Systematic review of treatment strategies for osteochondral defects of the talar dome.

The aim of this study was to summarize all eligible studies to compare the effectiveness of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from January 1966 to June 2000 were systematically screened. Based on our inclusion criteria, 39 studies describing the results of treatment strategies for OCD of the talus were included. No randomized clinical trials (RCT) were identified. Fourteen studies described the results of nonoperative treatment (NT); 4: the results of excision alone; 10: the results of excision and curettage (EC); 21: the results of excision, curettage, and drilling (ECD); 2: the results of cancellous bone grafting after EC; 1: the results of osteorchondral transplantation; 3: the results of fixation; and 1: the results of retrograde drilling. The average success rate of NT was 45%. Comparison of different surgical procedures showed that the highest average success rate is reached by excision, curettage, and drilling (ECD; 86%), followed by excision and curettage (EC; 78%) and excision alone (38%). On the basis of this systematic review, we conclude that NT and excision alone are not to be recommended in treating talar OCD. Both EC and ECD have been shown to lead to a high percentage good/excellent results. At the present time, ECD seems to be the most effective treatment strategy for osteochondral defect of the talus. Due to great diversity in the articles and variability in treatment results, however, no definitive conclusions can be drawn. Sufficiently powered randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus.