[Regeneration of osteochondral defects in the knee].

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Abstract

[Indexed for MEDLINE] 19. EFORT Open Rev. 2024 Mar 5;9(3):217-234. doi: 10.1530/EOR-23-0075. Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group 'clinical tissue regeneration' of the German Society of Orthopedics and Traumatology (DGOU). Walther M(1)(2)(3)(4)(5), Gottschalk O(1)(2)(5), Aurich M(5)(6)(7). Author information: (1)Schön Klinik München Harlaching - FIFA Medical Centre of Excellence, Harlachinger Straße, Munich, Germany. (2)Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany. (3)Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Brettreichstraße, Würzburg, Germany. (4)Paracelsus Medizinische Privatuniversität, Strubergasse, Salzburg, Austria. (5)Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany. (6)Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), DOUW - Abteilung für Unfall- und Wiederherstellungschirurgie, Ernst-Grube-Straße, Halle, Germany. (7)BG-Klinikum Bergmannstrost Halle, Halle, Saale, Germany. The working group 'Clinical Tissue Regeneration' of the German Society of Orthopedics and Traumatology (DGOU) issues this paper with updating its guidelines. Literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLT) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available with a grade of recommendation. All group members rated the statements to identify possible gaps between literature and current clinical practice. Fixation of a vital bony fragment should be considered in large fragments. In children with open physis, retrograde drilling seems to work better than in adults, but even there, the revision rate reaches 50%. The literature supports debridement with bone marrow stimulation (BMS) in lesions smaller than 1.0 cm² without bony defect. The additional use of a scaffold can be recommended in lesions larger than 1.0 cm². For other scaffolds besides AMIC®/Chondro-Gide®, there is only limited evidence. Systematic reviews report good to excellent clinical results in 87% of the patients after osteochondral transplantation (OCT), but donor site morbidity is of concern, reaching 16.9%. There is no evidence of any additional benefit from autologous chondrocyte implantation (ACI). Minced cartilage lacks any supporting data. Metallic resurfacing of OLT can only be recommended as a second-line treatment. A medial malleolar osteotomy has a minor effect on the clinical outcome compared to the many other factors influencing the clinical result. DOI: 10.1530/EOR-23-0075 PMCID: PMC10958247