

Supplemental material, sj-docx-1-car-10.1177_19476035231154746 for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions by Julian J. Hollander, Jari Dahmen, Kaj S. Emanuel, Sjoerd A.S. Stufkens, John G. Kennedy and Gino M.M.J. Kerkhoffs in CARTILAGE

Supplemental Material

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Supplemental material, sj-jpg-2-car-10.1177_19476035231154746 for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions by Julian J. Hollander, Jari Dahmen, Kaj S. Emanuel, Sjoerd A.S. Stufkens, John G. Kennedy and Gino M.M.J. Kerkhoffs in CARTILAGE

Supplemental Material

sj-jpg-3-car-10.1177_19476035231154746 – Supplemental material for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

Supplemental material, sj-jpg-3-car-10.1177_19476035231154746 for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions by Julian J. Hollander, Jari Dahmen, Kaj S. Emanuel, Sjoerd A.S. Stufkens, John G. Kennedy and Gino M.M.J. Kerkhoffs in CARTILAGE

Supplemental Material

sj-jpg-4-car-10.1177_19476035231154746 – Supplemental material for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

Supplemental material, sj-jpg-4-car-10.1177_19476035231154746 for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions by Julian J. Hollander, Jari Dahmen, Kaj S. Emanuel, Sjoerd A.S. Stufkens, John G. Kennedy and Gino M.M.J. Kerkhoffs in CARTILAGE

Supplemental Material

sj-jpg-5-car-10.1177_19476035231154746 – Supplemental material for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

Supplemental material, sj-jpg-5-car-10.1177_19476035231154746 for The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions by Julian J. Hollander, Jari Dahmen, Kaj S. Emanuel, Sjoerd A.S. Stufkens, John G. Kennedy and Gino M.M.J. Kerkhoffs in CARTILAGE

Footnotes

Supplementary material for this article is available on the Cartilage website at .

Author Contributions

J.J. Hollander, J. Dahmen, and K.S. Emanuel have made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data, and have been involved in drafting the manuscript. J.J. Hollander, J. Dahmen, K.S. Emanuel, S.A.S. Stufkens, J.G. Kennedy, and G.M.M.J. Kerkhoffs have been involved in revising the manuscript, critically for important intellectual content, and have given final approval of the version to be published.

Acknowledgments and Funding

The authors would like to thank F. van Etten-Jamaludin of the AMC Medical Library for her help with the literature search. The author(s) received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

Not applicable.

Informed Consent

Not applicable.

ORCID iDs

Julian J. Hollander

Jari Dahmen

References

Blom

Mol

van Ruijven

Kerkhoffs

Smit

. A single axial impact load causes articular damage that is not visible with micro-computed tomography: an ex vivo study on caprine tibiotalar joints. Cartilage. 2021 Sep 20;13:1490S-1500S. doi:10.1177/1947603519876353.

Martijn

Lambers

KTA

Dahmen

Stufkens

SAS

Kerkhoffs

. High incidence of (osteo)chondral lesions in ankle fractures. Knee Surg Sports Traumatol Arthrosc. 2021 May;29(5):1523-34. doi:10.1007/s00167-020-06187-y.

D’Ambrosi

Maccario

Serra

Ursino

Usuelli

. Relationship between symptomatic osteochondral lesions of the talus and quality of life, body mass index, age, size and anatomic location. Foot Ankle Surg. 2018 Aug;24(4):365-72. doi:10.1016/j.fas.2017.04.011.

Seo

Kim

Seo

Kim

Lee

. Osteochondral lesions of the talus. Acta Orthop. 2018 Aug;89(4):462-7. doi:10.1080/17453674.2018.1460777.

Akpancar

Gül

. Comparison of platelet rich plasma and prolotherapy in the management of osteochondral lesions of the talus: a retrospective cohort study. Med Sci Monit. 2019 Jul 30;25:5640-7. doi:10.12659/msm.914111.

Klammer

Maquieira

Spahn

Vigfusson

Zanetti

Espinosa

. Natural history of nonoperatively treated osteochondral lesions of the talus. Foot Ankle Int. 2015 Jan;36(1):24-31. doi:10.1177/1071100714552480.

Mei-Dan

Carmont

Laver

Mann

Maffulli

Nyska

. Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med. 2012 Mar;40(3):534-41. doi:10.1177/0363546511431238.

Shearer

Loomer

Clement

. Nonoperatively managed stage 5 osteochondral talar lesions. Foot Ankle Int. 2002 Jul;23(7):651-4. doi:10.1177/107110070202300712.

Rikken

QGH

Kerkhoffs

. Osteochondral lesions of the talus: an individualized treatment paradigm from the Amsterdam perspective. Foot Ankle Clin. 2021 Mar;26(1):121-36. doi:10.1016/j.fcl.2020.10.002.

10.

Yasui

Ramponi

Seow

Hurley

Miyamoto

Shimozono

, et al. Systematic review of bone marrow stimulation for osteochondral lesion of talus—evaluation for level and quality of clinical studies. World J Orthop. 2017 Dec 18;8(12):956-63. doi:10.5312/wjo.v8.i12.956.

11.

Hyer

Berlet

Philbin

Lee

. Retrograde drilling of osteochondral lesions of the talus. Foot Ankle Spec. 2008 Aug;1(4):207-9. doi:10.1177/1938640008321653.

12.

Kerkhoffs

GMMJ

Reilingh

Gerards

de Leeuw

. Lift, drill, fill and fix (LDFF): a new arthroscopic treatment for talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1265-71. doi:10.1007/s00167-014-3057-7.

13.

D'Ambrosi

Villafañe

Indino

Liuni

Berjano

Usuelli

. Return to sport after arthroscopic autologous matrix-induced chondrogenesis for patients with osteochondral lesion of the talus. Clin J Sport Med. 2019 Nov;29(6):470-5. doi:10.1097/jsm.0000000000000560.

14.

Giannini

Buda

Ruffilli

Cavallo

Pagliazzi

Bulzamini

, et al. Arthroscopic autologous chondrocyte implantation in the ankle joint. Knee Surg Sports Traumatol Arthrosc. 2014 Jun;22(6):1311-9. doi:10.1007/s00167-013-2640-7.

15.

Kerkhoffs

GMMJ

Altink

Stufkens

SAS

Dahmen

. Osteoperiostale Beckenkammtransplantation (TOPIC) für große Defekte der medialen Talusrolle: Operationstechnik [Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for large medial talar osteochondral defects: operative technique]. Oper Orthop Traumatol. 2021 Apr;33(2):160-9. doi:10.1007/s00064-020-00673-9.

16.

van Bergen

van Eekeren

Reilingh

Sierevelt

van Dijk

. Treatment of osteochondral defects of the talus with a metal resurfacing inlay implant after failed previous surgery: a prospective study. Bone Joint J. 2013 Dec;95-b(12):1650-5. doi:10.1302/0301-620x.95b12.32455.

17.

Adams

Jr Viens

Easley

Stinnett

Nunley

II . Midterm results of osteochondral lesions of the talar shoulder treated with fresh osteochondral allograft transplantation. J Bone Joint Surg Am. 2011 Apr 6;93(7):648-54. doi:10.2106/jbjs.J.00141.

18.

Charles

Gafni

Whelan

. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997 Mar;44(5):681-92. doi:10.1016/s0277-9536(96)00221-3.

19.

Dahmen

Lambers

KTA

Reilingh

van Bergen

CJA

Stufkens

SAS

Kerkhoffs

. No superior treatment for primary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2142-57. doi:10.1007/s00167-017-4616-5.

20.

Lambers

KTA

Dahmen

Reilingh

van Bergen

CJA

Stufkens

SAS

Kerkhoffs

. No superior surgical treatment for secondary osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2158-70. doi:10.1007/s00167-017-4629-0.

21.

Chien

Khan

Siassakos

. Registration of systematic reviews: PROSPERO. Bjog. 2012 Jul;119(8):903-5. doi:10.1111/j.1471-0528.2011.03242.x.

22.

Liberati

Altman

Tetzlaff

Mulrow

Gøtzsche

Ioannidis

, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009 Jul 21;339:b2700. doi:10.1136/bmj.b2700.

