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Better outcomes seen after adjuvant therapy, bone marrow aspirate concentrate for talar lesions
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BOSTON — A significantly higher modified MR observation of cartilage repair tissue score was seen in patients with osteochondral lesions of the talus treated with particulate allogenic cartilage extracellular matrix and bone marrow aspirate concentrate compared to patients treated with microfracture alone, according to a presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. According to researchers, the findings suggest the adjuvant therapy may be linked with better postoperative fill and structural integrity.
“In our study, we found that there was a lower failure rate when bone marrow aspirate concentrate was mixed with particulate allogenic cartilage after cellular matrix in the treatment of these lesions,” Mark C. Drakos, MD, foot and ankle surgeon at Hospital for Special Surgery, told Healio.com/Orthopedics. “They also had an appearance on MRI.”
Drakos and colleagues identified patients with osteochondral lesions of the talus. There were 47 patients treated with microfracture alone, 47 patients treated with microfracture augmented with bone marrow aspirate concentrate (BMAC) and 52 patients treated with a combination of adjuvant particulate allogenic cartilage extracellular matrix and BMAC. After a retrospective chart review, investigators studied information on lesion size, location and concurrent injuries. Preoperatively and at 1 year postoperatively, the foot and ankle outcomes scores (FAOS) were collected through a prospective registry database. The modified MR observation of cartilage repair tissue (MOCART) score was used to assess the structural quality of repaired lesions on MRIs collected at more than 6 months postoperatively. Analysis of variance tests were used to assess MOCART and FAOS scores.
Results showed the average MOCART score was significantly different between treatment groups. Patients who received adjuvant therapy had an average MOCART score of 73.5 at the average follow-up of 10.86 months. Patients treated with microfracture and BMAC and those who had microfracture alone had an average MOCART score of 63.33 and 55, respectively, at the average follow-up of 23.06 months and 43.6 months, respectively. There were no significant differences in FAOS scores among the groups. Two patients treated with adjuvant particulate allogenic cartilage extracellular matrix and BMAC needed revision surgery compared with nine patients treated with either microfracture and BMAC or microfracture alone. – by Monica Jaramillo
Reference:
Drakos MC, et al. Abstract 79. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 11-14, 2019; Boston.
Disclosure: Drakos reports he has no relevant financial disclosures.