scholarly journals Outcomes Following Treatment of Talar Osteochondral Lesions with a Mixture of Particulate Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate: A Case Control Series

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
Mark C. Drakos ◽  
Taylor Nicole Cabe ◽  
Carolyn Sofka ◽  
Peter D. Fabricant ◽  
Jonathan T. Deland
Keyword(s):  
Bone Marrow ◽  
Extracellular Matrix ◽  
Bone Marrow Aspirate ◽  
Case Control ◽  
Osteochondral Lesions ◽  
Treatment Groups ◽  
Cartilage Extracellular Matrix

Objectives: There continues to be a general lack of consensus regarding the optimal treatment for osteochondral lesions of the talus (OLTs). Microfracture, once considered the gold-standard, has been associated with poor long-term results due to the formation of biomechanically inferior reparative fibrocartilage as opposed to hyaline cartilage. Particulate allogenic cartilage extracellular matrix offers a promising solution as an adjuvant therapy; however, there is currently minimal objective evidence to indicate its effect on post-operative outcomes. This study compares post-operative radiographic and clinical outcomes following treatment of OLTs with an adjuvant mixture of particulate cartilage extracellular matrix and bone marrow aspirate concentrate (BMAC) against outcomes following microfracture with or without BMAC. Methods: Patients diagnosed with an OLT and treated by a fellowship-trained orthopedic surgeon were screened for inclusion. Those whose surgical intervention included microfracture, microfracture augmented with BMAC alone, or microfracture augmented with a mixture of BMAC and particulate allogenic cartilage extracellular matrix were eligible for this case-control study. Lesion size, location, and concurrent injuries were recorded following retrospective chart review. Foot and Ankle Outcome Scores (FAOS) were collected pre-operatively and at a minimum of 1 year post-operatively through the prospective Registry database at the authors’ institution. Modified magnetic resonance observation of cartilage repair tissue (MOCART) scoring evaluated the structural quality of repaired lesions on MRIs collected greater than six months post-operatively. Differences in post-operative MOCART and FAOS scores were evaluated using ANOVA tests. Results: Forty-seven patients treated with microfracture alone, forty-seven treated with microfracture augmented by BMAC, and fifty-two treated with an adjuvant mixture of particulate allogenic cartilage extracellular matrix and BMAC were identified at a minimum of 2 years post-operatively. Average MOCART scores were significantly different between treatment groups (p=0.03). At an average follow-up of 10.86 months, patients who received adjunctive therapy had an average MOCART score of 73.5 ± 11.13. At an average follow-up of 23.06 months and 43.6 months respectively, patients treated with microfracture and BMAC and microfracture alone scored 63.33 ± 22.23 and 55 ± 23.92. There was no detectable statistically significant difference in post-operative FAOS scores between treatment groups. With respect to revision surgery, two patients (3.84%) originally treated with adjuvant particulate cartilage extracellular matrix and BMAC have required a secondary surgery as opposed to nine patients (9.57%) treated with microfracture and BMAC or microfracture alone. Conclusion: Increases in post-operative FAOS scores compared to pre-operative FAOS scores for all treatment groups indicate patients’ function and symptoms improved regardless of intervention received. However, significantly higher MOCART scores for the particulate cartilage extracellular matrix and BMAC treatment group suggest adjuvant treatment may help achieve better post-operative fill and structural integrity. Thus, long-term outcomes and the quality of reparative tissues may be improved through use of adjuvant treatments such as particulate allogenic cartilage extracellular matrix and BMAC.

scholarly journals Treatment of Large Osteochondral Lesions with Adjuvant Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate Reduces Rate of Postoperative Adjacent Cysts

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0016
Author(s):  
Mark C. Drakos ◽  
Taylor N. Cabe ◽  
Carolyn Sofka ◽  
John Kennedy ◽  
Jonathan Deland
Keyword(s):  
Bone Marrow ◽  
Extracellular Matrix ◽  
Adjuvant Therapy ◽  
Bone Marrow Aspirate ◽  
Therapy Group ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Cartilage Extracellular Matrix ◽  
Outcome Scores

