This systematic review pooled 52 studies covering 1361 patients to compare treatment strategies for osteochondral lesions of the talus. It asks which surgical option gives the best success rate for talar OCD. Only one RCT existed, so study-weighted success percentages were used instead of formal meta-analysis.
When you see a symptomatic primary talar OCD under about 1.5 cm, the decision rule from this review is straightforward: trial non-operative management first, then move to arthroscopic debridement and bone marrow stimulation.
BMS wins not because it has the flashiest biology (it makes fibrocartilage, not hyaline) but because it delivers an 85% success rate cheaply, with low morbidity and quick recovery. OATS and ACI restore hyaline cartilage, but OATS costs you a donor knee (morbidity up to 36%) and ACI costs money and needs a two-stage procedure. Reserve them for large or failed lesions.
Know the Berndt and Harty stages and the lesion-size thresholds for boards. The critical caveat: this is Level IV evidence pooled from case series with only one weak RCT, so treat the success percentages as guidance, not proof.
This systematic review pooled 52 studies covering 1361 patients to compare treatment strategies for osteochondral lesions of the talus. It asks which surgical option gives the best success rate for talar OCD. Only one RCT existed, so study-weighted success percentages were used instead of formal meta-analysis.
When you see a symptomatic primary talar OCD under about 1.5 cm, the decision rule from this review is straightforward: trial non-operative management first, then move to arthroscopic debridement and bone marrow stimulation.
BMS wins not because it has the flashiest biology (it makes fibrocartilage, not hyaline) but because it delivers an 85% success rate cheaply, with low morbidity and quick recovery. OATS and ACI restore hyaline cartilage, but OATS costs you a donor knee (morbidity up to 36%) and ACI costs money and needs a two-stage procedure. Reserve them for large or failed lesions.
Know the Berndt and Harty stages and the lesion-size thresholds for boards. The critical caveat: this is Level IV evidence pooled from case series with only one weak RCT, so treat the success percentages as guidance, not proof.