Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus

Abstract Purpose The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up. Methods A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures. Results Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5–13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6–9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6–84.1). 78% (95% CI 69.5–86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1–9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4–3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3–33.2) of ankles. Conclusion Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS. Level of evidence Level IV.

Arthroscopic Bone Marrow Stimulation in the Treatment of Osteochondral Lesions of the Talus

10.1177/2473011418s00096 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0009

Author(s):

Kwang Hwan Park ◽

JaeHan Park ◽

Jai Bum Kwon ◽

Seung Hwan Han ◽

Jin Woo Lee

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Osteochondral Lesion ◽

Osteochondral Lesions ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

Operation Rate ◽

Category: Arthroscopy Introduction/Purpose: Arthroscopic bone marrow stimulation for osteochondral lesions of the talus (OLT) has presented promising clinical outcomes in recent studies. However, there were few studies which had investigated long-term clinical outcomes. The purpose of this study is to evaluate the long-term outcomes of arthroscopic bone marrow stimulation for osteochondral lesion of the talus and to identify prognostic factors that affect the outcome. Methods: Between January 2001 and December 2007, 159 patients (172 ankles) with OLT underwent arthroscopic bone marrow stimulation as a primary surgery. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and re-operation rate. Factors associated with re-operation were evaluated using bivariate analysis. Kaplan-Meier plot showed survival outcomes of OLT in long-term follow-up. Results: The mean follow-up time was 12.7 years (range 10.1-16.8) and the mean size of the lesion was 105.4 mm2 (range 19.8- 322.8). The mean VAS improved from 7.21 ± 1.71 to 1.76 ± 1.60. The mean preoperative AOFAS score was 57.98 ±14.43 and the mean postoperative AOFAS was 82.91 ± 11.58. FAOS at the time of final follow-up was comparable with those of previous literatures which showed outcomes of surgical treatments of OLT in short- and mid-term follow-up. Re-operation rate was 6.40% (11 patients with 12 revision surgery) including seven cases of re-arthroscopic bone marrow stimulation, and five cases of OAT. According to bivariate analysis, significant factor associated with re-operation was large sized OLT in preoperative MRI measurement. Conclusion: Arthroscopic bone marrow stimulation for osteochondral lesion of the talus has made satisfactory clinical outcomes through long-term follow-up over 10 years.

Arthroscopic Bone Marrow Stimulation for the Treatment of Osteochondral Lesions of the Talus Shows Promising Clinical Outcomes Over 10 Years

10.1177/2473011420s00068 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0006

Author(s):

Jae Han Park ◽

Jin Woo Lee ◽

Kwang Hwan Park ◽

Sang B. Kim ◽

Yoo Jung Park ◽

...

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Osteochondral Lesions ◽

Line Treatment ◽

Long Term Outcomes ◽

Bone Marrow Stimulation ◽

Factors Associated ◽

Marrow Stimulation

Category: Arthroscopy; Ankle Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) has been considered as the 1st-line treatment for osteochondral lesions of the talus (OLT) with its simplicity, cost-effectiveness, low complication rate and successful clinical results in numerous studies. However, there were few studies which had investigated long-term clinical outcomes about the arthroscopic BMS. The purpose of this study is to evaluate the long-term outcomes of arthroscopic BMS for OLT and to identify prognostic factors that affect the outcomes. Methods: A retrospective analysis was performed for 202 ankles (189 patients) who underwent arthroscopic BMS as a primary surgery for the OLT between January 2001 and December 2008 with more than 10 years of follow-up. Visual analog scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scales, Foot and Ankle Outcome Score (FAOS) were assessed as clinical outcomes and re-operation data were collected. The clinical scores were compared along the stream of time. Kaplan-Meier plot and log rank test showed survival outcomes of OLT in the long-term follow-up. Factors associated with revision surgery were evaluated with multivariate Cox proportional hazard regression model. Results: The VAS scales were improved from 7.11 +- 1.73 (preoperatively) to 1.51 +- 1.61 (3 to 6 years after BMS), and 2.00 +- 1.67 (over 10 years after BMS) (P < 0.001). Also the AOFAS ankle-hindfoot scale were also improved from 58.39 +- 13.7373 (preoperatively) to 85.85 +- 10.31 (3 to 6 years after BMS), and 82.56 +- 11.62 (over 10 years after BMS) (P < 0.001). FAOS at final follow-up was compatible with those of other literatures with short- and mid-term follow-up. Re-operation rate was 5.94 % (12 / 202 ankles). According to multivariate regression analysis, significant factors associated with the revision surgery were large- size (greater than 150mm2) OLT (P = 0.009) and body mass index greater than 25 kg/m2 (P = 0.014). Conclusion:: Arthroscopic bone marrow stimulation is an effective and reliable operative procedure for the primary treatment of osteochondral lesions of the talus with favorable long-term outcomes at a mean follow-up of 13.9 years. Therefore, we recommend this procedure for the 1st-line treatment of the OLT. Success of arthroscopic BMS depends on the size of the OLT and the body mass index of patients.

