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
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 11th consecutive year), No. 4 in rheumatology by U.S. News & World Report (2020-2021), and named a leader in pediatric orthopedics by U.S. News & World Report “Best Children’s Hospitals” list (2020-2021). HSS is ranked world #1 in orthopedics by Newsweek (2020-2021). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 130 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.