Treatment strategies in osteochondral defects of the talar dome: a systematic review

The aim of this study was to investigate the results of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databa ses from 1966 to July 1998 were systematically screened. Based on our inclu sion criteria 32 studies describing the results of treatment strategies for OCD of the talus were included. No randomized clinical trials (RCT's) were identified. Fourteen studies described the results of excision alone, 11 t he results of (EC), 14 the results of (ECD), 1 the results of cancellous bo ne grafting after EC, 1 the results of osteochondral transplantation and 3 the results of fixation. The average success rate of non-operative treatmen t (NT) was 45%. Comparison of different surgical procedures shows that the average highest success rate was reached by excision, curettage and drillin g (ECD) (85%) followed by excision and curettage (EC) (78%) and excision al one (38%). Based on this systematic review we conclude that NT and excision alone are not to be recommended in treating talar OCD. Both EC and ECD hav e been shown to lead to a high percentage good/excellent results, However, due to great diversity in the articles and variability in treatment results , no definitive conclusions can be drawn. Further prospective randomized co ntrolled trials are required to compare the outcome of these two surgical s trategies for OCD of the talus.