SLR - May 2013 - Christine Nolan
Reference: Kim YS, Park EH, Kim YC, Koh YG. Clinical Outcomes of Mesenchymal Stem Cell Injection with Arthroscopic Treatment in Older Patients with Osteochondral Lesions of the Talus. The American Journal of Sports Medicine. Volume 20, No 10. March 2013.
Scientific Literature Review
Reviewed by: Christine Nolan, DPM
Residency Program: Temple University Hospital, Philadelphia, PA
Podiatric Relevance: Osteochondral lesions of the talus (OLT) is a broad term for injuries of the articular cartilage of the talus. There are many proposed ways to treat these lesions, including subchondral drilling, curettage microfracture, mosaicsplasty, and osteochondral allograft. These methods are often successful in regeneration of fibrotic tissue. However, the fibrocartilage is a poor alternative tissue due to its biomechanical insufficiency. Mesenchymal stem cells (MSC) have now been proposed as a treatment for regeneration of hyaline cartilage for superior outcomes in the treatment of OLT.
Methods: One hundred and seven consecutive patients older than 50 years old with OLT were divided into two groups with similar demographic data. Patients treated with prior surgery or arthritic changes in the ankle were excluded. Group A was treated with arthroscopic debridement of damaged cartilage and microfracture through the subchondral bone; Group B was treated likewise, however after microfracture, they were injected with autogenous MSCs harvested from the gluteal fat pad 24 hours prior. All patients were treated with a short leg splint for two weeks with weight bearing as tolerated, and passive and active ROM four weeks after surgery. Sports and high impact activities were limited for at least three months. Clinical outcomes were evaluated with the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS), the Roles and Maudsley scale, and Tegner activity scale.
Results: Each of the groups saw a decrease in the VAS and an increase in AOFAS scores and Roles and Maudsley score postoperatively. VAS scores improved in Group A from 7.2 to four and in Group B from 7.1 to 3.2. AOFAS scores showed an increase in scores in Group A from 68 to 77.2 and in Group B 68.1 to 82.6, with statically significant difference at final follow-up. There was also a documented increase in the Tegner activity level which was significantly improved in Group B but not Group A at the final follow-up. According to the Roles and Maudsley score, 52 percent of Group A patients and 78 percent of Group B patients had good to excellent results postoperatively. The Tegner activity scale showed increases in Group B, but not in Group A at the final follow-up. Return to activity times also differed in the two groups, with Group A having an average of 17.3 weeks and Group B at 15.4 weeks, respectively.
Conclusions: The results demonstrate that microfracture with an injection of mesenchymal stem cell was superior in treatment of OLT’s in older patients and larger lesions, a group notorious for poor clinical outcomes after sustaining talar trauma.