Lesion Size Is a Predictor of Clinical Outcomes after Bone Marrow Stimulation for Osteochondral Lesions of the Talus

A Systematic Review

Laura Ramponi, Youichi Yasui, Christopher D. Murawski, Richard D. Ferkel, Christopher W. Digiovanni, Gino M.M.J. Kerkhoffs, James D.F. Calder, Masato Takao, Francesca Vannini, Woo Jin Choi, jinwoo lee, James Stone, John G. Kennedy

Research output: Contribution to journalReview article

32 Citations (Scopus)

Abstract

Background: The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. Purpose: To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. Study Design: Systematic review. Methods: A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QoE), lesion size, and clinical outcomes. Results: Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QoE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. Conclusion: An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.

Original languageEnglish
Pages (from-to)1698-1705
Number of pages8
JournalAmerican Journal of Sports Medicine
Volume45
Issue number7
DOIs
Publication statusPublished - 2017 Jun 1

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Talus
Bone Marrow
Ankle
Guidelines
MEDLINE
Orthopedics
Meta-Analysis
Foot
Databases

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Ramponi, L., Yasui, Y., Murawski, C. D., Ferkel, R. D., Digiovanni, C. W., Kerkhoffs, G. M. M. J., ... Kennedy, J. G. (2017). Lesion Size Is a Predictor of Clinical Outcomes after Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review. American Journal of Sports Medicine, 45(7), 1698-1705. https://doi.org/10.1177/0363546516668292
Ramponi, Laura ; Yasui, Youichi ; Murawski, Christopher D. ; Ferkel, Richard D. ; Digiovanni, Christopher W. ; Kerkhoffs, Gino M.M.J. ; Calder, James D.F. ; Takao, Masato ; Vannini, Francesca ; Choi, Woo Jin ; lee, jinwoo ; Stone, James ; Kennedy, John G. / Lesion Size Is a Predictor of Clinical Outcomes after Bone Marrow Stimulation for Osteochondral Lesions of the Talus : A Systematic Review. In: American Journal of Sports Medicine. 2017 ; Vol. 45, No. 7. pp. 1698-1705.
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abstract = "Background: The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. Purpose: To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. Study Design: Systematic review. Methods: A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QoE), lesion size, and clinical outcomes. Results: Twenty-five studies with 1868 ankles were included; 88{\%} were either LOE 3 or 4, and 96{\%} did not have good QoE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. Conclusion: An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.",
author = "Laura Ramponi and Youichi Yasui and Murawski, {Christopher D.} and Ferkel, {Richard D.} and Digiovanni, {Christopher W.} and Kerkhoffs, {Gino M.M.J.} and Calder, {James D.F.} and Masato Takao and Francesca Vannini and Choi, {Woo Jin} and jinwoo lee and James Stone and Kennedy, {John G.}",
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Ramponi, L, Yasui, Y, Murawski, CD, Ferkel, RD, Digiovanni, CW, Kerkhoffs, GMMJ, Calder, JDF, Takao, M, Vannini, F, Choi, WJ, lee, J, Stone, J & Kennedy, JG 2017, 'Lesion Size Is a Predictor of Clinical Outcomes after Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review', American Journal of Sports Medicine, vol. 45, no. 7, pp. 1698-1705. https://doi.org/10.1177/0363546516668292

Lesion Size Is a Predictor of Clinical Outcomes after Bone Marrow Stimulation for Osteochondral Lesions of the Talus : A Systematic Review. / Ramponi, Laura; Yasui, Youichi; Murawski, Christopher D.; Ferkel, Richard D.; Digiovanni, Christopher W.; Kerkhoffs, Gino M.M.J.; Calder, James D.F.; Takao, Masato; Vannini, Francesca; Choi, Woo Jin; lee, jinwoo; Stone, James; Kennedy, John G.

In: American Journal of Sports Medicine, Vol. 45, No. 7, 01.06.2017, p. 1698-1705.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Lesion Size Is a Predictor of Clinical Outcomes after Bone Marrow Stimulation for Osteochondral Lesions of the Talus

T2 - A Systematic Review

AU - Ramponi, Laura

AU - Yasui, Youichi

AU - Murawski, Christopher D.

AU - Ferkel, Richard D.

AU - Digiovanni, Christopher W.

AU - Kerkhoffs, Gino M.M.J.

AU - Calder, James D.F.

AU - Takao, Masato

AU - Vannini, Francesca

AU - Choi, Woo Jin

AU - lee, jinwoo

AU - Stone, James

AU - Kennedy, John G.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Background: The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. Purpose: To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. Study Design: Systematic review. Methods: A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QoE), lesion size, and clinical outcomes. Results: Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QoE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. Conclusion: An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.

AB - Background: The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. Purpose: To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. Study Design: Systematic review. Methods: A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QoE), lesion size, and clinical outcomes. Results: Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QoE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. Conclusion: An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.

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