Bone marrow aspirate concentrate and platelet-rich plasma as biological adjuncts to the surgical treatment of osteochondral lesions of the talus

Symptomatic osteochondral lesions of the talus can be debilitating injuries in both the general and athletic populations, where surgical treatment is often required to provide functional pain relief and return to play in athletes. The most common surgical treatment strategies include reparative (ie, microfracture and drilling) and restorative techniques. Reparative techniques allow fibrocartilage differentiation to fill the defect site and thereby protect the subchondral bone. The concern with the mechanically and biologically inferior fibrocartilage is that it may ultimately degrade over time, particular in larger lesions. Restorative techniques (ie, autologous osteochondral transplantation) provide a potential advantage over reparative techniques in that "like with like" in terms of hyaline cartilage at the site of cartilage repair and may afford the joint increased longevity over time. The current authors' have developed a treatment strategy by which the treatment strategy is based on lesion size. Lesions less than or equal to 8 mm in diameter are treated with microfracture whereas lesions greater than 8 mm in size are treated with autologous osteochondral transplantation. The current authors' are also investigating the use of bone marrow aspirate concentrate and platelet-rich plasma as a potential means of improving fibrocartilage and bone healing. This article will describe the potential uses of bone marrow aspirate concentrate and platelet-rich plasma in the surgical treatment of osteochondral lesions of the talus. © 2011 Lippincott Williams & Wilkins, Inc.

Duke Scholars

Author Christopher David Murawski Orthopaedic Surgery