Bone marrow stimulation for talar osteochondral lesions at long-term follow-up shows a high sports participation though a decrease in clinical outcomes over time

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06250-8 ◽

2020 ◽

Author(s):

Kaj T. A. Lambers ◽

Jari Dahmen ◽

J. Nienke Altink ◽

Mikel L. Reilingh ◽

Christiaan J. A. van Bergen ◽

...

Keyword(s):

Bone Marrow ◽

Osteochondral Lesions ◽

Bone Marrow Stimulation ◽

Sports Activity ◽

Marrow Stimulation ◽

Long Term Follow Up ◽

The Mean ◽

Over Time

Abstract Purpose Although bone marrow stimulation (BMS) as a treatment for osteochondral lesions of the talus (OCLT) shows high rates of sport resumption at short-term follow-up, it is unclear whether the sports activity is still possible at longer follow-up. The purpose of this study was, therefore, to evaluate sports activity after arthroscopic BMS at long-term follow-up. Methods Sixty patients included in a previously published randomized-controlled trial were analyzed in the present study. All patients had undergone arthroscopic debridement and BMS for OCLT. Return to sports, level, and type were assessed in the first year post-operative and at final follow-up. Secondary outcome measures were assessed by standardized questionnaires with use of numeric rating scales for pain and satisfaction and the Foot and Ankle Outcome Score (FAOS). Results The mean follow-up was 6.4 years (SD ± 1.1 years). The mean level of activity measured with the AAS was 6.2 pre-injury and 3.4 post-injury. It increased to 5.2 at 1 year after surgery and was 5.8 at final follow-up. At final follow-up, 54 patients (90%) participated in 16 different sports. Thirty-three patients (53%) indicated they returned to play sport at their pre-injury level. Twenty patients (33%) were not able to obtain their pre-injury level of sport because of ankle problems and eight other patients (13%) because of other reasons. Mean NRS for pain during rest was 2.7 pre-operative, 1.1 at 1 year, and 1.0 at final follow-up. Mean NRS during activity changed from 7.9 to 3.7 to 4.4, respectively. The FAOS scores improved at 1 year follow-up, but all subscores significantly decreased at final follow-up. Conclusion At long-term follow-up (mean 6.4 years) after BMS for OCLT, 90% of patients still participate in sports activities, of whom 53% at pre-injury level. The AAS of the patients participating in sports remains similar pre-injury and post-operatively at final follow-up. A decrease over time in clinical outcomes was, however, seen when the follow-up scores at 1 year post-operatively were compared with the final follow-up. Level of evidence Level II.

Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus

10.1177/2473011420s00176 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0017

Author(s):

Daniel Corr ◽

Jared Raikin ◽

Joseph T. O’Neil ◽

Steven M. Raikin

Keyword(s):

