SLR - March 2019 - Stephanie Kvas
Safety and Effectiveness of Talus Subchondroplasty and Bone Marrow Aspirate Concentrate for the Treatment of Osteochondral Defects of the Talus
Reference: Chan J, Guzman J, Vargas L, Myerson C, Chan J, Vulcano E. Safety and Effectiveness of Talus Subchondroplasty and Bone Marrow Aspirate Concentrate for the Treatment of Osteochondral Defects of the Talus. ORTHOPEDICS.2018; 41: e734-e737. doi: 10.3928/01477447-20180724-06
Scientific Literature Review
Reviewed By: Stephanie Kvas, DPM
Residency Program: Hennepin Healthcare, Minneapolis, MN
Podiatric Relevance: Podiatric surgeons often encounter patients with osteochondral defects (OCDs) of the talus. Although various procedures have been described to address this condition, there has been very little research on the treatment of OCDs presenting with accompanying bone marrow edema. In this article, the authors assess the safety and efficacy of arthroscopic percutaneous subchondroplasty and intra-articular injection of bone marrow aspirate for treatment of talar OCD with bone marrow edema.
Methods: The authors performed a retrospective case series involving 11 patients, all with talar OCDs measuring on average 1.3 x 1.4 cm with associated bone marrow edema of the talus identified on preoperative MRI imaging. All patients underwent arthroscopic percutaneous subchondroplasty with injectable calcium phosphate and intra-articular bone marrow aspirate. An average of 1.7 cm3 of calcium paste was injected into the subchondral bone corresponding with the area of maximum signal intensity on preoperative MRI. Lastly, 8.0 cm3 of bone marrow aspirate, obtained from the ipsilateral proximal medial tibial metaphysis, was injected intra-articular. All patients were allowed to weightbear as tolerated immediately following the procedure. Results were measured using VAS pain score and FAOS scores both pre and postoperatively.
Results: At one year follow-up, VAS pain score had improved from 7.8 preoperatively to 1.8 and mean FAOS improved from 67.1 to 89.6. One patient suffered from a stress fracture of the talar neck at the bone-calcium paste interface, which was attributed to overfilling of lesion with calcium phosphate paste. The remaining 10 patients recommended the procedure, stating they would go through it again, at one year follow-up. There was no postoperative imaging obtained to directly visualize results.
Conclusions: Based on the above findings, the authors concluded that this technique, which has been well described for treatment of OCDs with associated bone marrow edema in the knee, proves to be promising for treatment of lesions of the talus. They concluded that no more than 1.5 cm3 of calcium phosphate should be injected to prevent failure of subchondroplasty due to overfilling. Although the sample size was small and did not include a control cohort, the majority of patients experienced significant improvement in their symptoms at one year follow-up. A significant benefit of this procedure is the noninvasive nature, resulting in no compromise should additional treatments be required in the future. Based on the results of this article, the described procedure appears to be effective with minimal complications.