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Systematic review
Talar osteochondral size influences outcome after microfractures: a systematic review
  1. Vincenzo Candela,
  2. Umile Giuseppe Longo,
  3. Mauro Ciuffreda,
  4. Giuseppe Salvatore,
  5. Alessandra Berton,
  6. Matteo Cimmino,
  7. Vincenzo Denaro
  1. Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Roma, Italy
  1. Correspondence to Prof Umile Giuseppe Longo, Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome 00128, Italy; G.Longo{at}


Importance No accepted definition of lesion size exists to treat osteochondral defects (OCD) of talus with bone marrow stimulation.

Objective The aim of this study is to establish a relationship between the clinical outcomes and size of OCD lesion to identify the area or diameter best suited to be treated with arthroscopic bone marrow stimulation.

Evidence review A search was conducted of level I through IV studies from January 2000 to August 2017, to identify studies reporting on talus OCDs treated with bone marrow stimulation. 21 articles were identified. The overall quality of evidence was fair.

Findings 21 articles were included in which 1303 ankles with OCD of talus were evaluated. Patients were assessed at a median follow-up period of 38.1 months, ranging from 6.3 to 217 months. Considering a cut-off of an area <1.5 cm2 or with a diameter ≤1.5 cm, the mean postoperative AOFAS (American Orthopaedic Foot and Ankle Society) value was 89.1±3 and 84.65±2.7, respectively (p=0.016).

Conclusions and relevance Despite the current lack of high-level evidence, our results suggest that microfractures provide an effective and reliable means to treat small to mid-sized OCD. Arthroscopic microfracture for isolated osteochondral lesions of the talus is a safe and effective procedure that provides good clinical outcomes for lesions with an area less than 1.5 cm2 or with a diameter less than 1.5 cm. The attempt to find a new cut-off value to identify more precisely good outcome lesions was unsuccessful. However, the long-term benefits of microfractures should be tested in larger cohort of patients with longer term evaluations.

Level of evidence Systematic review, level III.

  • ankle
  • trauma
  • cartilage
  • outcome studies

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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