Bone Marrow ◽

Osteochondral Lesions ◽

Treatment Technique ◽

Foot And Ankle ◽

Bone Marrow Stimulation ◽

Time Of Surgery ◽

Patient Demographics ◽

Marrow Stimulation

Category: Ankle; Arthroscopy Introduction/Purpose: Bone marrow stimulation procedures, specifically microfracture, have become a common treatment technique for osteochondral lesions of the talus (OLT). Such procedures have been shown to be effective among a variety of patient populations at postoperative time points up to about 5 years (references?). While microfracture has been shown to be effective in short- to medium-term follow-up, there is a paucity of literature demonstrating the long-term efficacy of this procedure. Recently, the development of additional treatment techniques has been explored, with deterioration of the resultant fibrocartilage being a particular concern with microfracture. The purpose of this study is to determine the long-term effectiveness of microfracture bone marrow stimulation for treatment of OLTs in patients at least 10 years removed from surgery. Methods: A retrospective review of patients undergoing microfracture of an OLT with a single fellowship-trained orthopaedic foot and ankle surgeon at least 10 years prior was performed. Patients meeting the inclusion criteria were contacted to complete the Foot & Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales, visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the outcome of the procedure using a 5-point Likert scale. In addition to medical chart review, patients were asked directly over the phone about any subsequent foot and ankle procedures needed, any injections necessary, and whether they wore an ankle brace/orthotic in the time following the procedure. Patient demographics including sex, age at time of surgery, laterality of surgery, and surgical history following their index procedure were reviewed. Descriptive statistics were calculated for patient demographics and survey responses to assess functional outcomes. Results: Forty-two patients were contacted and completed postoperative surveys. Average patient age at the time of the procedure was 38.6 years, and 24 patients (57%) were male. On average, FAAM-ADL score was 86.57 (+-20.85), Sports score was 72.31 (+-30.48), and VAS pain score was 19.52 (scale of 0-100). Patients reported being satisfied with the outcome of the procedure in 35 of 42 cases (83.3%). Five patients (11.9%) had other foot/ankle procedures since their microfracture, with 3 directly addressing the talus in some fashion. Three patients (7.1%) received injection(s) in their ankle in the follow-up period, and 9 patients (21.4%) reported wearing a brace since the time of surgery with 6 patients (14.3%) reporting it as a direct relation to their OLT and surgery. Conclusion: This study demonstrates that microfracture is an effective functional treatment for OLT in the long term, and addresses the valid questions posed about the ability for the procedure to produce durable fibrocartilage. Patients report average functional and pain assessment scores at the 10-year postoperative mark consistent with a generally successful and effective treatment.

Results of Arthroscopic Talar Osteochondral Lesions with Bone Marrow Stimulation and BST-CarGel

10.1177/2473011419s00163 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0016

Author(s):

Jagwinder Dhaliwal ◽

Andrew Wines

Keyword(s):

Quality Of Life ◽

Bone Marrow ◽

Functional Outcome ◽

Osteochondral Lesions ◽

Foot And Ankle ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

Category: Ankle, Trauma Introduction/Purpose: Osteochondral lesions (OCL) are described as any defect involving both the articular surface and the subchondral bone of the talus. They are commonly associated with acute ankle injuries occurring often in active population. Bone marrow stimulation with microfracture is a standard reparative treatment for OCD however decline in related functional outcome has been reported. BST-CarGel contains chitosan which binds to negatively charged cartilage surface acting as biocompatible scaffold. This allows repair tissue with significant filling volume and proper integration into the surroundings. There has been reported better quantitative and qualitative cartilage repair tissue at 12 months with BST-CarGel. We first report on clinical results of bone marrow stimulation and BST-Cargel for recalcitrant talar OCL in patients previously treated with microfracture alone in a prospective study. Methods: This prospective single surgeon series was limited to patients with symptomatic OCL who previously had arthroscopic debridement and microfracture for same lesion. The pre-operative evaluation of all patients involved clinical assessment, weight bearing plain radiographs and magnetic resonance imaging of ankle joint. Inclusion criteria were age 18-55 years, single focal OCL of talus less than 3 cm2 and previous microfracture. Exclusion criteria was evidence of ankle osteoarthritis and allergy to chitosan or known hypersensitivity to crustaceans such as shrimp, lobster, and crab. Functional outcome assessment was measured using Foot and Ankle outcome score (FAOS) and EQ5D (Health related quality of life) pre and post-operatively. We used paired Student’s t-test for statistical analysis. Values for p < 0.05 were regarded as significant. The surgical technique used have been previously described in literature for OCL of the talus treated with bone marrow stimulation and Cargel. Results: There were fourteen patients who were treated with arthroscopic BST-Cargel with BMS and followed up prospectively. There was no loss to follow-up. The mean follow-up post-operatively was 28 months. There were eight males and six females in the study group. Patient mean age at the time of operation was 42 years (21–60 years). The mean size of talar OCL treated was 2.8 cm2 . Mean FAOS score for symptoms pre-operatively was 41.7 and post-operative was 52.8 (P<0.01). Mean FAOS pain subscale pre-operatively was 45.7 and post-operatively 55.6 (P<0.01). FAOS function and daily living score pre-operatively was 41.4 and post-operatively was 55.8 (P<0.01). Mean FAOS quality of life score was 39.2 pre-operatively and post-operative score 57.2 (P<0.01). EQ5D pre-operatively was 15 and post-operatively was 8 (P<0.01). Conclusion: We noted statistically significant improvement in each subscale of The Foot and Ankle Outcome questionnaire scores post-operatively. There was also significant improvement in generic health status instrument EQ-5D. We also noted talar OCL improvement on MRI scan taken pre and post BST-CarGel treatment. Recalcitrant OCL of talus present considerable challenge with persistent pain, functional limitations and secondary osteoarthritis. BST-Cargel treatment in our clinical study improved functional outcome scores similar to previously reported hip and knee studies. It requires standard arthroscopic technique and no complications were observed in our study.

