Surgical treatment of osteochondritis dissecans of the talus: a systematic review.

PURPOSE: Osteochondritis dissecans (OCD) is an aseptic bone necrosis and represents pathology of high clinical relevance, which is frequently located on the talus. Various treatment strategies including non-surgical and surgical approaches have been described. An evidence-based treatment algorithm is still lacking. The present systematic review focuses on surgical treatment options and their stage-dependent outcome described for treatment of osteochondritis dissecans of the talus with special regard to the best available evidence.
METHODS: For this purpose, an OVID-based systematic literature search was performed including the following databases; MEDLINE, MEDLINE preprints, EMBASE, CINAHL, Life Science Citations, British National Library of Health and Cochrane Central Register of Controlled trials (CENTRAL). Literature search period was from January 1967 up to December 2009. After applying study specific inclusion criteria (minimum follow-up 12 months, patient evaluation by standardized scoring systems, etc.), a total of 54 studies with clinical follow-up of 1,105 patients was included. Methodology of these studies was systematically analyzed by the means of the Coleman Methodology Score. Outcome and success rate was evaluated in dependence of surgical treatment applied and in dependence of the stage of disease.
RESULTS: All 54 studies included were classified as evidence level IV representing case series. The average Coleman Methodology Score was 63 (SD ± 17) points. The average follow-up of the 1,105 patients was 47 months (SD ± 17) with a mean age of 29 (SD ± 5.6) years. The proportion of excellent and good treatment results was stage-independent in total 75 %. According to the criteria of the score applied for patient's evaluation in the individual study, the overall percentage of "good" and "excellent" clinical outcome in 869 patients was 79 %, and according the classification of Berndt and Harty, 82 % in stage I, 86 % in stage II, 83 % in stage III and 76 % in stage IV.
CONCLUSIONS: Although OCD of the talus represents a frequently observed orthopedic pathology, evidence concerning operative treatment of osteochondrosis dissecans of the talus is still elusive. With over 1,100 included patients in the present study, no strong recommendations based upon scientific evidence can be given.