New Study Suggests Osteochondral Autograft Transplantation is Superior to Microfracture Treatment for Talar Osteochondral Lesions
A talar osteochondral lesion (OLT) can develop after ankle sprains or ankle trauma. An OLT is an injury to the cartilage and underlying bone of the talus within the joint, where it begins to soften and break off as a result of not healing properly.
Past research has indicated the size of an OLT is a predictive factor correlating with successful surgical outcomes. Microfracture or arthroscopic marrow stimulation has demonstrated less success when treating larger OLTs (greater than 150mm), whereas Osteochondral Autograft Transplantation (OAT) has been successful in treating larger lesions.
A new retrospective study from Hospital for Special Surgery (HSS) compared clinical outcomes after treatment of medium-sized OLTs using a microfracture technique augmented with extracellular matrix and bone marrow aspirate concentrate (MFX) versus OAT to determine which option is superior for treating medium-sized lesions. Fifty patients were evaluated, 27 of whom were treated with MFX, and 23 who were treated with OAT for an OLT (sized 80-165mm) between 2015-2018, at a minimum of 12 months follow up. Patient-reported functional outcomes were collected through the HSS prospective registry database. Postoperative MRIs were assessed using a modified magnetic resonance observation of cartilage repair tissue (MOCART) score.
The OAT group had a higher MOCART score indicating that the use of a single osteochondral autograft plug may result in better structural repair. Higher average FAOS scores, better than average PROMIS scores and greater pre-to-postoperative change in the OAT group also suggest functional results may be better in this group as well. Patients treated with OAT reported significantly less pain and depression and better psychological benefits than those who were treated with MFX.
“The key takeaways from this research are the open procedure more closely replicates the normal anatomy than the arthroscopic procedure - they are not equal,” said Mark C. Drakos, MD, HSS foot and ankle surgeon and senior study author. “The findings validate the need to perform additional research to ensure the less invasive arthroscopic procedure has better outcomes similar to those of the open procedure.”
This study is available online as part of the AAOS 2020 Virtual Education Experience.
Abstract Title: A Comparison of Functional and Radiographic Outcomes following Microfracture with Extracellular Matrix Augmentation versus Osteochondral Autograft Transplantation for the Treatment of Medium-Sized Osteochondral Lesions of the Talus
Authors: Taylor Cabe, Carolyn M. Sofka, MD, Jonathan T. Deland, MD, Mark C. Drakos, MD
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