Particulated juvenile cartilage allograft for the treatment of osteochondral lesions of the talus is associated with a high complication rate and a high failure rate at short‐term follow‐up: A systematic review

Author:

Butler James J.1,Rizla Muhammad Raziq Mohammed2,Egol Alexander J.1,Campbell Hilary1,Schoof Lauren3,Dahmen Jari456,Azam Mohammad T.1,Kerkhoffs Gino M. M. J.456,Kennedy John G.1ORCID

Affiliation:

1. Department of Orthopaedic Surgery, Foot and Ankle Division NYU Langone Health New York City New York USA

2. Royal College of Surgeons in Ireland Dublin Ireland

3. Department of Orthopedic Surgery NYU Langone Health New York City New York USA

4. Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC University of Amsterdam Amsterdam The Netherlands

5. Academic Center for Evidence‐Based Sports Medicine Amsterdam UMC Amsterdam The Netherlands

6. Amsterdam Collaboration for Health and Safety in Sports, International Olympic Committee Research Center Amsterdam UMC Amsterdam The Netherlands

Abstract

AbstractPurposeThe purpose of this systematic review was to evaluate the clinical and radiological outcomes together with the complication rates and failure rates at short‐term follow‐up following particulated juvenile cartilage allograft (PJCA) for the management of osteochondral lesions of the talus (OLT).MethodsDuring October 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following PJCA for the management of OLTs. Data regarding study characteristics, patient demographics, lesion characteristics, subjective clinical outcomes, radiological outcomes, complications and failures were extracted and analysed.ResultsTwelve studies were included. In total, 241 patients underwent PJCA for the treatment of OLT at a weighted mean follow‐up of 29.0 ± 24.9 months. The weighted mean lesion size was 138.3 ± 59.6 mm2. Prior surgical intervention was recorded in seven studies, the most common of which was microfracture (65.9%). The weighted mean American Orthopaedic Foot and Ankle Society score improved from a preoperative score of 58.5 ± 3.2 to a postoperative score of 83.9 ± 5.3. The weighted mean postoperative magnetic resonance observation of cartilage repair tissue (MOCART) score was 48.2 ± 3.3. The complication rate was 25.2%, the most common of which was allograft hypertrophy (13.2%). Thirty failures (12.4%) were observed at a weighted mean time of 9.8 ± 9.6 months following the index procedure.ConclusionThis systematic review demonstrated a moderate improvement in subjective clinical outcomes following PJCA for the treatment of OLT at short term follow‐up. However, postoperative MOCART scores were reported as poor. In addition, a high complication rate (25.2%) and a high failure rate (12.4%) at short‐term follow‐up was observed, calling into question the efficacy of PJCA for the treatment of large OLTs. In light of the available evidence, PJCA for the treatment of large OLTs cannot be currently recommended.Level of EvidenceLevel IV.

Publisher

Wiley

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