Interventions for treating defects of the joint surfaces of the ankle bone in adults

Osteochondral defects are limited areas of damage to the lining of a joint. These defects involve the joint surface (chondral) and also the bone underneath the surface (osteo). The ankle is composed of three bones named the tibia (shin bone), fibula (the other lower leg bone) and talus (ankle bone). This review just looks osteochondral defects in the talus. Such defects occur mainly after trauma. They are rare but can result in pain and significant disability.

Treatment can be either by non-surgical or surgical means. Non-surgical interventions include activity restriction, physiotherapy and supplementation of the synovial fluid (the lubricating fluid within a joint). Surgical interventions by keyhole or open surgery aim to regenerate or replace the articular surface of the joint. This review included only one very small randomised trial with 15 participants, all of whom had chronic pain from osteochondral defects in the ankle bone. This trial looked at the effect of injecting hyaluronic acid, a lubricant, into the joint three weeks after surgical repair. However, there was only a brief report of this small and probably biased trial. There were no numerical data to draw conclusions on the effects of the intervention.

Currently there is insufficient evidence from randomised trials to determine which interventions are best for osteochondral defects of the talus in adults.

Authors' conclusions: 

There is insufficient evidence from randomised trials to determine which interventions are best for osteochondral defects of the talus in adults. High quality randomised trials are required to guide non-surgical and surgical treatment decisions for these injuries.

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Background: 

Osteochondral defects of the talus are usually a consequence of trauma. They can cause chronic pain and serious disability. Various interventions, non-surgical and surgical, have been used for treating these defects.

Objectives: 

The objective of this review is to determine the benefits and harms of the interventions used for treating osteochondral defects of the talus in adults.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, MEDLINE In-Process, EMBASE, Current Controlled Trials, the WHO International Clinical Trials Registry Platform and reference lists of articles. Date of last search: December 2009.

Selection criteria: 

Eligible for inclusion were any randomised or quasi-randomised controlled clinical trials evaluating interventions for treating osteochondral defects of the talus in adults. Our primary outcomes included pain, ankle function, treatment failure (unresolved symptoms or reoperation) and health-related quality of life. Preference was given to validated, patient-reported outcome measures.

Data collection and analysis: 

Two review authors independently evaluated trials for inclusion and, for the included trial, independently assessed the risk of bias and extracted data.

Main results: 

One small trial with 15 participants and six months follow-up was included. This trial was published only as a conference abstract, which provided inadequate information to judge the trial's methods and no numerical results. The trial reported that a series of three intra-articular hyaluronan injections started three weeks after arthroscopic microfracture did not to improve pain but may have improved one aspect of mobility. There were no available data to check this claim.

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