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Abstract：
OBJECTIVE: The purpose of the present study was to assess the overall clinical success rate of non-operative management for osteochondral lesions of the talus (OLT).
METHODS: A literature search was conducted in the PubMed (MEDLINE), COCHRANE and EMBASE (Ovid) databases. Clinical success rates per separate study were calculated at the latest moment of follow-up and were defined as successful when a good or excellent clinical result at follow-up was reported in a qualitative manner or when a post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score at or above 80 was reached. When clinical outcomes were based on other clinical scoring systems, outcomes reported as good or excellent were considered as clinical success. Studies methodologically eligible for a simplified pooling method were combined to calculate an overall pooled clinical success rate. Radiological changes over the course of conservative treatment were assessed either considering local OLT changes and/or overall ankle joint changes.
RESULTS: Thirty articles were included, including an overall of 868 patients. The median follow-up of the included studies was 37 months (range: 3-288 months). A simplified pooling method was possible among 16 studies and yielded an overall pooled clinical success rate of 45% (95% CI 40-50%). As assessed with plain radiographs, progression of ankle joint osteoarthritis was observed in of 9% (95% CI 6-14%) of the patients. As assessed through a Computed Tomography (CT) scan, focal OLT deterioration was observed in 11% (95% CI 7-18%) of the patients. As assessed with a Magnetic Resonance Imaging (MRI) scan, focal OLT deterioration was observed in 12% (95% CI 6-24%) of the patients. An unchanged lesion was detected on plain radiographs in 53% (48/91; CI 43-63%), 76% (99/131; 95% CI 68-82%) on a CT scan and on MRI in 84% (42/50; 95% CI 71-92%) of the patients.
CONCLUSIONS: The current literature on non-operative management of OLTs is scarce and heterogeneous on indication and type of treatment. Promising clinical results are presented but need to interpreted with caution due to the heterogeneity in indication, duration and type of treatment. Further studies need to focus on specific types on conservative management, indications and its results.
METHODS: Systematic review, Level IV.
METHODS: A literature search was conducted in the PubMed (MEDLINE), COCHRANE and EMBASE (Ovid) databases. Clinical success rates per separate study were calculated at the latest moment of follow-up and were defined as successful when a good or excellent clinical result at follow-up was reported in a qualitative manner or when a post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score at or above 80 was reached. When clinical outcomes were based on other clinical scoring systems, outcomes reported as good or excellent were considered as clinical success. Studies methodologically eligible for a simplified pooling method were combined to calculate an overall pooled clinical success rate. Radiological changes over the course of conservative treatment were assessed either considering local OLT changes and/or overall ankle joint changes.
RESULTS: Thirty articles were included, including an overall of 868 patients. The median follow-up of the included studies was 37 months (range: 3-288 months). A simplified pooling method was possible among 16 studies and yielded an overall pooled clinical success rate of 45% (95% CI 40-50%). As assessed with plain radiographs, progression of ankle joint osteoarthritis was observed in of 9% (95% CI 6-14%) of the patients. As assessed through a Computed Tomography (CT) scan, focal OLT deterioration was observed in 11% (95% CI 7-18%) of the patients. As assessed with a Magnetic Resonance Imaging (MRI) scan, focal OLT deterioration was observed in 12% (95% CI 6-24%) of the patients. An unchanged lesion was detected on plain radiographs in 53% (48/91; CI 43-63%), 76% (99/131; 95% CI 68-82%) on a CT scan and on MRI in 84% (42/50; 95% CI 71-92%) of the patients.
CONCLUSIONS: The current literature on non-operative management of OLTs is scarce and heterogeneous on indication and type of treatment. Promising clinical results are presented but need to interpreted with caution due to the heterogeneity in indication, duration and type of treatment. Further studies need to focus on specific types on conservative management, indications and its results.
METHODS: Systematic review, Level IV.
摘要：
目的：本研究的目的是评估距骨软骨损伤（OLT）非手术治疗的总体临床成功率。
方法：在PubMed（MEDLINE）进行了文献检索，COCHRANE和EMBASE(Ovid)数据库。在随访的最新时刻计算每个单独研究的临床成功率，并将其定义为当以定性方式报告随访时良好或出色的临床结果或术后美国骨科足踝协会（AOFAS）评分达到80或以上时的成功。当临床结果基于其他临床评分系统时，报告为良好或优秀的结局被认为是临床成功.在方法学上符合简化合并方法的研究被组合以计算总体合并临床成功率。考虑到局部OLT变化和/或整体踝关节变化，评估了保守治疗过程中的放射学变化。
结果：包括30篇文章，包括868名患者。纳入研究的中位随访时间为37个月（范围：3-288个月）。在16项研究中，简化的合并方法是可能的，总体合并临床成功率为45％（95％CI40-50％）。根据普通射线照片评估，9％（95％CI6-14％）的患者中观察到踝关节骨关节炎的进展。通过计算机断层扫描（CT）扫描评估，在11%(95%CI7-18%)的患者中观察到局灶性OLT恶化.根据磁共振成像（MRI）扫描评估，在12%(95%CI6-24%)的患者中观察到局灶性OLT恶化.在X线平片上检测到未改变的病变占53％（48/91；CI43-63％），在84％（42/50；95％CI71-92％）的患者中，有76％（99/131；95％CI68-82％）的CT扫描和MRI扫描。
结论：目前关于OLTs非手术治疗的文献很少，在适应症和治疗类型上存在异质性。提出了有希望的临床结果，但由于适应症的异质性，需要谨慎解释。治疗的持续时间和类型。进一步的研究需要关注保守管理的特定类型，适应症及其结果。
方法：系统评价，四级。
方法：在PubMed（MEDLINE）进行了文献检索，COCHRANE和EMBASE(Ovid)数据库。在随访的最新时刻计算每个单独研究的临床成功率，并将其定义为当以定性方式报告随访时良好或出色的临床结果或术后美国骨科足踝协会（AOFAS）评分达到80或以上时的成功。当临床结果基于其他临床评分系统时，报告为良好或优秀的结局被认为是临床成功.在方法学上符合简化合并方法的研究被组合以计算总体合并临床成功率。考虑到局部OLT变化和/或整体踝关节变化，评估了保守治疗过程中的放射学变化。
结果：包括30篇文章，包括868名患者。纳入研究的中位随访时间为37个月（范围：3-288个月）。在16项研究中，简化的合并方法是可能的，总体合并临床成功率为45％（95％CI40-50％）。根据普通射线照片评估，9％（95％CI6-14％）的患者中观察到踝关节骨关节炎的进展。通过计算机断层扫描（CT）扫描评估，在11%(95%CI7-18%)的患者中观察到局灶性OLT恶化.根据磁共振成像（MRI）扫描评估，在12%(95%CI6-24%)的患者中观察到局灶性OLT恶化.在X线平片上检测到未改变的病变占53％（48/91；CI43-63％），在84％（42/50；95％CI71-92％）的患者中，有76％（99/131；95％CI68-82％）的CT扫描和MRI扫描。
结论：目前关于OLTs非手术治疗的文献很少，在适应症和治疗类型上存在异质性。提出了有希望的临床结果，但由于适应症的异质性，需要谨慎解释。治疗的持续时间和类型。进一步的研究需要关注保守管理的特定类型，适应症及其结果。
方法：系统评价，四级。