Mid-Term Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review

10.1177/2473011419s00391 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0039

Author(s):

Yoshiharu Shimozono ◽

James Toale ◽

Conor Mulvin ◽

Jari Dahmen ◽

Gino MMJ Kerkhoffs ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Reoperation Rate ◽

Osteochondral Lesions ◽

Long Term Outcomes ◽

Weighted Mean ◽

Bone Marrow Stimulation ◽

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Arthroscopic bone marrow stimulation (BMS) is the most common reparative surgical intervention in the treatment of small osteochondral lesions of the talus (OLT). BMS has shown favorable short term clinical outcomes but several recent studies have shown less satisfactory results in the mid- to long-term due to fibrocartilagenous repair tissue deterioration over time following BMS. However, conflicting results with good mid- to long-term outcomes following BMS have been reported. There is still a lack of evidence on the success rates of BMS at mid-term and longer-term follow-up. The purpose of this systematic review was to evaluate the clinical evidence of mid- to long-term outcomes following BMS for the treatment of OLT. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of evidence was decifered using the Modified Coleman methodology score (MCMS). Studies reporting outcomes of BMS for primary ostechndral lesions at a minimum 4-year follow-up were included. Clinical outcomes, radiological outcomes, and reported data were evaluated. Results: Fifteen studies containing 853 patients (858 ankles) were included at a weighted-mean follow-up time of 71.9 (48-141) months. The mean age was 35.3 (24.7-41.9) and the mean lesion size was 110.5mm2 (87-140). Nine studies (60%) used the AOFAS ankle hindfoot score with a weighted-mean postoperative score of 89.9 (78.4-91.8). Six studies showed both pre and post-operative AOFAS scores and showed a weighted-mean improvement of 24.5 (16-38.5). Four studies utilised the VAS score. The weighted-mean postoperative VAS scores were 2.4 (1.8-2.6). Three studies (20%) measured post-opeartive MRI at mid-term using the MOCART score and showed 48% complete filling, 74% complete integration, 76% surface damage, and 78% inhomogeneous repair tissue. Complication rate was 3.2% and reoperation rate was 6% following BMS at mid-term. Conclusion: This systematic review found good clinical outcomes following BMS for primary OLT at mid-term follow-up based on the AOFAS score. The complication rates were relatively low and the data showed a reoperation rate of 6% at mid-term. However, the radiological and MRI outcomes did not show similarly positive results, which may lead to recurrence and reoperation at long-term. Data were variable and numerous aspects largely under-reported in the literature relevant to the systematic review. Further high quality studies, a validated outcome scoring system and further MRI reports are required to accurately assess the success of BMS at mid-term.