23.

Ouzzani

Hammady

Fedorowicz

Elmagarmid

. Rayyan—a web and mobile app for systematic reviews. Syst Rev. 2016;5(1):210. doi:10.1186/s13643-016-0384-4.

24.

Slim

Nini

Forestier

Kwiatkowski

Panis

Chipponi

. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003 Sep;73(9):712-6. doi:10.1046/j.1445-2197.2003.02748.x.

25.

Sokol

Wilson

. What is a surgical complication? World J Surg. 2008 Jun;32(6):942-4. doi:10.1007/s00268-008-9471-6.

26.

Looney

Fackler

Pianka

Bodendorfer

Fryar

Conroy

, et al. No difference in complications between elbow ulnar collateral ligament reconstruction with the docking and modified Jobe techniques: a systematic review and meta-analysis. Am J Sports Med. 2022 Sep 7;50:2324-38. doi:10.1177/03635465211023952.

27.

Ebskov

Hegnet Andersen

Bro Rasmussen

Johansen

Benyahia

. Mid-term results after treatment of complex talus osteochondral defects with HemiCAP implantation. Foot Ankle Surg. 2020 Jun;26(4):384-90. doi:10.1016/j.fas.2019.05.003.

28.

Vuurberg

Reilingh

van Bergen

CJA

van Eekeren

ICM

Gerards

van Dijk

. Metal resurfacing inlay implant for osteochondral talar defects after failed previous surgery: a midterm prospective follow-up study. Am J Sports Med. 2018 Jun;46(7):1685-92. doi:10.1177/0363546518764916.

29.

Weigelt

Hartmann

Pfirrmann

Espinosa

Wirth

. Autologous matrix-induced chondrogenesis for osteochondral lesions of the talus: a clinical and radiological 2- to 8-year follow-up study. Am J Sports Med. 2019 Jun;47(7):1679-86. doi:10.1177/0363546519841574.

30.

Dodwell

Pathy

Widmann

Green

Scher

Blanco

, et al. Reliability of the modified Clavien-Dindo-sink complication classification system in pediatric orthopaedic surgery. JB JS Open Access. 2018 Dec 20;3(4):e0020. doi:10.2106/jbjs.Oa.18.00020.

31.

DerSimonian

Laird

. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177-88. doi:10.1016/0197-2456(86)90046-2.

32.

Jackson

Bowden

. Confidence intervals for the between-study variance in random-effects meta-analysis using generalised heterogeneity statistics: should we use unequal tails? BMC Med Res Methodol. 2016;16(1):118. doi:10.1186/s12874-016-0219-y.

33.

Clopper

Pearson

. The use of confidence or fiducial limits illustrated in the case of the binomial. Biometrika. 1934;26(4):404-13. doi:10.1093/biomet/26.4.404.

34.

Dusseldorp

Meulman

. Multiple moderator meta-analysis using the R-package meta-CART. Behav Res Methods. 2020 Dec;52(6):2657-73. doi:10.3758/s13428-020-01360-0.

35.

Balduzzi

Rücker

Schwarzer

. How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health. 2019 Nov;22(4):153-60. doi:10.1136/ebmental-2019-300117.

36.

Assenmacher

Kelikian

Gottlob

Kodros

. Arthroscopically assisted autologous osteochondral transplantation for osteochondral lesions of the talar dome: an MRI and clinical follow-up study. Foot Ankle Int. 2001 Jul;22(7):544-51. doi:10.1177/107110070102200703.

37.

Ahmad

Maltenfort

. Arthroscopic treatment of osteochondral lesions of the talus with allograft cartilage matrix. Foot Ankle Int. 2017 Aug;38(8):855-62. doi:10.1177/1071100717709571.

38.

Akmeşe

Ertan

Kocaoğlu

. Comparison of chitosan-based liquid scaffold and hyaluronic acid-based soft scaffold for treatment of talus osteochondral lesions. Foot Ankle Int. 2020 Oct;41(10):1240-8. doi:10.1177/1071100720937662.

39.

Al-Shaikh

Chou

Mann

Dreeben

Prieskorn

. Autologous osteochondral grafting for talar cartilage defects. Foot Ankle Int. 2002 May;23(5):381-9. doi:10.1177/107110070202300502.

40.

Albano

Martinelli

Bianchi

Messina

Malerba

Sconfienza

. Clinical and imaging outcome of osteochondral lesions of the talus treated using autologous matrix-induced chondrogenesis technique with a biomimetic scaffold. BMC Musculoskelet Disord. 2017 Jul 18;18(1):306. doi:10.1186/s12891-017-1679-x.

41.

Anders

Goetz

Schubert

Grifka

Schaumburger

. Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation—results at five years. Int Orthop. 2012 Nov;36(11):2279-85. doi:10.1007/s00264-012-1635-1.

42.

Anders

Lechler

Rackl

Grifka

Schaumburger

. Fluoroscopy-guided retrograde core drilling and cancellous bone grafting in osteochondral defects of the talus. Int Orthop. 2012 Aug;36(8):1635-40. doi:10.1007/s00264-012-1530-9.

43.

Angthong

Yoshimura

Kanazawa

Takeyama

Hagio

Ida

, et al. Critical three-dimensional factors affecting outcome in osteochondral lesion of the talus. Knee Surg Sports Traumatol Arthrosc. 2013 Jun;21(6):1418-26. doi:10.1007/s00167-013-2364-8.

44.

Arauz

JMY

Del Vecchio

Bilbao

Raimondi

. Osteochondral lesions of the talus treatment with fresh frozen allograft. Foot Ankle Surg. 2017 Dec;23(4):296-301. doi:10.1016/j.fas.2016.09.002.

45.

Aurich

Bedi

Smith

Rolauffs

Mückley

Clayton

, et al. Arthroscopic treatment of osteochondral lesions of the ankle with matrix-associated chondrocyte implantation: early clinical and magnetic resonance imaging results. Am J Sports Med. 2011 Feb;39(2):311-9. doi:10.1177/0363546510381575.

46.

Bai

Guan

Liu

You

Xie

Chen

, et al. Clinical outcomes of osteochondral lesions of the talus with large subchondral cysts treated with osteotomy and autologous chondral grafts: minimum 2-year follow-up and second-look evaluation. Orthop J Sports Med. 2020 Jul;8(7):2325967120937798. doi:10.1177/2325967120937798.

47.

Basal

Aslan

. A triplanar osteotomy technique in arthroscopy-assisted ankle mosaicplasty. J Orthop Surg (Hong Kong). 2020 Jan-Apr;28(1):2309499020905054. doi:10.1177/2309499020905054.

48.

Battaglia

Rimondi

Monti

Guaraldi

Sant’Andrea

Buda

, et al. Validity of T2 mapping in characterization of the regeneration tissue by bone marrow derived cell transplantation in osteochondral lesions of the ankle. Eur J Radiol. 2011 Nov;80(2):e132-9. doi:10.1016/j.ejrad.2010.08.008.

49.

Baumfeld

Prado

Nery

. All-arthroscopic AMIC(®) (AT-AMIC) for the treatment of talar osteochondral defects: a short follow-up case series. Foot (Edinb). 2018 Dec;37:23-7. doi:10.1016/j.foot.2018.07.006.

50.

Baumgartner

Wagner

Bösch

. Therapie der Osteochondrosis dissecans tali mittels Mosaikplastik. Fuss. 2006;4(4):247-55. doi:10.1007/s10302-006-0168-6.

51.

Baums

Heidrich

Schultz

Steckel

Kahl

Klinger

. Autologous chondrocyte transplantation for treating cartilage defects of the talus. J Bone Joint Surg Am. 2006 Feb;88(2):303-8. doi:10.2106/jbjs.E.00033.

52.

Becher

Thermann

. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int. 2005 Aug;26(8):583-9. doi:10.1177/107110070502600801.

53.

Beck

Claßen

Haversath

Jäger

Landgraeber

. Operative technique and clinical outcome in endoscopic core decompression of osteochondral lesions of the talus: a pilot study. Med Sci Monit. 2016 Jun 30;22:2278-83. doi:10.12659/msm.896522.

