What Are These Cysts Doing in My Graft?! A Meta-Analysis on Cystic Occurrence after Autografting and Allografting for Osteochondral Lesions of the Talus

Category: Sports; Arthroscopy Introduction/Purpose: Graft transplantation is a widely used treatment for large osteochondral lesions of the talus. However, cyst formation surrounding the graft is of concern. The primary purpose was to assess and compare cystic occurrence after autografting, allografting and osteoperiosteal grafting for osteochondral lesions of the talus. Our secondary aim was to assess correlation of clinical outcomes with the presence of postoperative cysts. Methods: A literature search was performed up to October 2023 through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the postoperative cystic occurrence rate. A random effects model with moderator analysis was used to calculate differences in occurrence rates between treatment groups. The relationship between the presence of cysts and clinical outcomes was additionally described. Results: Thirteen studies were included with 382 ankles that were radiologically assessed at follow-up after osteochondral autograft, allograft, and osteoperiosteal transplantation. The rates of cystic occurrence for the osteochondral autograft transplantation group, the allograft transplantation group, and the osteoperiosteal transplantation group were 42% (95% CI 24-61), 58% (95% CI 40-74), and 34% (95% CI 12-67), respectively, without any significant differences noted between these treatment groups. Six studies studied the relationship between the presence of cysts and clinical outcomes: none of these studies found a significant relationship between these two variables. Conclusion: Postoperative cystic occurrence is common after osteochondral autograft transplantation (42%), allograft transplantation (58%), and osteoperiosteal transplantation (34%) in osteochondral lesions of the talus – without significant intertreatment differences. The postoperative presence of cysts was not correlated with clinical outcomes.