The primary purpose of the present study was to determine and compare the complication rate of different surgical treatment options for osteochondral lesions of the talus. The secondary aim was to analyse and compare the severity and types of complications.
A literature search was performed in MEDLINE (PubMed), EMBASE (Ovid) and the Cochrane Library from inception to May 2022. Methodological quality was assessed using the methodological index for non-randomized studies (MINORS). The 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 analysed using a random effects model. A moderator test for subgroup-analysis was used to determine differences. The types of complications were presented as rates.
163 articles from the literature search were included, comprising a total of 5789 OLTs with a pooled mean age of 35 years and follow-up of 4 years. Methodological quality was considered fair. The overall complication rate was 5% [5%-6%] (treatment group effect p=.019). Analysis resulted in rates from 3% [2%-5%] for matrix assisted bone marrow stimulation to 15% [5%-35%] for metal implants. The complication rate for the insertion of metal implants was significantly higher than the other surgical treatment options (p<0.05). overall, (superficial) nerve injury was the most observed complication and no life-threatening complications were reported.
In 1 out of 20 (5%) patients treated surgically for an osteochondral lesion of the talus a complication of any kind occurs. Metal implantation yielded the highest complication rate (i.e., 15%) compared to the other surgical treatment modalities having been analysed in the present meta-analysis.