54.

Berlet

Hyer

Philbin

Hartman

Wright

. Does fresh osteochondral allograft transplantation of talar osteochondral defects improve function? Clin Orthop Relat Res. 2011 Aug;469(8):2356-66. doi:10.1007/s11999-011-1813-2.

55.

Bleazey

Brigido

. Reconstruction of complex osteochondral lesions of the talus with cylindrical sponge allograft and particulate juvenile cartilage graft: provisional results with a short-term follow-up. Foot Ankle Spec. 2012 Oct;5(5):300-5. doi:10.1177/1938640012457937.

56.

Bohnsack

Fischer

Lipka

Schmolke

Börner

Wirth

, et al. The influence of limited postoperative weight-bearing on the outcome of drilling in osteochondritis dissecans tali. Arch Orthop Trauma Surg. 2003 Nov;123(9):447-50. doi:10.1007/s00402-003-0550-8.

57.

Brigido

Protzman

Galli

Bleazey

. The role of demineralized allograft subchondral bone in the treatment of talar cystic OCD lesions that have failed microfracture. Foot Ankle Spec. 2014 Oct;7(5):377-86. doi:10.1177/1938640014531984.

58.

Buda

Vannini

Cavallo

Baldassarri

Natali

Castagnini

, et al. One-step bone marrow-derived cell transplantation in talar osteochondral lesions: mid-term results. Joints. 2013 Jul-Sep;1(3):102-7.

59.

Carlson

Antkowiak

Larsen

Applegate

Ferkel

. Arthroscopic treatment of osteochondral lesions of the talus in a pediatric population: a minimum 2-year follow-up. Am J Sports Med. 2020 Jul;48(8):1989-98. doi:10.1177/0363546520924800.

60.

Chen

Tang

Yuan

Zhou

Tao

. Intermediate results of large cystic medial osteochondral lesions of the talus treated with osteoperiosteal cylinder autografts from the medial tibia. Arthroscopy. 2015 Aug;31(8):1557-64. doi:10.1016/j.arthro.2015.02.027.

61.

Chuckpaiwong

Berkson

Theodore

. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy. 2008 Jan;24(1):106-12. doi:10.1016/j.arthro.2007.07.022.

62.

Cuttica

Smith

Hyer

Philbin

Berlet

. Osteochondral lesions of the talus: predictors of clinical outcome. Foot Ankle Int. 2011 Nov;32(11):1045-51. doi:10.3113/fai.2011.1045.

63.

de Lima

de Queiroz

Lopes

Jr Spinelli

LDF

. Treatment of osteochondral lesions of the talus by means of thearthroscopy-assisted microperforation technique. Rev Bras Ortop. 2011 Nov-Dec;46(6):702-8. doi:10.1016/s2255-4971(15)30328-1.

64.

DeSandis

Haleem

Sofka

O’Malley

Drakos

. Arthroscopic treatment of osteochondral lesions of the talus using juvenile articular cartilage allograft and autologous bone marrow aspirate concentration. J Foot Ankle Surg. 2018 Mar-Apr;57(2):273-80. doi:10.1053/j.jfas.2017.09.009.

65.

Di Cave

Versari

Sciarretta

Luzon

Marcellini

. Biphasic bioresorbable scaffold (TruFit Plug(®)) for the treatment of osteochondral lesions of talus: 6- to 8-year follow-up. Foot (Edinb). 2017 Dec;33:48-52. doi:10.1016/j.foot.2017.05.005.

66.

Doral

Bilge

Batmaz

Donmez

Turhan

Demirel

, et al. Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc. 2012 Jul;20(7):1398-403. doi:10.1007/s00167-011-1856-7.

67.

El-Rashidy

Villacis

Omar

Kelikian

. Fresh osteochondral allograft for the treatment of cartilage defects of the talus: a retrospective review. J Bone Joint Surg Am. 2011 Sep 7;93(17):1634-40. doi:10.2106/jbjs.J.00900.

68.

Emre

Ege

Cift

Demircioğlu

Seyhan

Uzun

. Open mosaicplasty in osteochondral lesions of the talus: a prospective study. J Foot Ankle Surg. 2012 Sep-Oct;51(5):556-60. doi:10.1053/j.jfas.2012.05.006.

69.

Ettinger

Stukenborg-Colsman

Waizy

Becher

Yao

Claassen

, et al. Results of HemiCAP(®) implantation as a salvage procedure for osteochondral lesions of the talus. J Foot Ankle Surg. 2017 Jul-Aug;56(4):788-92. doi:10.1053/j.jfas.2017.04.001.

70.

Flynn

Ross

Hannon

Yasui

Newman

Murawski

, et al. Autologous osteochondral transplantation for osteochondral lesions of the talus. Foot Ankle Int. 2016 Apr;37(4):363-72. doi:10.1177/1071100715620423.

71.

Fraser

Harris

Prado

Kennedy

. Autologous osteochondral transplantation for osteochondral lesions of the talus in an athletic population. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1272-9. doi:10.1007/s00167-015-3606-8.

72.

Galla

Duensing

Kahn

Barg

. Open reconstruction with autologous spongiosa grafts and matrix-induced chondrogenesis for osteochondral lesions of the talus can be performed without medial malleolar osteotomy. Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):2789-95. doi:10.1007/s00167-018-5063-7.

73.

Galli

Protzman

Bleazey

Brigido

. Role of demineralized allograft subchondral bone in the treatment of shoulder lesions of the talus: clinical results with two-year follow-up. J Foot Ankle Surg. 2015 Jul-Aug;54(4):717-22. doi:10.1053/j.jfas.2014.05.008.

74.

Gautier

Kolker

Jakob

. Treatment of cartilage defects of the talus by autologous osteochondral grafts. J Bone Joint Surg Br. 2002 Mar;84(2):237-44. doi:10.1302/0301-620x.84b2.11735.

75.

Georgiannos

Bisbinas

Badekas

. Osteochondral transplantation of autologous graft for the treatment of osteochondral lesions of talus: 5- to 7-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2016 Dec;24(12):3722-9. doi:10.1007/s00167-014-3389-3.

76.

Giannini

Battaglia

Buda

Cavallo

Ruffilli

Vannini

. Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10-year follow-up clinical and magnetic resonance imaging T2-mapping evaluation. Am J Sports Med. 2009 Nov;37(Suppl 1):112S-118S. doi:10.1177/0363546509349928.

77.

Giannini

Buda

Battaglia

Cavallo

Ruffilli

Ramponi

, et al. One-step repair in talar osteochondral lesions: 4-year clinical results and T2-mapping capability in outcome prediction. Am J Sports Med. 2013 Mar;41(3):511-8. doi:10.1177/0363546512467622.

78.

Giannini

Buda

Grigolo

Vannini

. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int. 2001 Jun;22(6):513-7. doi:10.1177/107110070102200612.

79.

Giannini

Buda

Grigolo

Vannini

De Franceschi

Facchini

. The detached osteochondral fragment as a source of cells for autologous chondrocyte implantation (ACI) in the ankle joint. Osteoarthritis Cartilage. 2005 Jul;13(7):601-7. doi:10.1016/j.joca.2005.02.010.

80.

Giannini

Buda

Vannini

Di Caprio

Grigolo

. Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: surgical technique and results. Am J Sports Med. 2008 May;36(5):873-80. doi:10.1177/0363546507312644.

81.

Goh

Bin

Abd

Razak

Mitra

. Outcomes are favorable after arthroscopic treatment of osteochondritis dissecans of the talus. J Foot Ankle Surg. 2015 Jan-Feb;54(1):57-60. doi:10.1053/j.jfas.2014.09.025.

82.

Shi

Mei

Xue

Zou

, et al. Management of Hepple stage v osteochondral lesion of the talus with a platelet-rich plasma scaffold. Biomed Res Int. 2017;2017:6525373. doi:10.1155/2017/6525373.

83.

Gül

Yavuz

Çetinkaya

Aykut

ÜS

Özkul

Kabukçuoğlu

. Chevron osteotomy in patients with scheduled osteotomy of the medial malleolus. Acta Orthop Traumatol Turc. 2015;49(4):399-404. doi:10.3944/aott.2015.14.0186.

