SLR - April 2019 - Joshua Lisonbee
Reference: Shimozono Y, Yasui Y, Hurley ET, Paugh RA, Deyer TW, Kennedy JG. Concentrated Bone Marrow Aspirate May Decrease Postoperative Cyst Occurrence Rate in Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus. Arthroscopy. 2019 Jan; 35(1):99-105.Scientific Literature Review
Reviewed By: Joshua Lisonbee, DPM
Residency Program: Long Beach Memorial Medical Center, CA
Podiatric Relevance: Osteochondral lesions of the talus (OLTs) are a common injury, noted to be present in up to 50 percent of acute ankle sprains and fractures and frequently requiring surgical intervention to treat. Autologous osteochondral transplantation (AOT) is a surgical intervention noted to have high clinical success rates in treating OLTs; however, high rates of subchondral cyst formation are noted postoperatively with AOT, and their presence can be correlated to graft failure. Concentrated bone marrow aspirate (CBMA) has shown potential for improving bone regeneration and cartilage repair and may improve integration between graft and native tissues. This study aims to evaluate whether CBMA has any impact on functional and MRI outcomes postoperatively, when used as an adjunct to AOT. Additionally, the study aims to assess the efficacy of CBMA in reducing the presence of postoperative cyst formation following AOT.
Methods: Level III retrospective comparative trial of all patients who underwent AOT between 2004 and 2008 by the senior author. Inclusion criteria were patients 18–60 years old with a minimum of five years of postoperative follow-up and MRI results. Patients from 2004–2005 formed the AOT-alone group (26 patients), while patients 2005–2008 received CBMA/AOT (28 patients). Primary outcome measures were Foot and Ankle Outcome Score (FAOS) and Short-Form 12 (SF-12), assessed preoperatively and at final follow-up. Secondary outcome measure was evaluation of postoperative MRI using the modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system.
Results: Both the AOT-alone and CBMA/AOT groups showed significant improvement in FAOS and SF-12 scores compared to their respective preoperative states. No significant difference was noted in FAOS and SF-12 scores between the two groups postoperatively. No significant difference was noted in MOCART scores between AOT-alone and CBMA/AOT groups. CBMA/AOT was found to have a statistically lower rate of cyst formation compared to AOT-alone; however, no significant difference was noted in the postoperative outcomes of patients with and without cysts, regardless of group.
Conclusions: The authors conclude that there were no significant differences in functional or radiographic outcomes in patients who underwent AOT with or without CBMA. Despite this, the conclusion that CBMA with AOT is able to significantly lower the rate of postoperative cyst formation is important. The lack of difference between groups can possibly be explained by prior literature, which suggests that cysts do not have a negative impact on short-term outcomes unless graft failure occurs, and long-term outcomes with cysts have not been fully investigated yet. Additionally, there was no analysis of the cellular components of CBMA, which may have varied between patients. Despite limitations, literature is very promising for CBMA, and further investigation warranted. This study was limited by being only short- and midterm follow-up, retrospectively, and with a limited sample size. Larger prospective studies would be useful.