SLR - November 2017 - Stephen F. Alayli

“One-Step” Bone Marrow-Derived Cells Transplantation and Joint Debridement for Osteochondral Lesions of the Talus in Ankle Osteoarthritis: Clinical and Radiological Outcomes at 36 Months

Reference: Buda R, Castagnini F, Cavallo M, Ramponi L, Vannini F, Giannini S. “One-Step” Bone Marrow-Derived Cells Transplantation and Joint Debridement for Osteochondral Lesions of the Talus in Ankle Osteoarthritis: Clinical and Radiological Outcomes at 36 Months. Arch Orthop Trauma Surg. 2016 Jan; 136(1):107–16.

Reviewed By: Stephen F. Alayli, DPM
Residency Program: Western Pennsylvania Hospital Pittsburgh, PA

Podiatric Relevance: Podiatric surgeons frequently deal with osteochondral lesions of the talus (OLTs) with concomitant ankle joint osteoarthritis (OA). The article outlines a joint debridement and one-step bone marrow-derived cell transplantation (BMDCT) technique to treat OLTs found with OA of the ankle.

Methods: Retrospective study of 56 patients placed into groups based on their osteoarthritis stage. Group 0 had MRI findings but no radiographic evidence of osteoarthritis. Groups 1, 2 and 3 were early, advanced and severe OA respectively. An AOFAS score was obtained preoperatively as well as at 6, 12, 18, 24 and 36 months postoperatively. Plain film radiographs were taken every year to investigate OA progression. MRI was performed at 36 months, including a Mocart score evaluation to assess cartilage repair.

Bone marrow was harvested from the posterior superior iliac spine. The ankle joint was approached arthroscopically or via open field. Ankle impingement or loose bodies were removed, and OLTs were debrided and measured. Bone marrow concentrate was fit into the OCD and stabilized with platelet-rich fibrin.

Results: AOFAS scores increased at all follow-ups with a peak at 24 months, the AOFAS score at 36 months was 77.8 + 18.3. The stage of OA was found to be significantly correlated to AOFAS scores at all follow-up intervals. Groups 0, 1, 2 and 3 achieved AOFAS values of 82.3 + 20.9, 82.6 + 15.7, 74.0 + 18.3 and 60.3 + 15.9, respectively at 36 months. AOFAS score at 36 months was influenced significantly by associate procedures and BMI. Group 0 had no failures, with groups 1, 2 and 3 having failure rates of 23 percent, 33 percent and 71 percent, respectively. In group 0, 7/8 patients had no change in their OA stage. Group 1 had 17/26 patients with no osteophyte reappearance. Groups 2 and 3 had 8/15 and 3/7 patients respectively with no OA progression. MRI with Mocart score was performed in 22 patients and was not found to significantly correlate with clinical and radiographic results at 36 months.

Conclusions: Clinical outcomes in this study were significantly dependent on preoperative OA stage. Patients with earlier-stage OA had better results. The size of the OLT had no impact on the results. In early OA defined as grade 0 and 1, a high rate of good results make BMDCT a reasonable approach according to the study. The authors recommend patients with advanced OA be warned of the high risk of failure, and patients with severe OA should not be treated with BMDCT. Limitations of the study include retrospective design, short-term follow-up and no control group. The biggest limitation of this study was that associate procedures were not controlled, which were found to have a statistically significant impact on AOFAS scores. The study outlines a reasonable approach for OLTs in concomitant ankle joint arthritis, but more research needs to be performed with longer follow-up periods, consistent techniques, larger patient populations and a control group to further investigate this surgical technique. 

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