84.

Hangody

Kish

Módis

Szerb

Gáspár

Diószegi

, et al. Mosaicplasty for the treatment of osteochondritis dissecans of the talus: two to seven year results in 36 patients. Foot Ankle Int. 2001 Jul;22(7):552-8. doi:10.1177/107110070102200704.

85.

Haraguchi

Shiratsuchi

Ota

Ozeki

Gibu

Niki

. Fixation of the osteochondral talar fragment yields good results regardless of lesion size or chronicity. Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):291-7. doi:10.1007/s00167-019-05716-8.

86.

Heida

Jr Tihista

Kusnezov

Dunn

Orr

. Outcomes and predictors of postoperative pain improvement following particulated juvenile cartilage allograft transplant for osteochondral lesions of the talus. Foot Ankle Int. 2020 May;41(5):572-81. doi:10.1177/1071100720903721.

87.

Hintermann

Wagener

Knupp

Schweizer

C J

Schaefer

. Treatment of extended osteochondral lesions of the talus with a free vascularised bone graft from the medial condyle of the femur. Bone Joint J. 2015 Sep;97-B(9):1242-9. doi:10.1302/0301-620x.97b9.35292.

88.

Guo

Jiao

Mei

Jiang

Wang

, et al. Treatment of large cystic medial osteochondral lesions of the talus with autologous osteoperiosteal cylinder grafts. Arthroscopy. 2013 Aug;29(8):1372-9. doi:10.1016/j.arthro.2013.05.014.

89.

Yue

Zhou

, et al. A novel medial malleolar osteotomy technique for the treatment of osteochondral lesions of the talus. Orthop J Sports Med. 2021 Mar;9(3):2325967121989988. doi:10.1177/2325967121989988.

90.

Imhoff

Paul

Ottinger

Wörtler

Lämmle

Spang

, et al. Osteochondral transplantation of the talus: long-term clinical and magnetic resonance imaging evaluation. Am J Sports Med. 2011 Jul;39(7):1487-93. doi:10.1177/0363546510397726.

91.

Jackson

Drayer

Samona

Dukes

Chen

Arrington

, et al. Osteochondral allograft transplantation surgery for osteochondral lesions of the talus in athletes. J Foot Ankle Surg. 2019 Jul;58(4):623-7. doi:10.1053/j.jfas.2018.11.020.

92.

Jung

Carag

Park

Kim

Moon

. Role of arthroscopic microfracture for cystic type osteochondral lesions of the talus with radiographic enhanced MRI support. Knee Surg Sports Traumatol Arthrosc. 2011 May;19(5):858-62. doi:10.1007/s00167-011-1411-6.

93.

Jurina

Dimnjaković

Mustapić

Smoljanović

Bojanić

. Clinical and MRI outcomes after surgical treatment of osteochondral lesions of the talus in skeletally immature children. J Pediatr Orthop. 2018 Feb;38(2):122-7. doi:10.1097/bpo.0000000000000745.

94.

Kanatlı

Eren

Vural

Geylan

Öner

. Single-step arthroscopic repair with cell-free polymer-based scaffold in osteochondral lesions of the talus: clinical and radiological results. Arthroscopy. 2017 Sep;33(9):1718-26. doi:10.1016/j.arthro.2017.06.011.

95.

Kennedy

Murawski

. The treatment of osteochondral lesions of the talus with autologous osteochondral transplantation and bone marrow aspirate concentrate: surgical technique. Cartilage. 2011 Oct;2(4):327-36. doi:10.1177/1947603511400726.

96.

Kim

Haskell

. Patient-reported outcomes after structural autograft for large or cystic talar dome osteochondral lesions. Foot Ankle Int. 2020 May;41(5):549-55. doi:10.1177/1071100720907313.

97.

Kolker

Murray

Wilson

. Osteochondral defects of the talus treated with autologous bone grafting. J Bone Joint Surg Br. 2004 May;86(4):521-6.

98.

Körner

Gonser

Döbele

Konrads

Springer

Keller

. Matrix-associated autologous chondrocyte implantation with autologous bone grafting of osteochondral lesions of the talus in adolescents: patient-reported outcomes with a median follow-up of 6 years. J Orthop Surg Res. 2021 Apr 8;16(1):243. doi:10.1186/s13018-021-02384-8.

99.

Koulalis

Schultz

Heyden

. Autologous chondrocyte transplantation for osteochondritis dissecans of the talus. Clin Orthop Relat Res. 2002 Feb;395:186-92. doi:10.1097/00003086-200202000-00021.

100.

Kreuz

Steinwachs

Edlich

Kaiser

Mika

Lahm

, et al. The anterior approach for the treatment of posterior osteochondral lesions of the talus: comparison of different surgical techniques. Arch Orthop Trauma Surg. 2006 May;126(4):241-6. doi:10.1007/s00402-005-0058-5.

101.

Kubosch

Erdle

Izadpanah

Kubosch

Uhl

Südkamp

, et al. Clinical outcome and T2 assessment following autologous matrix-induced chondrogenesis in osteochondral lesions of the talus. Int Orthop. 2016 Jan;40(1):65-71. doi:10.1007/s00264-015-2988-z.

102.

Kumai

Takakura

Kitada

Tanaka

Hayashi

. Fixation of osteochondral lesions of the talus using cortical bone pegs. J Bone Joint Surg Br. 2002 Apr;84(3):369-74. doi:10.1302/0301-620x.84b3.12373.

103.

Kwak

Kern

Ferkel

Chan

Kasraeian

Applegate

. Autologous chondrocyte implantation of the ankle: 2- to 10-year results. Am J Sports Med. 2014 Sep;42(9):2156-64. doi:10.1177/0363546514540587.

104.

Lambers

KTA

Dahmen

Reilingh

van Bergen

CJA

Stufkens

SAS

Kerkhoffs

. Arthroscopic lift, drill, fill and fix (LDFF) is an effective treatment option for primary talar osteochondral defects. Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):141-7. doi:10.1007/s00167-019-05687-w.

105.

Largey

Faure

Hebrard

Hamoui

Canovas

. Osteochondral transfer using a transmalleolar approach for arthroscopic management of talus posteromedial lesions. Orthop Traumatol Surg Res. 2009 Nov;95(7):537-42. doi:10.1016/j.otsr.2009.06.005.

106.

Lee

Yang

Moon

Song

. Modified step-cut medial malleolar osteotomy for osteochondral grafting of the talus. Foot Ankle Int. 2008 Nov;29(11):1107-10. doi:10.3113/fai.2008.1107.

107.

Lee

Kim

Young

Lee

Park

Kim

, et al. The use of fibrin matrix-mixed gel-type autologous chondrocyte implantation in the treatment for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2013 Jun;21(6):1251-60. doi:10.1007/s00167-012-2096-1.

108.

Leumann

Valderrabano

Wiewiorski

Barg

Hintermann

Pagenstert

. Bony periosteum-covered iliac crest plug transplantation for severe osteochondral lesions of the talus: a modified mosaicplasty procedure. Knee Surg Sports Traumatol Arthrosc. 2014 Jun;22(6):1304-10. doi:10.1007/s00167-013-2604-y.

109.

Liu

Wang

Liu

. Clinical outcomes of early weight-bearing after arthroscopic microfracture during the treatment of osteochondral lesions of the talus. Chin Med J (Engl). 2014;127(13):2470-4.

110.

Zhang

Tao

Hua

. Outcomes of arthroscopic bone graft transplantation for Hepple stage V osteochondral lesions of the talus. Ann Transl Med. 2021 May;9(10):884. doi:10.21037/atm-21-2006.

111.

Lin

Andersen

Juliano

. Effectiveness of composite bone graft substitute plugs in the treatment of chondral and osteochondral lesions of the talus. J Foot Ankle Surg. 2010 May-Jun;49(3):224-31. doi:10.1053/j.jfas.2010.02.008.

112.

