Abstract：
OBJECTIVE: Bone marrow aspirate concentrate can be used as an additive to surgical treatment of osteochondral lesions of the talus. This systematic literature review aims to study the effect of the additional use of bone marrow aspirate concentrate on top of a surgical treatment for osteochondral lesions of the talus on clinical outcomes compared to surgical treatment alone.
METHODS: An online literature search was conducted using PubMed (Medline), Embase (Ovid), and the Cochrane library for all studies comparing a surgical intervention with bone marrow aspirate concentrate, with a surgical intervention without bone marrow aspirate concentrate. The methodological quality was rated according to the methodological index for non-randomised studies checklist. The primary outcome measure were clinical outcomes. Secondary outcome measures consisted of revision rate, complication rate, radiographic outcome measures and histological analyses. Subgroups were created based on type of surgical intervention used in the studies. If multiple articles were included in a subgroup, a linear random-effects model was used to compare the bone marrow aspirate concentrate-augmented group with the control group.
RESULTS: Out of 1006 studies found, eight studies with a total of 718 patients were included. The methodological quality, assessed according to the methodological index for non-randomised studies checklist, was weak. A significantly better functional outcome measures (p < 0.05) was found in the subgroup treated with bone marrow stimulation + bone marrow aspirate concentrate compared to the group treated with bone marrow stimulation alone, based on three non-blinded studies. No significant differences regarding clinical outcomes were found in the subgroups comparing matrix-induced autologous chondrocyte implantation with matrix-induced bone marrow aspirate concentrate, osteochondral autologous transplantation alone with osteochondral autologous transplantation + bone marrow aspirate concentrate and autologous matrix-induced chondrogenesis plus peripheral blood concentrate vs. matrix-associated stem cell transplantation bone marrow aspirate concentrate.
CONCLUSIONS: There is insufficient evidence to support a positive effect on clinical outcomes of bone marrow aspirate concentrate as an additive to surgical treatment of osteochondral lesions of the talus. However, based on the safety reports and initial results, sufficiently powered, patient- and researcher-blinded, prospective randomised controlled trials are justified and recommended. Until then, we advise not to implement a therapy (addition of bone marrow aspirate concentrate) without clinical evidence that justifies the additional costs involved.
METHODS: Level III.
METHODS: An online literature search was conducted using PubMed (Medline), Embase (Ovid), and the Cochrane library for all studies comparing a surgical intervention with bone marrow aspirate concentrate, with a surgical intervention without bone marrow aspirate concentrate. The methodological quality was rated according to the methodological index for non-randomised studies checklist. The primary outcome measure were clinical outcomes. Secondary outcome measures consisted of revision rate, complication rate, radiographic outcome measures and histological analyses. Subgroups were created based on type of surgical intervention used in the studies. If multiple articles were included in a subgroup, a linear random-effects model was used to compare the bone marrow aspirate concentrate-augmented group with the control group.
RESULTS: Out of 1006 studies found, eight studies with a total of 718 patients were included. The methodological quality, assessed according to the methodological index for non-randomised studies checklist, was weak. A significantly better functional outcome measures (p < 0.05) was found in the subgroup treated with bone marrow stimulation + bone marrow aspirate concentrate compared to the group treated with bone marrow stimulation alone, based on three non-blinded studies. No significant differences regarding clinical outcomes were found in the subgroups comparing matrix-induced autologous chondrocyte implantation with matrix-induced bone marrow aspirate concentrate, osteochondral autologous transplantation alone with osteochondral autologous transplantation + bone marrow aspirate concentrate and autologous matrix-induced chondrogenesis plus peripheral blood concentrate vs. matrix-associated stem cell transplantation bone marrow aspirate concentrate.
CONCLUSIONS: There is insufficient evidence to support a positive effect on clinical outcomes of bone marrow aspirate concentrate as an additive to surgical treatment of osteochondral lesions of the talus. However, based on the safety reports and initial results, sufficiently powered, patient- and researcher-blinded, prospective randomised controlled trials are justified and recommended. Until then, we advise not to implement a therapy (addition of bone marrow aspirate concentrate) without clinical evidence that justifies the additional costs involved.
