Abstract
Objectives:
Bone marrow stimulation (BMS) is a common treatment for osteochondral lesions of the talus (OLTs) with favorable outcomes reported in the literature. However, there are concerns regarding the inferiority of fibrocartilage repair tissue and the potential degradation of results over time. To address these issues, the use of micronized cartilage matrix hydrated with bone marrow aspirate concentrate (MCM-BMAC) as an adjunct to BMS has been proposed to enhance chondrogenic differentiation and promote the development of hyaline-like cartilage. Despite its potential, evidence validating this approach remains limited. This study aimed to assess the clinical and radiographic outcomes of patients who underwent arthroscopic treatment of symptomatic OLTs using MCM-BMAC and BMS at a minimum follow-up of 2 years.
Methods:
Patients with symptomatic OLTs treated arthroscopically with MCM-BMAC and BMS were identified for this study. Patients were included if they were skeletally mature with a symptomatic chronic OLT as the surgical indication, failed nonoperative treatment, and had a minimum follow-up of 2 years. Outcome measures included American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Foot and Ankle Ability Measure (FAAM), Tegner Activity Scale, 36-Item Short Form Health Survey (SF-36, v2), visual analog scale (VAS) for pain, Patient-Reported Outcomes Measurement Information System 10 global survey (PROMIS-10), and patient satisfaction survey. Weightbearing radiographs were compared with preoperative radiographs via an ankle arthritis classification system. MRIs evaluated postoperative lesion characteristics using the magnetic resonance observation of cartilage repair tissue (MOCART 2.0) score and OsteoChondral Allograft MRI Scoring System (OCAMRISS).
Results:
The study group consisted of 22 patients (12 male, 10 female) with a mean age of 32.2 years (range, 15 – 63), mean follow-up of 4.2 years (range, 2 – 6.8 years), and mean lesion size of 84.2 mm2. Eighteen patients (82%) were very satisfied with their results and 20 patients (91%) reported their current level of function as normal or nearly normal. There was a significant reduction in VAS pain scores (7.0 vs 1.7, p < 0.05) and an increase in AOFAS scores (70.0 vs 90.9, p < 0.05) postoperatively. The mean postoperative Tegner activity level was 5.0, FAAM activities of daily living score was 88.8, and FAAM sports score was 69.0. The mean postoperative PROMIS-10 global physical health and mental health scores were 56.0 and 58.0, respectively, indicating very good and excellent results compared to the general population. The mean SF-36,v2 physical component score was 81.6. No patients showed evidence of radiographic progression of osteoarthritis. Postoperative MRI MOCART scores showed complete cartilage volume fill in 29% of cases, complete integration in 36% of cases, and an intact repair surface in 21% of cases, with a mean score of 58.2. The mean postoperative OCAMRISS score was 6.7. MRI findings did not correlate with clinical outcomes.
Conclusions:
Arthroscopic treatment of symptomatic OLTs treated with MCM-BMAC and BMS demonstrated high functional outcomes and clinical satisfaction rates despite discordant MRI results.