López-Alcorocho

Guillén-Vicente

Rodríguez-Iñigo

Navarro

Caballero-Santos

Guillén-Vicente

, et al. High-density autologous chondrocyte implantation as treatment for ankle osteochondral defects. Cartilage. 2021 Jul;12(3):307-19. doi:10.1177/1947603519835898.

113.

Lundeen

Dunaway

. Immediate unrestricted postoperative weightbearing and mobilization after bone marrow stimulation of large osteochondral lesions of the talus. Cartilage. 2017 Jan;8(1):73-9. doi:10.1177/1947603516657639.

114.

Magnan

Samaila

Bondi

Vecchini

Micheloni

Bartolozzi

. Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results. Adv Orthop. 2012;2012:942174. doi:10.1155/2012/942174.

115.

Manzi

Arzani

Hamula

Manchanda

Dhanaraj

Chapman

. Long-term patient-reported outcome measures following particulated juvenile allograft cartilage implantation for treatment of difficult osteochondral lesions of the talus. Foot Ankle Int. 2021 Jun 11;42:1399-409. doi:10.1177/10711007211014173.

116.

Masquijo

Ferreyra

Baroni

. Arthroscopic retrograde drilling in juvenile osteochondritis dissecans of the talus. J Pediatr Orthop. 2016 Sep;36(6):589-93. doi:10.1097/bpo.0000000000000498.

117.

Ming

Tay Keng Jin

Amit Kanta

. Arthroscopic treatment of osteochondritis dissecans of the talus. Foot and Ankle Surgery. 2004;10(4):181-6. doi:10.1016/j.fas.2004.07.009.

118.

Minokawa

Yoshimura

Kanazawa

Hagio

Nagatomo

Sugino

, et al. Retrograde drilling for osteochondral lesions of the talus in skeletally immature children. Foot Ankle Int. 2020 Jul;41(7):827-33. doi:10.1177/1071100720920847.

119.

Nakasa

Ikuta

Ota

Kanemitsu

Adachi

. Clinical results of bioabsorbable pin fixation relative to the bone condition for osteochondral lesion of the talus. Foot Ankle Int. 2019 Dec;40(12):1388-96. doi:10.1177/1071100719868726.

120.

Nguyen

Ramasamy

Walsh

McMenemy

Calder

JDF

. Autologous osteochondral transplantation for large osteochondral lesions of the talus is a viable option in an athletic population. Am J Sports Med. 2019 Dec;47(14):3429-35. doi:10.1177/0363546519881420.

121.

Ogilvie-Harris

Sarrosa

. Arthroscopic treatment of osteochondritis dissecans of the talus. Arthroscopy. 1999 Nov-Dec;15(8):805-8. doi:10.1053/ar.1999.v15.0150801.

122.

Orr

Dunn

Heida

Jr Kusnezov

Waterman

Belmont

Jr . Results and functional outcomes of structural fresh osteochondral allograft transfer for treatment of osteochondral lesions of the talus in a highly active population. Foot Ankle Spec. 2017 Apr;10(2):125-32. doi:10.1177/1938640016666924.

123.

Pagliazzi

Baldassarri

Perazzo

Vannini

Castagnini

Buda

. Tissue bioengineering in the treatment of osteochondritis dissecans of the talus in children with open physis: preliminary results. J Pediatr Orthop. 2018 Aug;38(7):375-81. doi:10.1097/bpo.0000000000000827.

124.

Pagliazzi

Vannini

Battaglia

Ramponi

Buda

. Autologous chondrocyte implantation for talar osteochondral lesions: comparison between 5-year follow-up magnetic resonance imaging findings and 7-year follow-up clinical results. J Foot Ankle Surg. 2018 Mar-Apr;57(2):221-5. doi:10.1053/j.jfas.2017.05.013.

125.

Park

Cho

Han

Lee

. Bone marrow stimulation for osteochondral lesions of the talus: are clinical outcomes maintained 10 years later? Am J Sports Med. 2021 Apr;49(5):1220-6. doi:10.1177/0363546521992471.

126.

Paul

Sagstetter

Kriner

Imhoff

Spang

Hinterwimmer

. Donor-site morbidity after osteochondral autologous transplantation for lesions of the talus. J Bone Joint Surg Am. 2009 Jul;91(7):1683-8. doi:10.2106/jbjs.H.00429.

127.

Penner

Younger

Wing

Cresswell

Veljkovic

. Arthroscopic repair of talar osteochondral defects with umbilical cord allograft: a prospective, single-center, pilot study. Foot Ankle Spec. 2021 Jun;14(3):193-200. doi:10.1177/1938640020910953.

128.

Petersen

Taheri

Schliemann

Achtnich

Winter

Forkel

. Osteochondral transplantation for the treatment of osteochondral defects at the talus with the Diamond twin system(®) and graft harvesting from the posterior femoral condyles. Arch Orthop Trauma Surg. 2014 Jun;134(6):843-52. doi:10.1007/s00402-014-1991-y.

129.

Sabaghzadeh

Mirzaee

Shahriari Rad

Bahramian

Alidousti

Aslani

. Osteochondral autograft transfer (mosaicplasty) for treatment of patients with osteochondral lesions of talus. Chin J Traumatol. 2020 Feb;23(1):60-2. doi:10.1016/j.cjtee.2019.12.001.

130.

Sadlik

Blasiak

Barg

Valderrabano

Wiewiorski

. Dry arthroscopy with a retraction system for matrix-aided cartilage repair of osteochondral lesions of the talus. Foot Ankle Int. 2015 Mar;36(3):339-43. doi:10.1177/1071100714557521.

131.

El Sallakh

. Arthroscopic debridement and microfracture for osteochondral lesions of the talus. Curr Orthop Pract. 2012;23(2):116-21. doi:10.1097/BCO.0b013e318247c2fb.

132.

Sammarco

Makwana

. Treatment of talar osteochondral lesions using local osteochondral graft. Foot Ankle Int. 2002 Aug;23(8):693-8. doi:10.1177/107110070202300803.

133.

Schneider

Karaikudi

. Matrix-induced autologous chondrocyte implantation (MACI) grafting for osteochondral lesions of the talus. Foot Ankle Int. 2009 Sep;30(9):810-4. doi:10.3113/fai.2009.0810.

134.

Schuh

Salminen

Zeiler

Schraml

. Ergebnisse der Refixation der Osteochondrosis Dissecans des Talus mit Kirschnerdrähten [Results of fixation of osteochondral lesions of the talus using K-wires]. Zentralbl Chir. 2004 Dec;129(6):470-5. doi:10.1055/s-2004-832393.

135.

Schuman

Struijs

van Dijk

. Arthroscopic treatment for osteochondral defects of the talus. Results at follow-up at 2 to 11 years. J Bone Joint Surg Br. 2002 Apr;84(3):364-8. doi:10.1302/0301-620x.84b3.11723.

136.

Scranton

Jr Frey

Feder

. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br. 2006 May;88(5):614-9. doi:10.1302/0301-620x.88b5.17306.

137.

Taranow

Bisignani

Towers

Conti

. Retrograde drilling of osteochondral lesions of the medial talar dome. Foot Ankle Int. 1999 Aug;20(8):474-80. doi:10.1177/107110079902000802.

138.

Tosun

. Posteromedial approach for osteochondral lesions of the talus. Foot Ankle Int. 2021 Jan;42(1):17-22. doi:10.1177/1071100720948842.

139.

Usuelli

D’Ambrosi

Maccario

Boga

de Girolamo

. All-arthroscopic AMIC(®) (AT-AMIC(®)) technique with autologous bone graft for talar osteochondral defects: clinical and radiological results. Knee Surg Sports Traumatol Arthrosc. 2018 Mar;26(3):875-81. doi:10.1007/s00167-016-4318-4.

140.

Valderrabano

Miska

Leumann

Wiewiorski

. Reconstruction of osteochondral lesions of the talus with autologous spongiosa grafts and autologous matrix-induced chondrogenesis. Am J Sports Med. 2013 Mar;41(3):519-27. doi:10.1177/0363546513476671.

