title: Treatment of osteochondral fractures of the knee: a meta-analysis of available scientific evidence.
abstract: OBJECTIVE
  Although traumatic osteochondral fractures of the knee represent a common pathology of the knee joint, there is no general agreement concerning specific treatment of this entity. This meta-analysis was initiated in order to evaluate scientific evidence on different treatment options for acute osteochondral fractures of the knee.
  
  
  METHODS
  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. The literature search period was from 1946 to January 2012, which led to the identification of 1,226 articles. After applying study-specific inclusion criteria a total of 19 studies with clinical follow-up of 638 patients were included. The methodology of these studies was systematically analysed by means of the Coleman Methodology Score. Outcome and success rates were evaluated depending on treatment applied.
  
  
  RESULTS
  All studies (n = 19) identified represent case series (evidence-based medicine level IV) and included a total of 638 patients. The average post-operative follow-up was 46 ± 27 months (range 3.75-108). The mean number of study subjects per study was 33 ± 44 patients (range 4-169). The average Coleman Methodology Score was 29 ± 17 points (range 5-72). Six different scoring systems were used for clinical assessment. The overall clinical success rate was 83% and varied between 45 and 100%.
  
  
  CONCLUSIONS
  This meta-analysis reveals a significant lack of scientific evidence for treatment of osteochondral fractures of the knee. No valid conclusion can be drawn from this study concerning the recommendation of a specific treatment algorithm. Nevertheless, the overall failure rate of 17% underlines that an acute osteochondral fracture of the knee represents an important pathology which is not a self-limiting injury and needs further investigation.
authors.forename: Jan
authors.initials: J
authors.lastname: Kühle
authors.forename: Peter
authors.initials: P
authors.lastname: Angele
authors.forename: Peter
authors.initials: P
authors.lastname: Balcarek
authors.forename: Martin
authors.initials: M
authors.lastname: Eichinger
authors.forename: Matthias
authors.initials: M
authors.lastname: Feucht
authors.forename: Carl
authors.initials: C
authors.lastname: Haasper
authors.forename: Gohm
authors.initials: G
authors.lastname: Alexander
authors.forename: Tobias
authors.initials: T
authors.lastname: Jung
authors.forename: Helmut
authors.initials: H
authors.lastname: Lill
authors.forename: Bastian
authors.initials: B
authors.lastname: Marquass
authors.forename: Michael
authors.initials: M
authors.lastname: Osti
authors.forename: Ralf
authors.initials: R
authors.lastname: Rosenberger
authors.forename: Gian
authors.initials: G
authors.lastname: Salzmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Steinwachs
authors.forename: Christine
authors.initials: C
authors.lastname: Voigt
authors.forename: Stephan
authors.initials: S
authors.lastname: Vogt
authors.forename: Johannes
authors.initials: J
authors.lastname: Zeichen
authors.forename: Philipp
authors.initials: P
authors.lastname: Niemeyer
mesh_terms: D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
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