scholarly journals Outcomes of Surgical Treatment of Talar Osteochondral Lesions using Bone Marrow Aspirate and Microgenized Allograft Cartilage Extra-cellular Matrix

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0021
Author(s):  
Robert Dekker ◽  
Milap Patel
Keyword(s):  
Bone Marrow ◽  
Surgical Treatment ◽  
Functional Outcomes ◽  
Bone Marrow Aspirate ◽  
Case Series ◽  
Cartilage Matrix ◽  
Osteochondral Lesions ◽  
Measurement Information ◽  
Significant Difference ◽  
Patient Reported

Category: Sports Introduction/Purpose: Osteochondral lesions (OCL) of the talus are frequently seen after ankle injury and often result in significant morbidity. Apart from a single case report, we are the first to present a case series of OCLs treated with bone marrow aspirate and micronized extracellular allograft cartilage matrix designed to serve as a scaffold to promote autologous healing. Short to mid-term outcomes using this technique are virtually absent in the literature. In this study, we sought to assess pre- and post-procedural functional outcomes using the validated Patient Reported Outcomes Measurement Information System (PROMIS) as well as assess cartilage incorporation on postoperative ankle MRI using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring. Methods: Twelve patients with symptomatic talar OCLs (14 lesions) were prospectively recruited. Average age was 44 years. Each underwent ankle arthroscopy, ankle arthrotomy, marrow stimulation and lesion repair using BMA and micronized extracellular allograft cartilage matrix by a single fellowship trained foot and ankle Orthopedic Surgeon. Preoperative, 6 month and 1 year postoperative PROMIS pain and function scores were collected prospectively. At six months, all patients underwent ankle MRI scans that were reviewed by a fellowship trained musculoskeletal radiologist for MOCART scoring. Results: No significant difference was detected between mean pre- and postoperative PROMIS function (41.4 vs 38.1; p=.54) and pain (61.3 vs 66.1) scores at 6 months. No significant difference was seen between mean pre- and postoperative PROMIS function (41.4 vs 41.8; p=.93) and pain (61.3 vs 58; p=.48) scores at 1 year. Mean postoperative MOCART score was 53.2 with a range of 5 to 90. Conclusion: Bone marrow aspirate and extracellular allograft cartilage matrix for surgical treatment of talar OCL showed no statistically significant improvement in functional outcomes at 6 months and 1 year. No correlation between functional outcomes and MOCART score was seen.

Comparison of Functional and Radiographic Outcomes of Talar Osteochondral Lesions Repaired With Micronized Allogenic Cartilage Extracellular Matrix and Bone Marrow Aspirate Concentrate vs Microfracture

2021 ◽  
pp. 107110072098326
Author(s):  
Mark C. Drakos ◽  
Stephanie K. Eble ◽  
Taylor N. Cabe ◽  
Karan Patel ◽  
Oliver B. Hansen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Extracellular Matrix ◽  
Magnetic Resonance ◽  
Bone Marrow Aspirate ◽  
Osteochondral Lesions ◽  
Measurement Information ◽  
Bone Marrow Aspirate Concentrate ◽  
Radiographic Outcomes ◽  
Patient Reported ◽  
Outcome Scores

Background: Microfracture (MF) has been used historically to treat osteochondral lesions of the talus (OLTs), with favorable outcomes reported in approximately 80% to 85% of cases. However, MF repairs have been shown to degrade over time at long-term follow-up, suggesting that further study into optimal OLT treatment is warranted. The use of adjuvant extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) has not been extensively evaluated in the literature. We present a comparison of patient-reported and radiographic outcomes following ECM-BMAC repair vs traditional MF. Methods: Patients who underwent MF (n = 67) or ECM-BMAC (n = 62) treatment for an OLT were identified and their charts were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) was evaluated and patient-reported outcome scores, either Foot and Ankle Outcome Scores (FAOS) or Patient-Reported Measurement Information System (PROMIS) scores, were collected. MRIs were scored by a radiologist, fellowship trained in musculoskeletal radiology, using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) system. Radiographic and clinical outcomes were compared between groups. Results: On average, patients treated with ECM-BMAC demonstrated a higher total MOCART score compared to the MF group (73 ± SD 11.5 vs 54.0 ± 24.1; P = .0015). ECM-BMAC patients also had significantly better scores for the Infill, Integration, and Signal MOCART subcategories. Last, patients treated with ECM-BMAC had a lower rate of revision compared to those treated with MF (4.8% vs 20.9%; P = .007). FAOS scores were compared between groups, with no significant differences observed. Conclusion: When comparing outcomes between patients treated for an OLT with ECM-BMAC vs traditional MF, we observed superior MRI results for ECM-BMAC patients. The rate of revision surgery was higher for MF patients, although patient-reported outcomes were similar between groups. The use of ECM-BMAC as an adjuvant therapy in the treatment of OLTs may result in improved reparative tissue when compared to MF. Level of Evidence: Level III, comparative series.

