Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence.

PURPOSE: While autologous chondrocyte implantation (ACI) has become an established surgical treatment for cartilage defects of the knee, only little is known about the clinical outcome following ACI for chondral or osteochondral lesion of the ankle. To evaluate efficiency and effectiveness of ACI for talar lesions was aim of the present meta-analysis.

METHODS: An OVID-based literature search was performed to identify any published clinical studies on autologous chondrocyte implantation (ACI) for the treatment of pathologies of the ankle including the following databases: MEDLINE, MEDLINE preprints, EMBASE, CINAHL, Life Science Citations, British National Library of Health, and Cochrane Central Register of Controlled Trials (CENTRAL). Literature search period was from the beginning of 1994 to February 2011. Of 54 studies that were identified, a total of 16 studies met the inclusion criteria of the present meta-analysis. Those studies were systematically evaluated.

RESULTS: All studies identified represented case series (EBM Leven IV). 213 cases with various treatment for osteochondral and chondral defects with a mean size of 2.3 cm(2) (±0.6) have been reported. A total of 9 different scores have been used as outcome parameters. Mean study size was 13 patients (SD 10; range 2-46) with a mean follow-up of 32 ± 27 months (range 6-120). Mean Coleman Methodology Score was 65 (SD 11) points. Overall clinical success rate was 89.9%.

CONCLUSIONS: Evidence concerning the use of ACI for osteochondral and chondral defects of the talus is still elusive. Although clinical outcome as described in the studies available seems promising--with regard to a lack of controlled studies--a superiority or inferiority to other techniques such as osteochondral transplantation or microfracturing cannot be estimated.