141.

van Bergen

Kox

Maas

Sierevelt

Kerkhoffs

van Dijk

. Arthroscopic treatment of osteochondral defects of the talus: outcomes at eight to twenty years of follow-up. J Bone Joint Surg Am. 2013 Mar 20;95(6):519-25. doi:10.2106/jbjs.L.00675.

142.

Vannini

Cavallo

Ramponi

Castagnini

Massimi

Giannini

, et al. Return to sports after bone marrow-derived cell transplantation for osteochondral lesions of the talus. Cartilage. 2017 Jan;8(1):80-7. doi:10.1177/1947603516642574.

143.

Ventura

Terzaghi

Legnani

Borgo

. Treatment of post-traumatic osteochondral lesions of the talus: a four-step approach. Knee Surg Sports Traumatol Arthrosc. 2013 Jun;21(6):1245-50. doi:10.1007/s00167-012-2028-0.

144.

Volpi

Bait

Quaglia

Redaelli

Prospero

Cervellin

, et al. Autologous collagen-induced chondrogenesis technique (ACIC) for the treatment of chondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2014 Jun;22(6):1320-6. doi:10.1007/s00167-013-2830-3.

145.

Walther

Altenberger

Kriegelstein

Volkering

Röser

. Reconstruction of focal cartilage defects in the talus with miniarthrotomy and collagen matrix. Oper Orthop Traumatol. 2014 Dec;26(6):603-10. doi:10.1007/s00064-012-0229-9.

146.

Wang

Kang

Kim

. Arthroscopic treatment of osteochondral lesions of the talus in a suspended position with the patient in a prone position. Foot Ankle Int. 2019 Jul;40(7):811-7. doi:10.1177/1071100719839697.

147.

Whittaker

Smith

Makwana

Roberts

Harrison

Laing

, et al. Early results of autologous chondrocyte implantation in the talus. J Bone Joint Surg Br. 2005 Feb;87(2):179-83. doi:10.1302/0301-620x.87b2.15376.

148.

Woelfle

Reichel

Javaheripour-Otto

Nelitz

. Clinical outcome and magnetic resonance imaging after osteochondral autologous transplantation in osteochondritis dissecans of the talus. Foot Ankle Int. 2013 Feb;34(2):173-9. doi:10.1177/1071100712467433.

149.

Yang

Lee

. Arthroscopic microfracture for osteochondral lesions of the talus: second-look arthroscopic and magnetic resonance analysis of cartilage repair tissue outcomes. J Bone Joint Surg Am. 2020 Jan 2;102(1):10-20. doi:10.2106/jbjs.19.00208.

150.

Younger

Wing

Penner

Cresswell

. A study to evaluate the safety of platelet-derived growth factor for treatment of osteochondral defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1250-8. doi:10.1007/s00167-015-3549-0.

151.

Zhang

Luo

Zhou

Wang

. Outcomes from osteochondral autograft transplant or mosaicplasty in 26 patients with type V osteochondral lesions of the talus. Med Sci Monit. 2021 May 25;27:e930527. doi:10.12659/msm.930527.

152.

Zhu

Yang

Duan

. Arthroscopically assisted anterior treatment of symptomatic large talar bone cyst. J Foot Ankle Surg. 2019 Jan;58(1):151-5. doi:10.1053/j.jfas.2018.03.028.

153.

Batista

Duarte Pereira

van Dijk

Del Vecchio

. Posterior arthroscopic treatment of ankle osteochondral lesions: technical note. J ISAKOS. 2020;5(2):104-8. doi:10.1136/jisakos-2019-000375.

154.

de l’Escalopier

Amouyel

Mainard

Lopes

Cordier

Baudrier

, et al. Long-term outcome for repair of osteochondral lesions of the talus by osteochondral autograft: a series of 56 Mosaicplasties®. Orthop Traumatol Surg Res. 2021 Dec;107(Suppl. 8):103075. doi:10.1016/j.otsr.2021.103075.

155.

Geyer

Mattes

Petersen

Imhoff

Achtnich

. Arthroskopische einzeitige matrixunterstützte Knochenmarkstimulation zur Behandlung osteochondraler Defekte des Talus [Arthroscopic one-step matrix-assisted bone marrow stimulation for the treatment of osteochondral defects of the talus]. Oper Orthop Traumatol. 2022 Aug;34(4):295-302. doi:10.1007/s00064-021-00737-4.

156.

Örs Ç

Sarpel Y

. Autologous osteochondral transplantation provides successful recovery in patients with simultaneous medial and lateral talus osteochondral lesions. Acta Orthop Traumatol Turc. 2021 Dec;55(6):535-40. doi:10.5152/j.aott.2021.21204.

157.

Richter

Zech

Meissner

Naef

. Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach—5-year follow-up. Foot Ankle Surg. 2022 Jul 3;28:1321-6. doi:10.1016/j.fas.2022.06.015.

158.

Schafer

Cusworth

Kazarian

Backus

Klein

Johnson

, et al. Outcomes following repeat ankle arthroscopy and microfracture for osteochondral lesions of the talus. Foot Ankle Spec. Epub 2022 Mar 6. doi:10.1177/19386400221079203.

159.

Wan

Huang

Dong

. Results of the osteochondral autologous transplantation for treatment of osteochondral lesions of the talus with harvesting from the ipsilateral talar articular facets. Int Orthop. 2022 Jul;46(7):1547-55. doi:10.1007/s00264-022-05380-7.

160.

Wang

Zhang

Jin

Shi

Hou

. Effect analysis of iliac bone autografting for Hepple V osteochondral lesions of the talus. J Orthop Surg Res. 2022 Jan 15;17(1):33. doi:10.1186/s13018-022-02924-w.

161.

Windhofer

Orthner

Bürger

. Vascularized osteochondral free flaps from the femoral trochlea as versatile procedure for reconstruction of osteochondral lesions of the talus. Foot Ankle Surg. 2022 Jan 14;28:935-43. doi:10.1016/j.fas.2022.01.002.

162.

Yontar

Aslan

Öğüt

. Functional outcomes of autologous matrix-related chondrogenesis to treat large osteochondral lesions of the talus. Foot Ankle Int. 2022 Jun;43(6):783-9. doi:10.1177/10711007221078021.

163.

Ahmad

Jones

. Comparison of osteochondral autografts and allografts for treatment of recurrent or large talar osteochondral lesions. Foot Ankle Int. 2016 Jan;37(1):40-50. doi:10.1177/1071100715603191.

164.

Allahabadi

Johnson

Whitney

Oji

Chou

Lau

. Short-term outcomes following dehydrated micronized allogenic cartilage versus isolated microfracture for treatment of medial talar osteochondral lesions. Foot Ankle Surg. 2022;28:642-9. doi:10.1016/j.fas.2021.07.012.

165.

Arıcan

Degirmenci

. Improved clinical outcomes after arthroscopic microfracture in isolated medial talar osteochondral lesions with a single injection of high molecular weight hyaluronic acid. Konuralp Tip Derg. 2019;11:460-7.

166.

Cadossi

Buda

Ramponi

Sambri

Natali

Giannini

. Bone marrow-derived cells and biophysical stimulation for talar osteochondral lesions: a randomized controlled study. Foot Ankle Int. 2014 Oct;35(10):981-7. doi:10.1177/1071100714539660.

167.

Camurcu

Ucpunar

Yapici

Karakose

Ozcan

Cobden

, et al. Clinical and magnetic resonance imaging outcomes of microfracture plus chitosan/blood implant vs microfracture for osteochondral lesions of the talus. Foot Ankle Int. 2020 Nov;41(11):1368-75. doi:10.1177/1071100720942173.

168.

Choi

Kim

Lee

. Prognostic significance of the containment and location of osteochondral lesions of the talus: independent adverse outcomes associated with uncontained lesions of the talar shoulder. Am J Sports Med. 2013 Jan;41(1):126-33. doi:10.1177/0363546512453302.

169.

D’Ambrosi

Maccario

Serra

Liuni

Usuelli

. Osteochondral lesions of the talus and autologous matrix-induced chondrogenesis: is age a negative predictor outcome? Arthroscopy. 2017 Feb;33(2):428-35. doi:10.1016/j.arthro.2016.09.030.

170.

