Use of Extracellular Matrix Cartilage Allograft May Improve Infill of the Defects in Bone Marrow Stimulation for Osteochondral Lesions of the Talus

SLR - December 2021 - David Sved

Reference: Shimozono Y, Williamson ERC, Mercer NP, Hurley ET, Huang H, Deyer TW, Kennedy JG. Use of Extracellular Matrix Cartilage Allograft May Improve Infill of the Defects in Bone Marrow Stimulation for Osteochondral Lesions of the Talus. Arthroscopy. 2021 Jul;37(7):2262-2269. doi: 10.1016/j.arthro.2021.03.032. Epub 2021 Mar 24. PMID: 33771691.

Level of Evidence: Level III, Retrospective Comparative Study

Scientific Literature Review

Reviewed By: David Sved, DPM
Residency Program: Ascension SE Wisconsin – Milwaukee, WI

Podiatric Relevance: Talar dome lesions are a common pathology encountered within the tibial talar joint with much debate on proper treatment of these lesions. Much debate is had on the topic of Bone Marrow Stimulation (BMS) alone versus the use of Extracellular Matrix Cartilage Allograft (EMCA). This study aims at assessing the viability of these grafts along with their ability to infill defects and improve patient outcome scores.

Methods: A retrospective cohort study was performed comparing patients treated with BMS with EMCA and BMS alone. This was performed between 2014 and 2019. Clinical outcomes were evaluated with the FAOS score pre and post operatively. MRI was utilized to post operatively to evaluate the talar lesion and evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MROCRT) Score. Comparisons between the two groups were made.  

Results: Twenty-four patients underwent BMS with EMCA and 24 patients underwent BMS alone. The mean age was 40.8 in the EMCA group and 47.8 in the BMS alone group. Mean follow up time was 20-26.9 months. Both groups showed significant improvements in all FAOS subscalles with no differences in their postoperative values. MROCRT score in the BMS-EMCA was much higher (76.3 vs 66.3), however this was not statistically significant. MRI showed that 87.5 percent of the BMS-EMCA patients had complete infill of the defect while only 46.5 percent of BMS alone patients encountered complete infill.

Conclusions: This study is helpful in the management of talar dome lesions. This study showed that BMS combined with EMCA is an effective treatment for osteochondral lesions of the talus and provides superior cartilage infill in the defect on MRI compared to BMS alone. However, these findings did not improve functional outcomes of the patients. In fact, there was no significant difference in clinical function scoring between the two groups post operatively. In conclusion EMCA is helpful in filling cartilage defects of the talus however without improvement in functional outcome as well as increased surgical cost the practicality of its use is debatable. Limitations of this study include a relatively small patient size with short follow up.