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Table 1 Comparison of three surgical techniques in the treatment of OCLA

From: Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients

  Arthroscopy, BMS Retrograde drilling ACI
Advantages - Indicated for chondral and osteochondral lesions [17]
- Reported reduction of pain and improvement of function (e.g. AOFAS score) [9]
- Low complication rate [9]
- Re-BMS is possible [17]
- Indicated for subchondral lesions [9]
- Can be performed with intraoperative imaging and/or targeting device [18]
- Good reported outcomes in patients with open growth plates and when performed as first-line surgical intervention [9]
- Can be combined with bone grafting (lesion diameter > 1 cm, depth > 1 cm, cysts > 100 mm3) [18]
- Indicated for lesions with size > 1 cm2 with or without cysts [19]; vs other recommendations: lesion size ≥ 1.5 cm2 [20]
- Good reported functional outcomes, even when performed after failed first-line surgical treatment [9]
- Can be combined with bone grafting
Limitations - Formation of fibrocartilage instead of hyaline cartilage [9]
- Lesions < 10 mm in diameter, < 100 mm2 in area and < 5 mm in depth [17]; vs. other recommendations: lesion size < 1.5 cm2 [20]
- Overlaying cartilage must be intact to achieve good outcome [9, 18] - Two-step procedure (harvesting and implantation) [9]
- Harvest-site morbidity
- Open procedure might be needed for implantation
  1. OCLA osteochondral lesion of the ankle, BMS bone marrow stimulation, ACI autologous chondrocyte implantation, AOFAS American Orthopaedic Foot and Ankle Society