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Previous studies have established a correlation between the size of osteochondral lesions (OCLs) and the relative success of outcomes following surgical repair. Poorer results have been associated with traditional microfracture for lesions larger than 150 mm2. In these cases, osteochondral autograft transplantation (OAT) has shown to be a generally effective treatment despite associated disadvantages that include donor site morbidity, need to perform an osteotomy, and formation of postoperative adjacent cysts. The purpose of this study was to assess the effect of using a micronized allogenic cartilage extracellular matrix (ECM) mixed with bone marrow aspirate concentrate (BMAC) as an adjuvant therapy to augment and potentially improve the quality of repair achieved using OAT to treat larger lesions. Methods: Seventy cases (average age 38) treated by a fellowship-trained foot and ankle surgeon for an osteochondral lesion using OAT between December 2009 and June 2018 were identified. Retrospective chart review determined that 40 patients received adjuvant micronized ECM mixed with BMAC (average follow-up 25.6 months) while 30 had only BMAC injected into the joint or lesion (average follow-up 81.9 months). Preoperative lesion size, lesion location, and any concurrent injuries were also recorded. Foot and Ankle Outcome Scores (FAOS) were completed pre- and postoperatively through the prospective registry database at the authors’ institution. Structural integrity of reparative cartilage was assessed on available postoperative MRIs using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score. In addition, the presence of postoperative edema and adjacent cystic changes were recorded. Linear regression analysis was performed to analyze differences in MOCART scores, FAOS, postoperative rate of adjacent cysts, and postoperative rate of edema. Results: Twenty-four postoperative MRIs, average follow-up 14.04 (SD 9.52) months, were available for the ECM+BMAC adjuvant therapy group. Twenty-one MRIs, average follow-up 35.06 months (SD 28.41), were available for the non-adjuvant therapy group. 20.8% of the ECM+BMAC group exhibited signs of postoperative cysts compared to 60.9% of patients in the non- adjuvant therapy OAT group (p<0.01). Similarly, 66.7% of ECM+BMAC patients had edema postoperatively versus 90.5% of patients in the non-adjuvant therapy cohort (p = 0.05). MOCART scores were similar in each group: 68.33 (SD=15.99) in the OAT and ECM+BMAC group and 65.95 (SD=22.50) in the non-adjuvant therapy group. Finally, the post-operative FAOS Symptoms scores were significantly greater in patients receiving adjuvant therapy (p=0.03). Conclusion: Using micronized allogenic cartilage ECM mixed with BMAC to augment traditional OAT helps reduce the rate of postoperative adjacent cysts and edema. In addition, greater increases in patient reported functional outcome scores indicate this adjuvant therapy may help improve clinical outcomes. Application of this adjuvant therapy could be especially useful in allowing easier treatment of non-circular lesions of amorphous shapes. By improving integration of OAT into surrounding bone and reducing the rate of postoperative cysts, adjuvant therapy may improve long-term outcomes for large OCLs.

scholarly journals Concentrated Bone Marrow Aspirate Injection for Hallux Sesamoid Disorders

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0039
Author(s):  
Yoshiharu Shimozono ◽  
Dexter Seow ◽  
John G. Kennedy
Keyword(s):  
Quality Of Life ◽  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Shockwave Therapy ◽  
Vas Score ◽  
Concentrated Bone Marrow ◽  
The Mean

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Sesamoidectomy is the most common surgical procedure for the treatment of hallux sesamoid pathology, including fracture, acute separation of bipartite sesamoid, sesamoiditis, and avascular necrosis (AVN). However, there is a concern of complications following sesamoidectomy, such as the development of hallux valgus/varus and transfer metatarsalgia due to the altered mechanical loading on the forefoot. Recent systematic review showed high complication rate of 22.5% following sesamoidectomy, prompting surgeons to find alternative methods. Concentrated bone marrow aspirate (CBMA) may have the potential to treat sesamoid disorders with avoidance of sesamoid resection. However, there is no studies investigating the effect of CBMA for sesamoid disorders. The purpose of this study was to evaluate the functional outcomes following the use of CBMA for hallux sesamoid disorders. Methods: A retrospective cohort study investigating consecutive patients treated with CBMA injection for the treatment of sesamoid disorders were performed. The sesamoid disorders included sesamoiditis, symptomatic bipartite or chronic nonunited sesamoid and AVN. The CBMA injection was indicated for patients with failed a minimum of 3 months non-surgical management including activity limitation, customized orthotics, physiotherapy and extracorporeal shockwave therapy. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS), Short-Form 12 (SF-12), and visual analog scale (VAS) scores preoperatively and at final follow-up. Results: Total of 13 feet were included. The mean age was 26.9 years and mean follow-up time was 19.1 months. Patient demographic is shown in Table 1. Mean symptoms, pain, daily activities, sports activities and quality of life scores in FAOS significantly improved from 63.9, 55.4, 68.4, 37.3, and 30.9 preinjection to 91.2, 84.1 92.9, 72.7, and 64.8 postinjection, respectively at final follow-up (p<0.001). The mean SF-12 and VAS score significantly improved (34.3 to 62.5, 5.7 to 1.5, respectively, p<0.001). Of 9 patients played sports at preinjection, 7 patients returned to play at previous level. Two patients failed the treatment. One had second-CBMA injection and final VAS score was 1.0. Another one required subsequent shockwave-therapy followed by platelet-rich plasma injection with final VAS score of 1.5. Conclusion: No complications and adverse effects were reported in this cohort. In addition, no patients had any signs of progression or new emerge of AVN on plain radiographs. The current study demonstrates that CBMA injection is a safe and effective treatment for hallux sesamoid disorders when conservative treatment fails, with avoidance of sesamoid resection. CBMA injection can be a valid alternative for the treatment of sesamoid disorders, as it permits preservation of the biomechanical stability provided by the sesamoids which is an element inevitably vital for long-term quality of life. Further studies investigating long-term effects of this treatment should be warranted.