Lesion Size Is a Predictor of Clinical Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus: A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546516668292 ◽

2016 ◽

Vol 45 (7) ◽

pp. 1698-1705 ◽

Cited By ~ 73

Author(s):

Laura Ramponi ◽

Youichi Yasui ◽

Christopher D. Murawski ◽

Richard D. Ferkel ◽

Christopher W. DiGiovanni ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Lesion Size ◽

Osteochondral Lesions ◽

Lesion Area ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

Mean Diameter ◽

Background: The critical lesion size treated with bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) has been 150 mm2 in area or 15 mm in diameter. However, recent investigations have failed to detect a significant correlation between the lesion size and clinical outcomes after BMS for OLTs. Purpose: To systematically review clinical studies reporting both the lesion size and clinical outcomes after BMS for OLTs. Study Design: Systematic review. Methods: A systematic search of the MEDLINE and EMBASE databases was performed in March 2015 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies were evaluated with regard to the level of evidence (LOE), quality of evidence (QOE), lesion size, and clinical outcomes. Results: Twenty-five studies with 1868 ankles were included; 88% were either LOE 3 or 4, and 96% did not have good QOE. The mean area was 103.8 ± 10.2 mm2 in 20 studies, and the mean diameter was 10.0 ± 3.2 mm in 5 studies. The mean American Orthopaedic Foot and Ankle Society score improved from 62.4 ± 7.9 preoperatively to 83.9 ± 9.2 at a mean 54.1-month follow-up in 14 studies reporting both preoperative and postoperative scores with a mean follow-up of more than 2 years. A significant correlation was found in 3 studies, with a mean lesion area of 107.4 ± 10.4 mm2, while none was reported in 8 studies, with a mean lesion area of 85.3 ± 9.2 mm2. The lesion diameter significantly correlated with clinical outcomes in 2 studies (mean diameter, 10.2 ± 3.2 mm), whereas none was found in 2 studies (mean diameter, 8.8 ± 0.0 mm). However, the reported lesion size measurement method and evaluation method of clinical outcomes widely varied among the studies. Conclusion: An assessment of the currently available data does suggest that BMS may best be reserved for OLT sizes less than 107.4 mm2 in area and/or 10.2 mm in diameter. Future development in legitimate prognostic size guidelines based on high-quality evidence that correlate with outcomes will surely provide patients with the best potential for successful long-term outcomes.

Bone Marrow Stimulation for Osteochondral Lesions of the Talus: Are Clinical Outcomes Maintained 10 Years Later?

The American Journal of Sports Medicine ◽

10.1177/0363546521992471 ◽

2021 ◽

pp. 036354652199247

Author(s):

Jae Han Park ◽

Kwang Hwan Park ◽

Jae Yong Cho ◽

Seung Hwan Han ◽

Jin Woo Lee

Keyword(s):

Prognostic Factors ◽

Clinical Outcomes ◽

Revision Surgery ◽

Lesion Size ◽

Osteochondral Lesions ◽

Bone Marrow Stimulation ◽

Factors Associated ◽

Background: Arthroscopic bone marrow stimulation (BMS) is considered the first-line treatment for osteochondral lesions of the talus (OLTs). However, the long-term stability of the clinical success of BMS remains unclear. Purpose: To investigate the long-term clinical outcomes among patients who underwent BMS for OLT and to identify prognostic factors for the need for revision surgery. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis was performed on 202 ankles (189 patients) that were treated with BMS for OLT and had a minimum follow-up of 10 years. The visual analog scale for pain, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, and the Foot and Ankle Outcome Score (FAOS) were assessed by repeated measures analysis of variance. Prognostic factors associated with revision surgery were evaluated with Cox proportional hazard regression models and log-rank tests. Results: The mean lesion size was 105.32 mm2 (range, 19.75-322.79); 42 ankles (20.8%) had large lesions (≥150 mm2). The mean visual analog scale for pain improved from 7.11 ± 1.73 (mean ± SD) preoperatively to 1.44 ± 1.52, 1.46 ± 1.57, and 1.99 ± 1.67 at 1, 3 to 6, and ≥10 years, respectively, after BMS ( P < .001). The mean ankle-hindfoot score also improved, from 58.22 ± 13.57 preoperatively to 86.88 ± 10.61, 86.17 ± 10.23, and 82.76 ± 11.65 at 1, 3 to 6, and ≥10 years after BMS ( P < .001). The FAOS at the final follow-up was 82.97 ± 13.95 for pain, 81.81 ± 14.64 for symptoms, 83.49 ± 11.04 for activities of daily living, 79.34 ± 11.61 for sports, and 78.71 ± 12.42 for quality of life. Twelve ankles underwent revision surgery after a mean 53.5 months. Significant prognostic factors associated with revision surgery were the size of the lesion (preoperative magnetic resonance imaging measurement ≥150 mm2; P = .014) and obesity (body mass index ≥25; P = .009). Conclusion: BMS for OLT yields satisfactory clinical outcomes at a mean follow-up of 13.9 years. The success of the surgery may depend on the lesion size and body mass index of the patient.

