Objective
To compare patient-reported outcome measures (PROMs) and complication rates of
scaffold-based cartilage repair techniques versus microfractures (MFx) in treating focal
osteochondral lesions of the talar dome (OLTs).
Design: A systematic review of PubMed, Embase, and Scopus databases up to November 1st,
2021, by two independent reviewers following PRISMA guidelines. Clinical studies comparing
PROMs and complications of scaffold-based techniques versus bone marrow stimulation
techniques were eligible if (1) were published in English or Spanish; (2) evaluated PROMs
with/without complications; (3) had a minimum 6-month follow-up. Citation screening was
performed on potentially eligible articles and was included when eligibility criteria were met.
Methodological quality was assessed using the Modified Coleman Methodology Score (mCMS).
Results
Seven studies were included: four retrospective cohort studies, two randomized
controlled trials, and a prospective cohort study. Three studies implanted collagen scaffolds, two
utilized chitosan scaffolds, and two hyaluronan scaffolds. The methodological quality of the
included studies was fair (mCMS mean, 58.57; range, 43–71). Both MFx and augmented MFx with
scaffolds yield good to excellent short- and medium-term PROMs improvement, which was
significantly better in the scaffold-based techniques in larger or uncontained lesions and at longer
follow-up. Additionally, both techniques showed comparable complication rates and profiles.
Conclusions
Scaffold-augmented MFx is safe and yields satisfactory short- and medium-term
clinical improvement, especially in large or uncontained lesions and at longer follow-up.
Keywords: Microfractures, augmented microfractures, scaffolds, osteochondral lesions, talus.