Background:

No consensus has been reached regarding the optimal surgical treatment for focal chondral defects of the talus.

Purpose:

A Bayesian network meta-analysis was conducted to compare the clinical scores and complications of mosaicplasty, osteochondral auto- and allograft transplant, microfracture, matrix-assisted autologous chondrocyte transplant, and autologous matrix-induced chondrogenesis (AMIC) for chondral defects of the talus at midterm follow-up.

Study Design:

Bayesian network meta-analysis; Level of evidence, 4.

Methods:

This Bayesian network meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions. PubMed, Embase, Google Scholar, and Scopus databases were accessed in February 2021. All clinical trials comparing 2 or more surgical interventions for the management of chondral defects of the talus were accessed. The outcomes of interest were visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, rate of failure, and rate of revision surgery. The network meta-analysis were performed through the routine for Bayesian hierarchical random-effects model analysis. The log odds ratio (LOR) effect measure was used for dichotomous variables, and the standardized mean difference (SMD) was used for continuous variables.

Results:

Data from 13 articles (521 procedures) were retrieved. The median length of the follow-up was 47.8 months (range, 31.7-66.8 months). Analysis of variance revealed no difference between the treatment groups at baseline in terms of age, sex, body mass index, AOFAS score, VAS score, and mean number of defects. AMIC demonstrated the greatest AOFAS score (SMD, 11.27) and lowest VAS score (SMD, –2.26) as well as the lowest rates of failure (LOR, 0.94) and revision (LOR, 0.94). The test for overall inconsistency was not significant.

Conclusion:

At approximately 4 years of follow-up, the AMIC procedure for management of focal chondral defects of the talus produced the best outcome.

中文翻译：

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距骨局灶性软骨缺损的手术治疗：贝叶斯网络荟萃分析

背景：

关于距骨局灶性软骨缺损的最佳手术治疗尚未达成共识。

目的：

进行贝叶斯网络荟萃分析，比较镶嵌成形术、自体和同种异体骨软骨移植、微骨折、基质辅助自体软骨细胞移植和自体基质诱导软骨形成 (AMIC) 治疗距骨软骨缺损的临床评分和并发症。中期跟进。

学习规划：

贝叶斯网络荟萃分析；证据水平，4。

方法：

该贝叶斯网络荟萃分析遵循 PRISMA（系统评价和荟萃分析的首选报告项目）扩展声明，用于报告纳入医疗保健干预网络荟萃分析的系统评价。2021 年 2 月访问了 PubMed、Embase、Google Scholar 和 Scopus 数据库。访问了所有比较两种或多种手术干预治疗距骨软骨缺损的临床试验。感兴趣的结果是视觉模拟评分 (VAS) 评分、美国骨科足踝协会 (AOFAS) 评分、失败率和翻修手术率。通过贝叶斯分层随机效应模型分析的常规进行网络荟萃分析。对数优势比（LOR）效应测量用于二分变量，

结果：

检索了 13 篇文章（521 个程序）的数据。中位随访时间为 47.8 个月（范围 31.7-66.8 个月）。方差分析显示，基线时治疗组在年龄、性别、体重指数、AOFAS 评分、VAS 评分和平均缺陷数方面没有差异。AMIC 表现出最高的 AOFAS 评分 (SMD, 11.27) 和最低的 VAS 评分 (SMD, –2.26) 以及最低的失败率 (LOR, 0.94) 和翻修率 (LOR, 0.94)。对整体不一致的测试并不显着。

结论：

在大约 4 年的随访中，用于管理距骨局灶性软骨缺损的 AMIC 程序产生了最佳结果。