A Review of Arthroscopic Bone Marrow Stimulation Techniques of the Talus

Cartilage ◽

10.1177/1947603510364403 ◽

2010 ◽

Vol 1 (2) ◽

pp. 137-144 ◽

Cited By ~ 48

Author(s):

Christopher D. Murawski ◽

Li Foong Foo ◽

John G. Kennedy

Keyword(s):

Bone Marrow ◽

Spin Echo ◽

T2 Mapping ◽

Fast Spin Echo ◽

Osteochondral Lesions ◽

Ankle Sprains ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

Over Time

Osteochondral lesions of the talus are common injuries following acute and chronic ankle sprains. Numerous surgical treatment strategies have been employed for treating these lesions; arthroscopic bone marrow stimulation is recognized as the first-line technique to provide fibrocartilage infill of the defect site. While the short- and medium-term outcomes of this technique are good, the long-term outcomes are not yet known. An increasing number of studies, however, show a cause for concern in employing this technique, including declining outcome scores over time. The current authors have therefore developed a treatment strategy based on previously established guidelines in addition to morphological cartilage-sensitive fast spin echo techniques and quantitative T2 mapping magnetic resonance imaging (MRI). Accordingly, the authors advocate arthroscopic bone marrow stimulation in lesion sizes up to 8 mm in diameter and osteochondral autograft transplant (OATS) in lesion sizes greater than 8 mm in diameter. In the absence of long-term studies, confining the use of arthroscopic bone marrow stimulation to smaller lesions may support prolonged joint life by decreasing the rate at which the fibrocartilage ultimately degenerates over time. Employing the OATS procedure in larger lesions has the advantage of replacing “like with like.” The current review examines the role of arthroscopic bone marrow stimulation techniques of the talus.

Immediate Unrestricted Postoperative Weightbearing and Mobilization after Bone Marrow Stimulation of Large Osteochondral Lesions of the Talus

Cartilage ◽

10.1177/1947603516657639 ◽

2016 ◽

Vol 8 (1) ◽

pp. 73-79 ◽

Cited By ~ 2

Author(s):

Gregory A. Lundeen ◽

Linda J. Dunaway

Keyword(s):

Bone Marrow ◽

Case Series ◽

Lesion Size ◽

Arthroscopic Treatment ◽

Osteochondral Lesions ◽

Postoperative Rehabilitation ◽

Level Of Evidence ◽

Bone Marrow Stimulation ◽

Marrow Stimulation

Objective There remains no consensus on a postoperative protocol following arthroscopic treatment of osteochondral lesions of the talus (OLTs) and most studies report a period of immobilization and nonweightbearing. Outcomes are believed to decrease with larger size. The purpose of our study was to evaluate patients who underwent arthroscopic treatment of large (≥150 mm2) OLTs with immediate unrestricted weightbearing and mobilization postoperatively. Design Patients who underwent arthroscopic bone marrow stimulation for osteochondral defects were identified. Exclusion criteria included lesions less than 150 mm2, additional procedures other than ligament reconstruction, incongruent ankle joint, arthritis, and tibial plafond lesions. Postoperatively, all patients were placed into a soft dressing and were allowed immediate weightbearing as tolerated. Patients were considered failures if their AOFAS (American Orthopaedic Foot and Ankle Society) score was less than 80 or if they underwent osteochondral transplant. Results Thirteen patients were available for follow-up. Two patients underwent osteochondral transplant and were considered failures. Of the remaining 11, the average follow-up time after surgery was 33 months (range, 7-59 months). Average age was 37 years (range, 15-56 years), and lesion size averaged 239 mm2 (range, 150-400 mm2). Average postoperative scores included foot function index 50 (range, 23-136), visual analog scale 3 (range, 0-8), and AOFAS hindfoot 82 (range, 40-100). The group’s overall success rate was 54% (7/13). Conclusion The results of our study are higher than those previously published studies on large lesions with a more restricted postoperative rehabilitation, suggesting that unrestricted weightbearing and range of motion does not diminish patient outcomes. Level of Evidence: IV, Case series.