Summary

An updated review and meta-analysis of the various techniques for the treatment of osteochondral lesions of the talus, analyzing the return to sport and activity levels after surgery.

Abstract

Background

Osteochondral lesions of the talus (OLTs) are common injuries among athletes. The unique characteristics of the osteochondral unit, combined with high functional demands, present a treatment challenge. This review and meta-analysis aim to highlight the differences between techniques and identify the most effective surgical strategies for athletes.

Methods

A systematic review of the literature from January 1990 to April 2024 was conducted, with the search strategy registered in PROSPERO. Surgical procedure details, return-to-sport (RTS) rates, sport-related scores, clinical scores, and demographics were extracted. Meta-analyses were performed when possible.

Results

The mean age at surgery was 34.5 ± 9.9 years, the mean BMI was 25.7 ± 4.2 kg/m², the mean lesion size was 111.5 ± 75.8 mm², and the mean follow-up was 4.7 ± 3.4 years. No statistically significant differences were detected among the postoperative values of the VAS score, AOFAS score, or FAOS sport score reported for the different surgical strategies (p-value > 0.05). Significant differences were observed in return-to-sport rates and return-to-sport at pre-injury levels. The highest number of studies reporting RTS rates involved bone marrow stimulation, with an RTS rate of 83.3% (95% CI 80.3-86.2%) and an RTS to pre-injury level of 52.7% (95% CI 47.8-57.6%). The second most reported technique was osteochondral replacement, with an RTS rate of 83.7% (95% CI 79.6-87.8%) and an RTS to pre-injury level of 54.6% (95% CI 45.6-63.6%), though this difference was not statistically significant (p-value > 0.05). The best RTS to pre-injury level was reported for cartilage regeneration cell-based techniques: 72.5% (95% CI 55.9-94.4%), though based on only four studies. Differences in RTS rates and RTS to pre-injury levels between cartilage implantation and BMS, and between cartilage regeneration cell-based and osteochondral replacement, were statistically significant (p-value < 0.05).

Conclusions

The various surgical treatment options for talar OCD allow for adequate return-to-sport (RTS) times and rates. However, RTS rates decrease when considering patients’ return to their pre-injury levels compared to returning at any level. A tailored approach for each case is recommended to ensure an optimal return to sport for the athlete without compromising long-term clinical outcomes.