METHODS: Level III.
摘要：
目的：骨髓穿刺液浓缩物可作为距骨软骨损伤手术治疗的添加剂。本系统文献综述旨在研究与单独手术治疗相比，在距骨骨软骨病变的手术治疗之上额外使用骨髓穿刺液对临床结果的影响。
方法：使用PubMed（Medline）进行在线文献检索，Embase(Ovid),和Cochrane图书馆，用于比较手术干预与骨髓穿刺液浓缩物的所有研究，没有骨髓穿刺液浓缩物的手术干预。根据非随机研究检查表的方法学指标对方法学质量进行评级。主要结果指标是临床结果。次要结果指标包括修订率，并发症发生率,影像学结果测量和组织学分析。根据研究中使用的手术干预类型创建亚组。如果一个子组中包含多个文章，我们使用线性随机效应模型比较骨髓穿刺液浓缩液强化组与对照组.
结果：在1006项研究中发现，纳入了8项研究,共718例患者.方法的质量，根据非随机研究检查表的方法学指标进行评估，很弱。与单独使用骨髓刺激治疗的组相比，在使用骨髓刺激+骨髓穿刺液浓缩物治疗的亚组中发现了明显更好的功能结局指标（p<0.05）。基于三项非盲研究。在比较基质诱导的自体软骨细胞植入与基质诱导的骨髓穿刺液浓缩物的亚组中，没有发现关于临床结果的显着差异。骨软骨自体移植与骨软骨自体移植+骨髓抽吸物浓缩物和自体基质诱导的软骨形成+外周血浓缩物基质相关干细胞移植骨髓穿刺液浓缩物。
结论：没有足够的证据支持骨髓穿刺液浓缩物作为距骨软骨病的外科治疗添加剂对临床结果的积极作用。然而,根据安全报告和初步结果，足够的动力，病人和研究人员失明，前瞻性随机对照试验是合理的,值得推荐.在那之前,我们建议在没有临床证据证明额外费用合理的情况下,不要实施治疗(添加骨髓穿刺液浓缩物).
方法：三级。
方法：使用PubMed（Medline）进行在线文献检索，Embase(Ovid),和Cochrane图书馆，用于比较手术干预与骨髓穿刺液浓缩物的所有研究，没有骨髓穿刺液浓缩物的手术干预。根据非随机研究检查表的方法学指标对方法学质量进行评级。主要结果指标是临床结果。次要结果指标包括修订率，并发症发生率,影像学结果测量和组织学分析。根据研究中使用的手术干预类型创建亚组。如果一个子组中包含多个文章，我们使用线性随机效应模型比较骨髓穿刺液浓缩液强化组与对照组.
结果：在1006项研究中发现，纳入了8项研究,共718例患者.方法的质量，根据非随机研究检查表的方法学指标进行评估，很弱。与单独使用骨髓刺激治疗的组相比，在使用骨髓刺激+骨髓穿刺液浓缩物治疗的亚组中发现了明显更好的功能结局指标（p<0.05）。基于三项非盲研究。在比较基质诱导的自体软骨细胞植入与基质诱导的骨髓穿刺液浓缩物的亚组中，没有发现关于临床结果的显着差异。骨软骨自体移植与骨软骨自体移植+骨髓抽吸物浓缩物和自体基质诱导的软骨形成+外周血浓缩物基质相关干细胞移植骨髓穿刺液浓缩物。
结论：没有足够的证据支持骨髓穿刺液浓缩物作为距骨软骨病的外科治疗添加剂对临床结果的积极作用。然而,根据安全报告和初步结果，足够的动力，病人和研究人员失明，前瞻性随机对照试验是合理的,值得推荐.在那之前,我们建议在没有临床证据证明额外费用合理的情况下,不要实施治疗(添加骨髓穿刺液浓缩物).
方法：三级。
