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Short-term outcomes following dehydrated micronized allogenic cartilage versus isolated microfracture for treatment of medial talar osteochondral lesions. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons Allahabadi, S., Johnson, B., Whitney, M., Oji, D., Chou, L., Lau, B. C. 2021

Abstract

BACKGROUND: Osteochondral lesions of the talus (OLTs) have been traditionally treated with bone marrow stimulation techniques such as microfracture. However, conventional microfracture results in a biomechanically weaker repair tissue of predominantly type I collagen. Acellular micronized cartilage matrix (MCM) serves as a bioactive scaffold to restore hyaline cartilage. The purpose was to compare short-term outcomes after microfracture with and without augmentation with MCM for medial-sided OLTs.METHODS: A retrospective review was performed between 2010-2019 for medial-sided OLTs undergoing treatment with either microfracture augmented with MCM or isolated microfracture. The MCM was hydrated with either bone marrow aspirate concentrate (BMAC) or platelet-rich plasma (PRP). Outcomes included visual analogue scale (VAS) pain scores, Foot and Ankle Activity Measure (FAAM) scores, return-to-daily activities, and return-to-sport.RESULTS: 48 patients (14 MCM with PRP, 6 MCM with BMAC; 28 isolated microfracture) with average age 35.5 years (range: 13.8-67.2 years) and mean follow-up 4.0±3.4 years (range,.13-10.7) were included. There was no difference in average lesion size between MCM and microfracture groups (64.0±49.4 mm2 versus 57.3±44.2 mm2, P=.63) and a trend toward larger lesion size for BMAC compared to PRP (106.5±59.2 versus 45.9±32.1 mm2, P=.056). There was no difference in time to return-to-activity (83.5±18.8 versus 87.3±49.1 days) or return-to-sports (151.9±62.2 versus 165±99.2 days) with MCM versus isolated microfracture. However, the MCM group had a significantly greater improvement in VAS pain score at final follow-up (4.9±2.2 versus 2.7±2.6, P=.0032) and significantly higher post-operative FAAM-Activities of Daily Living subscale scores (97.2±8.2 versus 79.7±32.8, P=.033).CONCLUSIONS: Augmenting microfracture with MCM hydrated with PRP or BMAC may result in beneficial changes in pain scores and activities of daily living, but similar return-to-activities and return-to-sport times compared to microfracture alone in management of medial OLT.LEVEL OF EVIDENCE: IV.

View details for DOI 10.1016/j.fas.2021.07.012

View details for PubMedID 34366249