Osteochondral fragment fixation may yield better outcomes vs. bone marrow stimulation
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Published results showed osteochondral fragment fixation for treatment of osteochondral lesions of the talus yielded superior clinical outcomes compared with bone marrow stimulation, even for lesions sized smaller than 100 mm2.
Researchers compared clinical outcomes, including American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale and bone marrow edema as identified on MRI, among 59 patients with osteochondral lesions of the talus who underwent either bone marrow stimulation (BMS; n = 26) or osteochondral fragment fixation (n = 36) between January 2008 and December 2020. Researchers also compared the lesion location on CT scans with or without bone marrow edema in each group.
Results showed patients in the fixation group had significantly higher AOFAS scores compared with patients in the BMS group, even when the lesion size was smaller than 100 mm2. At the final follow-up, researchers found significantly lower AOFAS scores among patients with bone marrow edema vs. patients without bone marrow edema in the BMS group. Researchers noted lesions with bone marrow edema in the sagittal plane were located more centrally than lesions without bone marrow edema in the BMS group. Patients in the fixation group had no significant differences in AOFAS scores and location of the lesion in the ankle with or without bone marrow edema, according to results.
“We recommend fixation of the osteochondral fragment with a cartilage surface of [International Cartilage Research Society] grade 2 or less rather than BMS to prevent deterioration of the subchondral bone and achieve good clinical results, even when the lesion size is less than 100 mm2,” the authors wrote.
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