SLR - March 2019 - Michelle L. Winder
Reference: Hannon CP, Ross KA, Murawski CD, Deyer TW, Smyth NA, Hogan MV, Do HT, O’Malley MJ, Kennedy JG. Arthroscopic Bone Marrow Stimulation and Concentrated Bone Marrow Aspirate for Osteochondral Lesions of the Talus: A Case-Control Study of Functional and Magnetic Resonance Observation of Cartilage Repair Outcomes. Arthroscopy. 2016 Feb;32(2): 339–47.Scientific Literature Review
Reviewed By: Michelle L. Winder, DPM
Residency Program: Hennepin County Medical Center, Minneapolis, MN
Podiatric Relevance: Osteochondral defects (OCDs) of the talus are relativity common injuries that predispose patients to osteoarthritis. Multiple treatment methods have been developed in an attempt to prevent sequelae as well as provide the patient with symptomatic relief. Bone marrow stimulation (BMS) by microfracture has been shown to provide good functional outcomes. One disadvantage of this procedure is that it stimulates the production of fibrocartilage at the defect site, which is biologically and mechanically inferior to hyaline cartilage. This has lead to an interest in the use of other biological adjuncts that may improve the quality of the repaired tissue. One such adjunct is concentrated bone marrow aspirate (cBMA), which serves as a rich source of multiple growth factors that have been shown to induce chondrogenesis. The purpose of this study was to compare functional and MRI outcomes after arthroscopic BMS with and without cBMA for treatment of OCDs of the talus.
Methods: This is a level III retrospective comparative study, which compared MRI and functional outcomes of 22 patients who underwent BMS with cBMA to 12 patients who underwent BMS alone for treatment of talar OCDs. Exclusion criteria included any concomitant procedures, rheumatoid arthritis, diabetes mellitus or patients who received postoperative hyaluronan injections. BMA was harvested from the ipsilateral iliac crest concentrated by centrifugation. Outcomes assessed include MRI preoperatively and at two years postoperatively in which lesion area was measured at the widest point in coronal and sagittal views. Assessment of cartilage on MRI was performed using the magnetic resonance observation of cartilage repair (MOCART) scoring system. Additionally, all patients were assessed with Foot and Ankle Outcome (FAOS) and Short Form-12 (SF-12) questionnaires at the last visit prior to surgery and at each visit postoperatively.
Results: Demographics were similar between the two groups besides mean follow-up, which was significantly greater in the BMS-alone group at 77.3 months compared to 48.3 months in the BMS/cBMA group. Mean lesion size was 111.2 mm2 in the BMS-alone group and 103.0 mm2 in the BMS/cBMA group, which was not significantly different. Mean FAOS and SF-12 postoperative scores improved significantly in both groups compared to preoperative scores; however, there was no significant difference between the two groups. The average MOCART score was significantly higher in the BMS/cBMA group compared to the BMS-alone group, but T2-relaxation values did not reach the same values as adjacent native cartilage with cBMA.
Conclusions: Based on the results of this study, the authors conclude that BMS remains an effective treatment for OCDs of the talus, with good medium-term functional results. Arthroscopic BMS with cBMA has similar functional results to BMS alone, but MRI analysis further demonstrates that BMS with cBMA yields improved border repair tissue integration, higher rates of complete infill of the defect and decreased fissuring and fibrillation. Nonetheless, cartilage repair tissue was still inferior to adjacent native cartilage based on MRI, and the longevity of the effects of cBMA have yet to be determined.