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      Cell therapies for chondral defects of the talus: a systematic review

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          Abstract

          Background

          This systematic review investigated the efficacy and safety of surgical procedures augmented with cell therapies for chondral defects of the talus.

          Methods

          The present systematic review was conducted according to the 2020 PRISMA guidelines. PubMed, Google scholar, Embase, and Scopus databases were accessed in March 2022. All the clinical trials investigating surgical procedures for talar chondral defects augmented with cell therapies were accessed. The outcomes of interest were to investigate whether surgical procedures augmented with cell therapies promoted improvement in patients reported outcomes measures (PROMs) with a tolerable rate of complications.

          Results

          Data from 477 procedures were retrieved. At a mean follow-up of 34.8 ± 9.7 months, the Visual Analogic Scale (VAS) improved of 4.4/10 ( P = 0.002) and the American Orthopaedic Foot and Ankle Score (AOFAS) of 31.1/100 ( P = 0.0001) points. No improvement was found in Tegner score ( P = 0.4). Few articles reported data on complications. At last follow-up, the rate of reoperation and failure were 0.06% and 0.03%, respectively. No graft delamination or hypertrophy was observed.

          Conclusion

          The current evidence suggests that cell therapies may be effective and safe to enhance surgical procedures for chondral defects of the talus. These results should be considered within the limitations of the present study. The current literature should be enriched with randomized controlled clinical trials with larger population size and longer follow-up.

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          Most cited references92

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions

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              Grading quality of evidence and strength of recommendations.

              Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts. In this article we present a summary of our approach from the perspective of a guideline user. Judgments about the strength of a recommendation require consideration of the balance between benefits and harms, the quality of the evidence, translation of the evidence into specific circumstances, and the certainty of the baseline risk. It is also important to consider costs (resource utilisation) before making a recommendation. Inconsistencies among systems for grading the quality of evidence and the strength of recommendations reduce their potential to facilitate critical appraisal and improve communication of these judgments. Our system for guiding these complex judgments balances the need for simplicity with the need for full and transparent consideration of all important issues.
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                Author and article information

                Contributors
                migliorini.md@gmail.com
                Journal
                J Orthop Surg Res
                J Orthop Surg Res
                Journal of Orthopaedic Surgery and Research
                BioMed Central (London )
                1749-799X
                11 June 2022
                11 June 2022
                2022
                : 17
                : 308
                Affiliations
                [1 ]GRID grid.412301.5, ISNI 0000 0000 8653 1507, Department of Orthopaedic, Trauma, and Reconstructive Surgery, , RWTH University Hospital, ; Pauwelsstraße 30, 52074 Aachen, Germany
                [2 ]GRID grid.5570.7, ISNI 0000 0004 0490 981X, Department of Orthopaedic Surgery, , Auguste-Viktoria Clinic, Ruhr University Bochum, ; 32545 Bad Oeynhausen, Germany
                [3 ]GRID grid.413354.4, ISNI 0000 0000 8587 8621, Department of Orthopaedic and Trauma Surgery, , Cantonal Hospital, ; 6000 Lucerne, Switzerland
                [4 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, IRCCS Istituto Ortopedico Galeazzi, University of Milan, ; 20161 Milan, Italy
                [5 ]GRID grid.11780.3f, ISNI 0000 0004 1937 0335, Department of Medicine, Surgery and Dentistry, , University of Salerno, ; 84081 Baronissi, Italy
                [6 ]GRID grid.9757.c, ISNI 0000 0004 0415 6205, Faculty of Medicine, School of Pharmacy and Bioengineering, , Keele University, ; ST4 7QB Stoke on Trent, England
                [7 ]GRID grid.4868.2, ISNI 0000 0001 2171 1133, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, , Mile End Hospital, Queen Mary University of London, ; E1 4DG London, England
                Author information
                http://orcid.org/0000-0001-7220-1221
                Article
                3203
                10.1186/s13018-022-03203-4
                9188715
                f11a0b91-d8ef-4055-a47e-fc53f4b0976c
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 30 March 2022
                : 31 May 2022
                Funding
                Funded by: RWTH Aachen University (3131)
                Categories
                Systematic Review
                Custom metadata
                © The Author(s) 2022

                Surgery
                ankle,cartilage defects,mesenchymal stem cells,autologous chondrocyte implantation
                Surgery
                ankle, cartilage defects, mesenchymal stem cells, autologous chondrocyte implantation

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