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

2021 ◽  
Author(s):  
Quinten G. H. Rikken ◽  
Jari Dahmen ◽  
Sjoerd A. S. Stufkens ◽  
Gino M. M. J. Kerkhoffs
Keyword(s):  
Bone Marrow ◽  
Clinical Outcomes ◽  
Degenerative Changes ◽  
Osteochondral Lesions ◽  
Ankle Osteoarthritis ◽  
Bone Marrow Stimulation ◽  
Marrow Stimulation ◽  
The Mean

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.

scholarly journals Minimal residual hairy cell leukemia eradication with moxetumomab pasudotox: phase 1 results and long-term follow-up

Blood ◽  
2018 ◽  
Vol 131 (21) ◽  
pp. 2331-2334 ◽  
Author(s):  
Robert J. Kreitman ◽  
Martin S. Tallman ◽  
Tadeusz Robak ◽  
Steven Coutre ◽  
Wyndham H. Wilson ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspirate ◽  
Phase 1 ◽  
Hairy Cell ◽  
Cell Leukemia ◽  
Key Points ◽  
Long Term Follow Up ◽  
Minimal Residual

Key Points Moxetumomab pasudotox eradicated HCL MRD in >50% of CRs, even by the most sensitive measure, bone marrow aspirate flow cytometry. Elimination of MRD was significantly associated with prolonged CR duration.

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

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.

EXTENDED FOLLOW-UP IN 212 LONG-TERM ALLOGENEIC BONE MARROW TRANSPLANT SURVIVORS ISSUES OF QUALITY OF LIFE

1993 ◽  
Vol 55 (3) ◽  
pp. 551-556 ◽  
Author(s):  
GERHARD M. SCHMIDT ◽  
JOYCE C. NILAND ◽  
STEPHEN J. FORMAN ◽  
FILAR P. FONBUENA ◽  
ANDREW C. DAGIS ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bone Marrow ◽  
Bone Marrow Transplant ◽  
Marrow Transplant ◽  
Allogeneic Bone Marrow ◽  
Allogeneic Bone ◽  
Allogeneic Bone Marrow Transplant

scholarly journals Patient-Reported Outcomes After Platelet-Rich Plasma, Bone Marrow Aspirate, and Adipose-Derived Mesenchymal Stem Cell Injections for Symptomatic Knee Osteoarthritis

2020 ◽  
Vol 13 ◽  
pp. 117954412093108
Author(s):  
Esteban Estrada ◽  
Jose L Décima ◽  
Marcelo Rodríguez ◽  
Marianela Di Tomaso ◽  
Javier Roberti
Keyword(s):  
Bone Marrow ◽  
Stem Cell ◽  
Mesenchymal Stem Cell ◽  
Bone Marrow Aspirate ◽  
Platelet Rich Plasma ◽  
Functional Score ◽  
Treatment Groups ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee

Objective: The objective of this study was to compare platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and adipose-derived mesenchymal stem cell (MSC) injections in the treatment of osteoarthritis (OA) of the knee using functional scores. Methods: A total of 89 patients with painful knee OA were included in this study. Patients were assigned to one of the 3 treatments according to severity of OA as indicated by symptoms and radiography to PRP (stage I), BMAC (stage II), or adipose-derived MSC (stage III). Clinical assessment was performed using the Knee Society Score, which combines the Knee Score, based on the clinical parameters, and the Functional Score, and IKDC score. Surveys were completed at preoperative and at 90, 180, and 265 days postoperative. The follow-up responses were compared with baseline and between treatment groups. Results: Treatment with PRP, BMAC, and adipose-derived MSC included 29 (32.6%), 27 (30.3%), and 33 (37.1%) patients, respectively. For the total group, median age was 61 years (range: 22-84 years). Score values were comparable among treatment groups at baseline. Statistically significant improvement was observed in the 3 groups according to the 3 scores at all time points during follow-up compared with baseline. No difference was found among treatment type. Conclusions: Our findings support previous reports and encourage further research on the use of these cost-effective treatments for OA of the knee.

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

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 ◽  
The Mean

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.

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

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.

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