Bone marrow stimulation and biological adjuncts for treatment of osteochondral lesions of the talus

Osteochondral lesions of the talus (OLT) frequently occur after ankle sprain or fracture. Although there has been a growing interest in OLT treatment recently, the pathology has been recognized for hundreds of years. Yet there is a lack of consensus as to the most effective treatment strategy. Because of a lack of vasculature and the relative hypocellularity of articular cartilage, OLT are difficult to treat. Arthroscopic bone marrow stimulation (BMS) has become a commonly used method of treating smaller, primary OLT because of technical simplicity, the advantages of minimally invasive access, and cost-effectiveness. Results of BMS are good in the short-tomidterm with high overall success rates reported in the literature. However, the fibrocartilagenous repair tissue formed after BMS confers inferior biological and mechanical properties compared with native hyaline cartilage. Poorer outcomes have also been demonstrated in large and uncontained talar shoulder lesions. Subchondral bone compaction and thermal necrosis with drilling may be the cause for concern. There is also evidence of high rates of cracks and fissuring in fibrocartilage and inadequate integration with native cartilage postoperatively. Furthermore, there is a lack of long-term BMS outcome data available. Concerns with BMS have prompted investigation of biological adjuncts that could potentially improve the quality of BMS repair tissue and form a more hyaline-like repair. Arthroscopic BMS has much promise for the future but long-term, high-level studies are required. Enhancement of BMS with biological adjuncts and improved surgical instrumentation has the potential to improve cartilage repair and outcomes.

Duke Scholars

Author Mark Erik Easley Orthopaedic Surgery