Gao

Chen

Sun

Wang

Shi

Cheng

, et al. Combined therapy with shock wave and retrograde bone marrow-derived cell transplantation for osteochondral lesions of the talus. Sci Rep. 2017 May 18;7(1):2106. doi:10.1038/s41598-017-02378-9.

171.

Gobbi

Francisco

Lubowitz

Allegra

Canata

. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy. 2006 Oct;22(10):1085-92. doi:10.1016/j.arthro.2006.05.016.

172.

Gül

Çetinkaya

Aykut

ÜS

Özkul

Saygılı

Akman

, et al. Effect of the presence of subchondral cysts on treatment results of autologous osteochondral graft transfer in osteochondral lesions of the talus. J Foot Ankle Surg. 2016 Sep-Oct;55(5):1003-6. doi:10.1053/j.jfas.2016.05.012.

173.

Guney

Yurdakul

Karaman

Bilal

Kafadar

Oner

. Medium-term outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet-rich plasma in the treatment of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1293-8. doi:10.1007/s00167-015-3834-y.

174.

Haasper

Zelle

Knobloch

Jagodzinski

Citak

Lotz

, et al. No mid-term difference in mosaicplasty in previously treated versus previously untreated patients with osteochondral lesions of the talus. Arch Orthop Trauma Surg. 2008 May;128(5):499-504. doi:10.1007/s00402-007-0513-6.

175.

Haleem

Ross

Smyth

Duke

Deyer

, et al. Double-plug autologous osteochondral transplantation shows equal functional outcomes compared with single-plug procedures in lesions of the talar dome: a minimum 5-year clinical follow-up. Am J Sports Med. 2014 Aug;42(8):1888-95. doi:10.1177/0363546514535068.

176.

Hannon

Ross

Murawski

Deyer

Smyth

Hogan

, et al. Arthroscopic bone marrow stimulation and concentrated bone marrow aspirate for osteochondral lesions of the talus: a case-control study of functional and magnetic resonance observation of cartilage repair tissue outcomes. Arthroscopy. 2016 Feb;32(2):339-47. doi:10.1016/j.arthro.2015.07.012.

177.

Kono

Takao

Naito

Uchio

Ochi

. Retrograde drilling for osteochondral lesions of the talar dome. Am J Sports Med. 2006 Sep;34(9):1450-6. doi:10.1177/0363546506287300.

178.

Kreuz

Steinwachs

Erggelet

Lahm

Henle

Niemeyer

. Mosaicplasty with autogenous talar autograft for osteochondral lesions of the talus after failed primary arthroscopic management: a prospective study with a 4-year follow-up. Am J Sports Med. 2006 Jan;34(1):55-63. doi:10.1177/0363546505278299.

179.

Lanham

Carroll

Cooper

Perumal

Park

. A comparison of outcomes of particulated juvenile articular cartilage and bone marrow aspirate concentrate for articular cartilage lesions of the talus. Foot Ankle Spec. 2017 Aug;10(4):315-21. doi:10.1177/1938640016679697.

180.

Lee

Park

Cho

Seon

. Comparison of arthroscopic microfracture for osteochondral lesions of the talus with and without subchondral cyst. Am J Sports Med. 2015 Aug;43(8):1951-6. doi:10.1177/0363546515584755.

181.

Lee

Young

Kim

Lee

Cho

Kim

. Arthroscopic microfracture with atelocollagen augmentation for osteochondral lesion of the talus: a multicenter randomized controlled trial. BMC Musculoskelet Disord. 2020 Nov 3;21(1):716. doi:10.1186/s12891-020-03730-3.

182.

Murphy

McGoldrick

Curtin

Kearns

. A prospective evaluation of bone marrow aspirate concentrate and microfracture in the treatment of osteochondral lesions of the talus. Foot Ankle Surg. 2019 Aug;25(4):441-8. doi:10.1016/j.fas.2018.02.011.

183.

Park

Lee

. Comparison of chondral versus osteochondral lesions of the talus after arthroscopic microfracture. Knee Surg Sports Traumatol Arthrosc. 2015 Mar;23(3):860-7. doi:10.1007/s00167-014-3061-y.

184.

Park

Hwang

Han

Park

Shim

Choi

, et al. Primary versus secondary osteochondral autograft transplantation for the treatment of large osteochondral lesions of the talus. Am J Sports Med. 2018 May;46(6):1389-96. doi:10.1177/0363546518758014.

185.

Rak Choi

Soo Kim

Kim

Park

Cho

, et al. Internal fixation of osteochondral lesion of the talus involving a large bone fragment. Am J Sports Med. 2021 Mar;49(4):1031-9. doi:10.1177/0363546520988739.

186.

Reilingh

Lambers

KTA

Dahmen

Opdam

KTM

Kerkhoffs

. The subchondral bone healing after fixation of an osteochondral talar defect is superior in comparison with microfracture. Knee Surg Sports Traumatol Arthrosc. 2018 Jul;26(7):2177-82. doi:10.1007/s00167-017-4654-z.

187.

Reilingh

van Bergen

Gerards

van Eekeren

de Haan

Sierevelt

, et al. Effects of pulsed electromagnetic fields on return to sports after arthroscopic debridement and microfracture of osteochondral talar defects: a randomized, double-blind, placebo-controlled, multicenter trial. Am J Sports Med. 2016 May;44(5):1292-300. doi:10.1177/0363546515626544.

188.

Ross

Murawski

Fraser

Ross

Deyer

, et al. Autologous osteochondral transplantation for osteochondral lesions of the talus: does previous bone marrow stimulation negatively affect clinical outcome? Arthroscopy. 2016 Jul;32(7):1377-83. doi:10.1016/j.arthro.2016.01.036.

189.

Sadlik

Kolodziej

Puszkarz

Laprus

Mojzesz

Whyte

. Surgical repair of osteochondral lesions of the talus using biologic inlay osteochondral reconstruction: clinical outcomes after treatment using a medial malleolar osteotomy approach compared to an arthroscopically-assisted approach. Foot Ankle Surg. 2019 Aug;25(4):449-56. doi:10.1016/j.fas.2018.02.010.

190.

Shang

Tao

Chen

Hua

. Clinical and MRI outcomes of HA injection following arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2016 Apr;24(4):1243-9. doi:10.1007/s00167-015-3575-y.

191.

Shimozono

Hurley

Nguyen

Deyer

Kennedy

. Allograft compared with autograft in osteochondral transplantation for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2018 Nov 7;100(21):1838-44. doi:10.2106/jbjs.17.01508.

192.

Shimozono

Williamson

ERC

Mercer

Hurley

Huang

Deyer

, et al. Use of extracellular matrix cartilage allograft may improve infill of the defects in bone marrow stimulation for osteochondral lesions of the talus. Arthroscopy. 2021 Jul;37(7):2262-9. doi:10.1016/j.arthro.2021.03.032.

193.

Shimozono

Yasui

Hurley

Paugh

Deyer

Kennedy

. Concentrated bone marrow aspirate may decrease postoperative cyst occurrence rate in autologous osteochondral transplantation for osteochondral lesions of the talus. Arthroscopy. 2019 Jan;35(1):99-105. doi:10.1016/j.arthro.2018.06.047.

194.

Struckmann

Harhaus

Simon

von Recum

Woelfl

Kneser

, et al. Vascularized medial femoral condyle autografts for osteochondral lesions of the talus: a preliminary prospective randomized controlled trial. J Foot Ankle Surg. 2020 Mar-Apr;59(2):307-13. doi:10.1053/j.jfas.2019.03.025.

195.

Tahta

Akkaya

Gursoy

Isik

Bozkurt

. Arthroscopic treatment of osteochondral lesions of the talus: nanofracture versus hyaluronic acid-based cell-free scaffold with concentration of autologous bone marrow aspirate. J Orthop Surg (Hong Kong). 2017 May-Aug;25(2):2309499017717870. doi:10.1177/2309499017717870.

196.

Takao

Uchio

Kakimaru

Kumahashi

Ochi

. Arthroscopic drilling with debridement of remaining cartilage for osteochondral lesions of the talar dome in unstable ankles. Am J Sports Med. 2004 Mar;32(2):332-6. doi:10.1177/0363546503261718.

