Matrix-associated stem cell transplantation is successful in treating talar osteochondral lesions

Abstract

Purpose Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to try and treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix-associated stem cell transplantation (MAST) is one such treatment described for larger lesions > 15 mm 2 or failed alternative therapies. This cohort study describes a 3 year review of the outcomes of talar lesions treated with MAST. Methods A review of all patients treated with MAST by a single surgeon was conducted. Pre-operative radiographs, MRIs, and FAOS outcome questionnaire scores were reviewed. Intraoperative classification was undertaken to correlate with imaging. Post-operative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment, and progression to ankle fusion. Results In this study, 38 OCLs in 32 patients were identified. Median patient age was 35 years of which (68.8%) were male. Median length of follow-up was 36.7 months (range 12-64 months). (83%) returned to playing sport. Twenty-three patients underwent MAST in the setting of a failed previous operative attempt, with just nine having MAST as a first option. Nine patients out of 32 had a further procedure. Improvements were seen in all domains of the FAOS (p < 0.05). Conclusion MAST has demonstrated encouraging results in lesions which prove challenging to treat, even in a "failed microfracture" cohort. Level of evidence IV.

Comparison of Clinical and Radiographic Outcomes Following Arthroscopic Debridement With Extracellular Matrix Augmentation and Osteochondral Autograft Transplantation for Medium-Size Osteochondral Lesions of the Talus

“…9 A similar matrix plus BMAC technique, known as MAST, has also demonstrated promising outcomes in treating medium to large lesions, but without radiographic data or a control group. 15 There is also a lack of existing literature on the use of ECM-BMAC alongside OAT, though supplementing OAT with BMAC alone seems to lower the rate of postoperative cysts. 20 ECM and BMAC in combination may further improve the results of OAT by providing a structural scaffold, stem cells, and growth factors to encourage thorough cartilage repair around the OAT plug.…”

Frontiers in Orthobiologics for the Treatment of Osteochondral Lesions of the Ankle Joint

“…Clinical studies have reported promising outcomes after autologous cell transplantation; however, most of the literature consists of smaller case series with wide heterogeneity [35][36][37][38][39].…”

Functional Outcomes of Autologous Matrix-Related Chondrogenesis to Treat Large Osteochondral Lesions of the Talus

“…In the literature, these techniques were compared with each other, but no technique was found to be superior to another. 3,14,17,18,20,27 AMIC technique consists of bone marrow stimulation via microfracture, structural support via autograft application for filling the defective area, and application of potentially chondrogenic agents, such as commercially available collagen type I/III bilayer matrix. Therefore, AMIC has the advantages of being a single-step (unlike ACI/MACI), less expensive (unlike ACI/MACI or allograft applications) procedure 27 and avoids the difficulties like obtaining a matching allograft or knee-related donor site morbidity, which is a major concern for OATS.…”