Fixation for osteochondral lesions of the talus leads to successful clinical outcomes in 9 out of 10 patients: A systematic review

IMPORTANCE: Osteochondral lesions of the talus (OLT) with an osteochondral fragment are amenable for fixation. Fixation aims to stabilize the osteochondral fragment while retaining the native cartilage. Though fixation for OLT is a promising treatment, no systematic overview of the literature on its efficacy and safety exists. AIM: The primary aim of the present study is to assess the clinical success rate of fixation for OLT. The secondary outcomes concern the union rate and adverse events. EVIDENCE REVIEW: A systematic literature search of PubMed, Embase (Ovid), and Cochrane Library was performed up to December 2023. The methodological quality of the included studies was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) tool. The primary outcome the clinical success rate following fixation was pooled using a random effects model with 95% confidence interval (95%-CI). Success was predefined based on cut-off values for commonly used patient- or physician-reported outcome measures. Secondary outcomes concerned the union rate, complication rate, and revision rate. FINDINGS: A total of 10 studies with 241 ankles were included at a mean follow-up of 40 months. 88% of lesions were chronic in nature, and 12% acute. In total, 9 non-comparative studies had a mean MINORS score of 10.3 (range: 6-14) out of 16 points and 1 comparative study had and a MINORS score of 20 of 24 points. The pooled clinical success rate was 91% [95%-CI: 81%-96%]. The pooled union rate was 91% [95%-CI: 87%-94%]. The addition of biological adjuncts in the form of autologous bone-grafting did not show a statistically superior success rate. The pooled complication and revision rate were 1% [95%-CI: 0-4] and 6% [95%-CI: 0%-4%], respectively. CONCLUSION AND RELEVANCE: Fixation for osteochondral lesions of the talus leads to successful clinical outcomes in 9 out of 10 patients. Moreover, fragment union is achieved in 9 out of 10 patients, with a low reported complication rate. These findings show that when a symptomatic OLT is fixable physicians should consider fixation. LEVEL OF EVIDENCE: IV.