Abstract：
BACKGROUND: Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes debridement and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage.
METHODS: A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).
RESULTS: Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.
CONCLUSIONS: Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.
METHODS: IV.
METHODS: A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).
RESULTS: Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.
CONCLUSIONS: Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.
METHODS: IV.
摘要：
背景：关于软骨完整的稳定性距骨软骨炎（OCD）的最佳治疗方法存在分歧。有些人建议保守管理，而其他人更喜欢手术治疗，包括清创和微骨折，通过直接或内踝入路和关节后钻孔的经关节钻孔。关节后钻孔的基本原理是在不接触完整软骨的情况下诱导骨髓愈合。本系统评价的目的是总结后关节钻孔作为稳定的距骨OCD和完整软骨的独立手术的临床结果。
方法：按照系统审查和荟萃分析（PRISMA）指南的首选报告项目对PROSPERO注册的前瞻性文献进行了系统审查。Medline,从开始到2021年12月，对EMBASE和循证医学数据库进行了搜索，以进行关节后钻孔，以获得具有完整软骨的稳定距骨OCD。两名独立评估人员筛选了搜索结果，选择要纳入分析的文章，并用纽卡斯尔-渥太华量表（NOS）评估所有纳入文章的方法学质量。
结果：12项研究，99例患者被纳入最终分析.所有纳入研究的方法学质量均较差。高度异质性阻止了任何汇集或荟萃分析，但是根据美国骨科足和安克评分（AOFAS）的出色干预后评分，报告了良好的临床结果，范围从88.9到100。通过视觉模拟量表（VAS）测量，疼痛也有显着改善，范围在2.3和5.9之间。
结论：对于具有完整软骨的稳定距骨强迫症，不移植的关节后钻孔似乎取得了良好的结果，但需要在手术选择和保守治疗之间进行更有力的比较研究，以建立黄金标准治疗。
方法：IV.
方法：按照系统审查和荟萃分析（PRISMA）指南的首选报告项目对PROSPERO注册的前瞻性文献进行了系统审查。Medline,从开始到2021年12月，对EMBASE和循证医学数据库进行了搜索，以进行关节后钻孔，以获得具有完整软骨的稳定距骨OCD。两名独立评估人员筛选了搜索结果，选择要纳入分析的文章，并用纽卡斯尔-渥太华量表（NOS）评估所有纳入文章的方法学质量。
结果：12项研究，99例患者被纳入最终分析.所有纳入研究的方法学质量均较差。高度异质性阻止了任何汇集或荟萃分析，但是根据美国骨科足和安克评分（AOFAS）的出色干预后评分，报告了良好的临床结果，范围从88.9到100。通过视觉模拟量表（VAS）测量，疼痛也有显着改善，范围在2.3和5.9之间。
结论：对于具有完整软骨的稳定距骨强迫症，不移植的关节后钻孔似乎取得了良好的结果，但需要在手术选择和保守治疗之间进行更有力的比较研究，以建立黄金标准治疗。
方法：IV.