scholarly journals Functional and Radiographic Outcomes Following Repair of Osteochondral Lesions After Ankle Fracture with Arthrex BioCartilage and Bone Marrow Aspirate Concentrate compared to Microfracture

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Drew N. Stal ◽  
Stephanie K. Eble ◽  
Oliver B. Hansen ◽  
Bopha Chrea ◽  
Mark C. Drakos
Keyword(s):  
Bone Marrow ◽  
Outcome Measures ◽  
Fracture Fixation ◽  
Ankle Fracture ◽  
Bone Marrow Aspirate ◽  
Osteochondral Lesions ◽  
Bone Marrow Aspirate Concentrate ◽  
Significant Difference ◽  
Patient Reported

Category: Arthroscopy; Basic Sciences/Biologics; Trauma Introduction/Purpose: There has been an increasing role for arthroscopy in ankle fracture fixation, particularly in assessing osteochondral lesions (OCL). Initial cartilage damage has been found to be an independent risk factor for post-traumatic ankle arthritis. Rates of osteochondral injury with ankle fracture remain varied, but have been reported up to 62-80%. Treatment for osteochondral injuries classically included debridement alone or debridement with microfracture. Recently, new biologic augments have come to market, including BioCartilage (Arthrex): a mixture of cadaveric articular cartilage extracellular matrix. This has been used in conjunction with bone marrow aspirate concentrate (BMAC). To date, no study has evaluated the outcomes of utilizing BioCartilage in the treatment of osteochondral lesions, or in comparison to microfracture alone, in conjunction with ankle fracture fixation. Methods: We conducted a retrospective analysis of all adult patients (age > 18) undergoing operative ankle fracture or syndesmotic fixation with concomitant ankle arthroscopy utilizing our Foot and Ankle Registry. Institutional Review Board (IRB) approval was obtained prior to data collection. Patient demographic data, laterality, fracture pattern and OCL size were documented. Those with full-thickness lesions requiring treatment were divided into groups based on the use of Biocartilage + BMAC or microfracture alone. Exclusion criteria included pediatric patients, distal tibia intra-articular, and open fractures. Outcome scores for pre- and postoperative patient reported outcome measures (PROMIS) were recorded, with a minimum 6- month follow up. Magnetic resonance observation of cartilage repair tissue (MOCART) scoring was performed for those with postoperative MRIs to evaluate OCL healing. We also included a group that had ankle fracture fixation and arthroscopy but without any osteochondral lesion to serve as a control. Results: 28 patients were treated with Biocartilage/BMAC; 19 with preoperative and 17 with postoperative PROMIS. 41 patients had microfracture; 20 with preoperative and 18 with postoperative PROMIS. 75 patients were identified in the non-OCL group; 60 with preoperative and 45 with postoperative PROMIS. Average follow-up was 20.61 months. There were no significant differences in postoperative PROMIS scores between the two treatment groups in all sub-categories. When comparing each treatment group to the control, there was a statistically significant increase in pre to postoperative global physical health scores for the non-OCL group compared to Biocartilage/BMAC. Postoperative MRIs were obtained in 12/28 patients with Biocartilage/BMAC and 10 /41 with microfracture. There was no significant difference between either group in overall MOCART scores or individual scoring categories. Conclusion: The role for arthroscopy in ankle fracture fixation is evolving, as is the treatment of identifiable osteochondral lesions. We sought to compare a novel biologic technique of Biocartilage and BMAC with microfracture for OCL management. Our results demonstrated no significant difference between treatments for postoperative PROMIS and MOCART scores. Outcome measures did not differ significantly when compared to our control group. Unfortunately, complete PROMIS and MOCART data was lacking in each group, limiting the ability to draw definitive conclusions. However, we believe this is a positive first step in understanding the role in treating osteochondral lesions associated with ankle fractures.

scholarly journals Outcomes Following the Treatment of Talar Osteochondral Lesions with BioCartilage and Bone Marrow Aspirate Concentrate Mixture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0004
Author(s):  
Ashraf Fansa ◽  
Mark Drakos ◽  
Taylor Cabe ◽  
Peter Fabricant
Keyword(s):  
Bone Marrow ◽  
Patient Reported Outcomes ◽  
Bone Marrow Aspirate ◽  
Statistical Significance ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Bone Marrow Aspirate Concentrate ◽  
Patient Reported ◽  
The Mean

