SLR - August 2023 - Kayli A Hurst DPM, MS
Title: Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus with Autologous Cancellous Bone GraftsReference: Gorgun B, Gamlı A, Duran ME, Bayram B, Ulku TK, Kocaoglu B. Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus With Autologous Cancellous Bone Grafts. Orthop J Sports Med. 2023 Jan 25;11(1):23259671221145733. doi: 10.1177/23259671221145733. PMID: 36743728; PMCID: PMC9893375.
Level of Evidence: Level III, Cohort Study
Reviewed By: Kayli A Hurst DPM, MS
Residency Program: Ascension St Vincent Indianapolis Podiatric Residency Program in Indianapolis, Indiana
Podiatric Relevance: Osteochondral lesions of the talus (OLT) are a challenging injury commonly encountered in patients following ankle trauma. Surgical intervention has recently become more popular as a form of treatment for patients who have larger lesions or fail conservative treatment. The purpose of this article is to compare results of arthroscopic OLT reconstruction with autologous bone grafting with versus without a type I/III porcine collagen scaffold.
Methods: Authors retrospectively reviewed patients with chronic ankle pain lasting >6 months, diagnosed with OLT, who underwent arthroscopic reconstructive surgery between 2010 and 2018. A total of 94 patients were included in the study that met criteria. The single-step arthroscopic procedure was applied with bone grafting only (without collagen scaffold) in 48 patients. Bone grafting with type I/III porcine collagen scaffold was applied to 46 patients. Clinical outcomes were obtained using AOFAS and VAS scores during the postoperative period and final follow up. Radiological evaluation was performed as well as MRI at final surgical follow up. MOCART scores were determined postoperatively using MRI.
Results: No statistically significant difference between groups in demographic characteristics or pre-operative AOFAS and VAS scores. The improvement in AOFAS and VAS scores postoperatively were not statistically significant between groups. A significant difference was found in MOCART scores between the two groups with non-collagen group achieving 66.0 and collagen group achieving 61.4. Complete healing with or without graft hypertrophy was not statistically different between the two groups. There was no statistically significant difference in postoperative complications between groups.
Conclusions: The results of this study outline that all-arthroscopic surgical treatment of an OLT achieved statistically similar clinical and radiological outcomes when compared with the additional measure of utilizing a collagen membrane. This study highlights that the mainstay of treatment should be to address the osseous component of OLT with debridement, microfracture, autologous bone graft and stabilization with fibrin glue. In this case, collagen implantation does not lead to more optimal outcomes radiologically or clinically. The goal of treatment should be primarily to treat the bone lesion.