Surgical treatment of osteochondritis dissecans of the talus: a systematic review.
Summary of "Surgical treatment of osteochondritis dissecans of the talus: a systematic review."
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.
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.
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.
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.
Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Hugstetter Str. 55, 79098, Freiburg, Germany, firstname.lastname@example.org.
This article was published in the following journal.
Name: Archives of orthopaedic and trauma surgery
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22622794
- DOI: http://dx.doi.org/10.1007/s00402-012-1544-1
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Medical and Biotech [MESH] Definitions
A type of osteochondritis in which articular cartilage and associated bone becomes partially or totally detached to form joint loose bodies. Affects mainly the knee, ankle, and elbow joints.
Fibrous, bony, cartilaginous and osteocartilaginous fragments in a synovial joint. Major causes are osteochondritis dissecans, synovial chondromatosis, osteophytes, fractured articular surfaces and damaged menisci.
Review of the medical necessity of hospital or other health facility admissions, upon or within a short time following an admission, and periodic review of services provided during the course of treatment.
Formal programs for assessing drug prescription against some standard. Drug utilization review may consider clinical appropriateness, cost effectiveness, and, in some cases, outcomes. Review is usually retrospective, but some analysis may be done before drugs are dispensed (as in computer systems which advise physicians when prescriptions are entered). Drug utilization review is mandated for Medicaid programs beginning in 1993.
Organizations representing designated geographic areas which have contracts under the PRO program to review the medical necessity, appropriateness, quality, and cost-effectiveness of care received by Medicare beneficiaries. Peer Review Improvement Act, PL 97-248, 1982.