Category: Arthroscopy Introduction/Purpose: With reported incidence rates ranging from 40% to 70% post ankle sprains and fractures, osteochondral lesions of the talus (OLT) are not uncommon. However, management of such defects remains challenging. Microfracturing is considered the standard treatment for symptomatic OLTs.Larger lesions however typically require more invasive restorative procedures such as autologous osteochondral transplantation. Microfracture results are variable due to the fact that the resulting reparative fibrocartilage is weaker and biomechanically inferior to native hyaline cartilage. In this study, we examine the functional and radiological outcomes following use of a new arthroscopic technique utilizing a mixture of micronized allograft cartilage matrix (BioCartilage) (Arthrex, Naples, FL) soaked in Bone Marrow Aspirate Concentrate (BMAC) to fill OLTs. Methods: Eighty-six consecutive patients treated for OLT using arthroscopic debridement and BioCartilage matrix soaked in BMAC were identified. All patients were treated by a single fellowship-trained sports medicine and foot and ankle surgeon. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS). This information was obtained from a prospective registry at the authors’ institution. Wilcoxon signed rank tests were used to determine statistical significance between pre and postoperative clinical scores. Additionally, an attending radiologist assessed the reparative cartilage morphology on postoperative MRI scans. This was evaluated and scored using a modified magnetic resonance observation of cartilage tissue (MOCART) scoring system. Results: Thirty-one patients (19 Females; 12 Males) with a mean age of 37.8 years (Range 15–54) had a minimum follow-up duration of 12 months and were thus included in this review. Mean follow-up duration was 15.8 months (Range 12 –25.7). The mean patient BMI was 27.4 (Range 19.6 – 39.4), while the average osteochondral lesion size was 85.9 mm2 (Range 35 – 220). The Physical Function domain of the PROMIS score, demonstrated statistically significant change, improving from 40.63 ±8.31 to 48.31 ±10.07 (p=0.02). The Pain Intensity domain also improved significantly from 49.06 ±9.32 to 42.14 ±9.38 (p=0.03). The Pain Interference domain and FAOS scores did improve but not reaching statistical significance. The mean MRI MOCART score was 69 ±13.34 with 13.3 months average follow-up duration. Conclusion: Achieving the longest duration possible of symptom-free functioning postoperatively is the main goal of any cartilage repair procedure. Augmentation of an articular lesion’s infill with BioCartilage and BMAC may help enhance the biomechanical properties of the reparative fibrocartilage construct and its longevity. Our initial findings demonstrate favorable patient-reported outcomes. Moreover, postoperative MRIs demonstrate the majority of the lesions showed either complete or hypertrophic infill, complete or hypertrophic integration, homogenous repair tissue, and isointense signals. Long-term studies prospectively assessing the effectiveness of this technique in maintaining pain-free-function of the ankle joint are warranted.

Patient-Reported Outcomes After Structural Autograft for Large or Cystic Talar Dome Osteochondral Lesions

2020 ◽  
Vol 41 (5) ◽  
pp. 549-555
Author(s):  
Todd Kim ◽  
Andrew Haskell
Keyword(s):  
Patient Reported Outcomes ◽  
Distal Tibia ◽  
Case Series ◽  
Osteochondral Lesions ◽  
Measurement Information ◽  
Talar Dome ◽  
Level Of Evidence ◽  
Structural Bone Graft ◽  
Patient Reported

Background: While smaller talar dome osteochondral lesions (OCLs) are successfully treated with bone marrow stimulation techniques, the optimal treatment for large or cystic OCLs remains controversial. This study tested the hypothesis that transferring structural autograft bone from the distal tibia to the talus for large or cystic OCLs improves pain and function. Methods: Thirty-two patients with large or cystic OCLs underwent structural bone grafting from the ipsilateral distal tibia to the talar dome. Patients were assessed with subjective patient-centered tools and objective clinical outcomes. Average age was 48.6 ± 14.9 years, and average follow-up was 19.5 ± 13.3 months. Average lesion area was 86.2 ± 23.5 mm2, and average depth was 8.4 ± 3.0mm. Results: At final follow-up, improvement compared to preoperative scores was seen in American Orthopaedic Foot & Ankle Society (65.4 ± 21.2 to 86.9 ± 15.0, P < .05), Foot Function Index (48.9 ± 20.8 to 21.1 ± 18.9, P < .05), visual analog scale for pain (4.7 ± 3.0 to 1.4 ± 1.5, P < .05), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (40.4 ± 5.4 to 45.5 ± 7.4, P < .05) scores. There was no improvement in PROMIS pain interference (54.7 ± 18.1 to 52.4 ± 7.3, P > .05). Satisfaction with surgery was 8.4 ± 1.3/10, and 96% of patients would have the procedure again. Ninety-four percent of patients returned to work and/or play. One patient had a deep vein thrombosis 6 weeks postoperatively, and 1 patient underwent ankle fusion at 18 months postoperatively. Conclusion: This study demonstrates that structural bone graft harvested from the distal tibia transferred to the talus was a safe and effective treatment for large and cystic OCLs. Outcomes compare favorably to other described techniques for treatment of these injuries. Level of Evidence: Level IV, case series.

