title: Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review.
abstract: BACKGROUND
  The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs.
  
  
  OBJECTIVE
  To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes.
  
  
  RESULTS
  Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm2in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies.
  
  
  CONCLUSIONS
  An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.
authors.affiliation: Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ramponi
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.|Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.|University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Murawski
authors.affiliation: Southern California Orthopedic Institute, Van Nuys, California, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Ferkel
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: DiGiovanni
authors.affiliation: Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.|Academic Center for Evidence Based Sports Medicine, Amsterdam, the Netherlands.|Amsterdam Collaboration on Health and Safety in Sports, Amsterdam, the Netherlands.
authors.forename: Gino M M J
authors.initials: GMMJ
authors.lastname: Kerkhoffs
authors.affiliation: The Fortius Clinic, London, UK.
authors.forename: James D F
authors.initials: JDF
authors.lastname: Calder
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.affiliation: Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vannini
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Choi
authors.affiliation: Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin Woo
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: James
authors.initials: J
authors.lastname: Stone
authors.affiliation: Hospital for Special Surgery, New York, New York, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
mesh_terms: D001182:Arthroscopy; D001853:Bone Marrow / Q000601:surgery*; D002356:Cartilage / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: bone marrow stimulation; lesion size; systematic review; talar osteochondral lesion