Outcomes of Autologous Osteochondral Transplantation With and Without Extracellular Matrix Cartilage Allograft Augmentation for Osteochondral Lesions of the Talus

Abstract

Background: Autologous osteochondral transplantation (AOT) using a cylindrical graft in the treatment of osteochondral lesions of the talus (OLTs) is typically indicated for patients with larger lesions. However, with lesions that are irregular in shape, the AOT graft may not completely replace the lesion. For these lesions, we utilize extracellular matrix cartilage allograft (EMCA) augmentation in AOT to act as a physiologic grout at the host-graft interface. Purpose: To determine if the combination of EMCA with concentrated bone marrow aspirate (CBMA) would improve integration of the host-graft interface and subsequently reduce postoperative cyst formation after AOT. It was also hypothesized that EMCA in conjunction with CBMA would demonstrate improved MOCART (magnetic resonance observation of cartilage repair tissue) scores and functional outcome scores at a minimum 2 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed comparing patients treated with AOT/CBMA alone and AOT with CBMA/EMCA. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score. Magnetic resonance imaging appearance was evaluated with the use of the MOCART (magnetic resonance observation of cartilage repair tissue) score. Cyst formation was also evaluated on postoperative magnetic resonance imaging. Results: A total of 26 patients were included in the AOT + CBMA/EMCA group (10 male, 16 female), and 34 patients were included in the AOT/CBMA group (17 male, 17 female). The mean Foot and Ankle Outcome Score significantly improved in both groups ( P < .001) across all subscales (symptoms, pain, activities of daily living, sports activities, and quality of life), but there was no significant difference between groups at final follow-up. There was no significant difference in mean MOCART scores between the groups ( P = .118). In the AOT/CBMA group, 3 patients (8.8%) complained of knee pain, and 1 (2.9%) required additional surgery (hardware removal). In the AOT + CBMA/EMCA group, 2 patients (7.7%) complained of knee pain, and 6 patients (23%) required additional surgery (3 hardware removals and 3 arthroscopic debridements of scar tissue in the ankle). Conclusion: We found that while EMCA with CBMA has benefit in regeneration and repair of OLT treated with bone marrow stimulation, there appears to be little benefit of EMCA over CBMA alone as a physiologic grout at the graft-host interface in OLT treated with AOT.

The Frequency and Severity of Complications in Surgical Treatment of Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis of 6,962 Lesions

“… f Multiple studies: 15,36,39,47,48,50,60,68,70,71,74,75,83,84,87 -90,95 -97,100,105,106,108,110,120,126,128,129,132,136,138,148,151,152,154,156,159 -161,163,171 -175,178,184,188,191,193,194,197,203 . …”

Comparison of Arthroscopic Microfracture for Osteochondral Lesions of the Talus With and Without Small and Shallow Subchondral Cysts

“…15 However, few studies paid attention to the depth of the subchondral lesion with small cysts presented. Traditional concepts suggest not to treat cystic lesions with microfracture 3,23 ; however, it is difficult to justify the use of osteochondral or osteoperiosteal transplantation for small cystic lesions. Jung et al 16,17 used microfracture to treat a group of cystic OLTs and reported promising clinical and radiographic outcomes based on pain and function scores and computed tomography scans.…”

Rethinking Cartilage Lesions of the Ankle: An Update on the Role of Biologic Adjuvants

“…The CBMA was truly biologically active, and the secretome produced was responsible not only for chondrogenic integration but was also chondroprotective of the surrounding cells. 17,18…”

“…The CBMA was truly biologically active, and the secretome produced was responsible not only for chondrogenic integration but was also chondroprotective of the surrounding cells. 17,18 Figure 1 A, Images identifying the anterior superior iliac crest, and a jamshidi needle is used to access the area between the inner and outer tables of the iliac crest. B, Heparin solution is within the syringe to prevent clotting.…”