scholarly journals Percutaneous cheilectomy combined with Watermann and Moberg osteotomies for the treatment of hallux rigidus

2019 ◽  
Vol 13 (2) ◽  
pp. 135-139
Author(s):  
Júlio Ferreira de Arruda ◽  
André Donato Baptista
Keyword(s):  
Surgical Treatment ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Plantar Flexion ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Functional Improvement ◽  
Percutaneous Technique ◽  
Significant Difference

Objective: To evaluate the clinical and functional outcomes of patients subjected to surgical treatment of hallux rigidus by the percutaneous cheilectomy combined with Watermann and Moberg osteotomies. Methods: Between May 2017 and August 2018, the clinical outcomes of 7 patients with a diagnosis of hallux rigidus (HR) treated using the percutaneous technique were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) scale, the visual analogue scale (VAS) for pain and hallux metatarsophalangeal joint range of motion measurements during the pre- and postoperative periods. Clinical and functional outcomes were followed up for a minimum of 6 months (mean of 8 months). Results: The range of motion of the metatarsophalangeal joint during the pre- and postoperative periods showed the following results: dorsiflexion increased on average from 28.00º (± 15.63) to 44.43º (± 17.33) (p = 0.006), demonstrating an effective gain in dorsal articular movement. Plantar flexion ranged on average from 27.43º (± 2.22) to 24.43º (± 5.28) (p = 0.228), with no significant difference between the evaluated periods. The AOFAS score increased on average from 52.71 (± 9.63) to 88.00 (± 8.10) (p < 0.01), representing important functional improvement. The VAS score decreased on average from 7.00 (± 1.52) to 2.14 (± 2.19) (p = 0.002), indicating a significant improvement in patient pain. No patient presented postoperative complications. Conclusion: The results of the present study demonstrated that cheilectomy combined with percutaneous Watermann and Moberg osteotomies is an effective surgical treatment for hallux rigidus, with satisfactory clinical and functional outcomes. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Functional outcomes of bone marrow aspirate concentrate application in osteoarthritis of the knee

2019 ◽  
Vol 7 (2) ◽  
pp. 587
Author(s):  
Safa Gursoy ◽  
Mustafa Akkaya ◽  
Mehmet Emin Simsek ◽  
Murat Bozkurt
Keyword(s):  
Bone Marrow ◽  
Functional Recovery ◽  
Functional Outcomes ◽  
Bone Marrow Aspirate ◽  
Osteoarthritis Of The Knee ◽  
Bone Marrow Aspirate Concentrate ◽  
Symptomatic Knee ◽  
Significant Difference ◽  
The Mean

Background: Osteoarthritis (OA) of the knee is a very common musculoskeletal disorder. Although total knee replacement is a suitable option in the treatment of severe OA, it has some limitations when performed in the early stage and early age. Bone marrow aspirate concentrate (BMAC), which is rich in mesenchymal stem cells, is promising due to its potentially regenerative and symptomatic effects in many disorders of the musculoskeletal system. This study aims to investigate the efficacy of BMAC in terms of functional recovery in OA of the knee joint.Methods: Total of 52 patients with unilateral symptomatic knee OA but no inflammatory disease, advanced malalignment or instability were enrolled in this study. Bone marrow aspirate was collected from the iliac crest in one session, prepared using a manufactured kit and the patients received intra-articular injections of this BMAC. The mean age of the patients was 59.2±7.4 and the mean follow-up period was 22.1±3.6 months. Functional outcomes of the patients were evaluated using Modified Cincinnati and Tegner Lysholm scoring systems.Results: It was observed that both Lysholm and Cincinnati scores of the patients were statistically significantly higher throughout the follow-up period as compared to the period before the procedure (p=0.0001). There was no statistically significant difference in Lysholm and Cincinnati ratings between gender, side and body mass index groups throughout the follow-up period (p >0.05). It was found that the results of the patients with Kellgren-Lawrence Grade 4 severe joint arthrosis were statistically significantly lower (p <0.05).Conclusions: Considering the functional outcomes of the patients up to two years, it was observed that the application of concentrated bone marrow aspirate provided functional recovery in arthrosis of the knee joint.

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