197.

Yoon

Park

Lee

Choi

Lee

. Osteochondral autologous transplantation is superior to repeat arthroscopy for the treatment of osteochondral lesions of the talus after failed primary arthroscopic treatment. Am J Sports Med. 2014 Aug;42(8):1896-903. doi:10.1177/0363546514535186.

198.

Yoshimura

Kanazawa

Takeyama

Angthong

Ida

Hagio

, et al. Arthroscopic bone marrow stimulation techniques for osteochondral lesions of the talus: prognostic factors for small lesions. Am J Sports Med. 2013 Mar;41(3):528-34. doi:10.1177/0363546512472979.

199.

Danilkowicz

Grimm

Zhang

Lefebvre

Lau

Adams

, et al. Impact of early weightbearing after ankle arthroscopy and bone marrow stimulation for osteochondral lesions of the talus. Orthop J Sports Med. 2021 Sep;9(9):23259671211029883. doi:10.1177/23259671211029883.

200.

Gianakos

Williamson

ERC

Mercer

Kerkhoffs

Kennedy

. Gender differences may exist in the presentation, mechanism of injury and outcomes following bone marrow stimulation for osteochondral lesions of the talus. J Foot Ankle Surg. 2023 Apr 29;62:75-9. doi:10.1053/j.jfas.2022.04.010.

201.

Kim

Jang

. Outcomes of bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) for treatment of osteochondral lesions of the talus. Foot Ankle Surg. 2022;28:944-9. doi:10.1016/j.fas.2022.01.005.

202.

Koh

DTS

Tan

MWP

Zhan

Tay

Tan

, et al. Association of elevated body mass index and outcomes of arthroscopic treatment for osteochondral lesions of the talus. Foot Ankle Orthop. 2022 Apr;7(2):24730114221103263. doi:10.1177/24730114221103263.

203.

Mercer

Samsonov

Dankert

Kennedy

. Outcomes of autologous osteochondral transplantation with and without extracellular matrix cartilage allograft augmentation for osteochondral lesions of the talus. Am J Sports Med. 2022 Jan;50(1):162-9. doi:10.1177/03635465211057117.

204.

Tan

MWP

Tay

Yeo

EMN

. Atelocollagen-induced chondrogenesis versus microfracture alone for osteochondral lesions of the talus: surgical technique and a 1-year clinical outcome study. Foot Ankle Spec. Epub 2022 Jul 11. doi:10.1177/19386400221107003.

205.

Wei

Song

Yun

Zhang

Wei

. Outcomes of single-stage versus staged treatment of osteochondral lesions in patients with chronic lateral ankle instability: a prospective randomized study. Orthop J Sports Med. 2022 Feb;10(2):23259671211069909. doi:10.1177/23259671211069909.

206.

Zhao

Liu

Zhao

. Effect of mosaic allograft osteochondral transplantation combined with corrective osteotomy in treating osteochondral lesions of the talus on ankle and knee joint function and lower limb alignment. Comput Math Methods Med. 2022;2022:9688098. doi:10.1155/2022/9688098.

207.

Birkmeyer

Finks

O’Reilly

Oerline

Carlin

Nunn

, et al. Surgical skill and complication rates after bariatric surgery. N Engl J Med. 2013 Oct 10;369(15):1434-42. doi:10.1056/NEJMsa1300625.

208.

Cheng

Chen

Soleas

Ferko

Cameron

Hinoul

. Prolonged operative duration increases risk of surgical site infections: a systematic review. Surg Infect (Larchmt). 2017 Aug/Sep;18(6):722-35. doi:10.1089/sur.2017.089.

209.

Gasparetto

Collo

Pisanu

Villella

Drocco

Cerlon

, et al. Posterior ankle and subtalar arthroscopy: indications, technique, and results. Curr Rev Musculoskelet Med. 2012 Jun;5(2):164-70. doi:10.1007/s12178-012-9118-y.

210.

Vega

Dalmau-Pastor

Malagelada

Fargues-Polo

Peña

. Ankle arthroscopy: an update. J Bone Joint Surg Am. 2017 Aug 16;99(16):1395-407. doi:10.2106/jbjs.16.00046.

211.

Ferkel

Heath

Guhl

. Neurological complications of ankle arthroscopy. Arthroscopy. 1996;12(2):200-8. doi:10.1016/S0749-8063(96)90011-0.

212.

Schimmel

Walschot

Louwerens

. Comparison of the short-term results of the first and last 50 Scandinavian total ankle replacements: assessment of the learning curve in a consecutive series. Foot Ankle Int. 2014 Apr;35(4):326-33. doi:10.1177/1071100713518187.

213.

van Bergen

Zengerink

Blankevoort

van Sterkenburg

van Oldenrijk

van Dijk

. Novel metallic implantation technique for osteochondral defects of the medial talar dome. A cadaver study. Acta Orthop. 2010 Aug;81(4):495-502. doi:10.3109/17453674.2010.492764.

214.

van Bergen

CJA

Reilingh

van Dijk

. Novel metal implantation technique for secondary osteochondral defects of the medial talar dome—one-year results of a prospective study. Fuss. 2012;10(2):130-7. doi:10.1016/j.fuspru.2012.03.004.

215.

Stetson

Ferkel

. Ankle arthroscopy: I. Technique and complications. J Am Acad Orthop Surg. 1996 Jan;4(1):17-23. doi:10.5435/00124635-199601000-00003.

216.

Chaytor

Conti

. Arthroscopy of the foot and ankle: current concepts review. Foot Ankle Int. 1998 Mar;19(3):184-92. doi:10.1177/107110079801900315.

217.

van Dijk

Scholten

Krips

. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy. 2000 Nov;16(8):871-6. doi:10.1053/jars.2000.19430.

218.

Kelly

Lenke

Godzik

Pellise

Shaffrey

Smith

, et al. Retrospective analysis underestimates neurological deficits in complex spinal deformity surgery: a Scoli-RISK-1 Study. J Neurosurg Spine. 2017 Jul;27(1):68-73. doi:10.3171/2016.12.Spine161068.

219.

Boddapati

Schairer

Ranawat

Dines

Taylor

, et al. Increased shoulder arthroscopy time is associated with overnight hospital stay and surgical site infection. Arthroscopy. 2018 Feb;34(2):363-8. doi:10.1016/j.arthro.2017.08.243.

220.

Carvalho

RLR

Campos

Franco

LMC

Rocha

Ercole

. Incidence and risk factors for surgical site infection in general surgeries. Rev Lat Am Enfermagem. 2017;25:e2848. doi:10.1590/1518-8345.1502.2848.

221.

Held

Boddapati

Sarpong

Cooper

Shah

Geller

. Operative duration and short-term postoperative complications after unicompartmental knee arthroplasty. J Arthroplasty. 2021 Mar;36(3):905-9. doi:10.1016/j.arth.2020.09.007.

222.

Naranje

Lendway

Mehle

Gioe

. Does operative time affect infection rate in primary total knee arthroplasty? Clin Orthop Relat Res. 2015 Jan;473(1):64-9. doi:10.1007/s11999-014-3628-4.

223.

Peersman

Laskin

Davis

Peterson

Richart

. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J. 2006 Feb;2(1):70-2. doi:10.1007/s11420-005-0130-2.

224.

Swindell

Alrabaa

Boddapati

Trofa

Jobin

Levine

. Is surgical duration associated with postoperative complications in primary shoulder arthroplasty? J Shoulder Elbow Surg. 2020 Apr;29(4):807-13. doi:10.1016/j.jse.2019.08.015.

225.

Young

Mutu-Grigg

Frampton

Cullen

. Does speed matter? Revision rates and functional outcomes in TKA in relation to duration of surgery. J Arthroplasty. 2014 Jul;29(7):1473-7.e1. doi:10.1016/j.arth.2014.03.004.

226.

Cheng

Clymer

Po-Han Chen

Sadeghirad

Ferko

Cameron

, et al. Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res. 2018 Sep;229:134-44. doi:10.1016/j.jss.2018.03.022.

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