Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2023

17-06-2023 | Ankle Fracture | ANKLE

Hyaluronic scaffold transplantation with bone marrow concentrate for the treatment of osteochondral lesions of the talus: durable results up to a minimum of 10 years

Authors: Francesca Vannini, Luca Berveglieri, Angelo Boffa, Giuseppe Filardo, Valentina Viglione, Roberto Buda, Sandro Giannini, Cesare Faldini

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2023

Login to get access

Abstract

Purpose

The aim of this study was to evaluate the long-term clinical results of the transplantation of a hyaluronic acid membrane augmented with bone marrow aspirate concentrate (BMAC) in an one-step technique for the treatment of patients affected by osteochondral lesions of the talus (OLT).

Methods

A total of 101 patients (64 men, 37 women, age 32.9 ± 10.9) were evaluated for a minimum of 10 years of follow-up (151.5 ± 18.4 months) The mean lesion size was 2.2 ± 1.4 cm2, the lesion had a post-traumatic origin in 73 patients, 15 patients previously had an ankle fracture, 22 patients had ankle osteoarthritis. All patients were clinically evaluated at baseline and at 2, 5, and a minimum of 10 years after treatment using the AOFAS score, the NRS for pain, and the Tegner score. A survival analysis was performed to check the survival to failure up to the last follow-up.

Results

The AOFAS score significantly improved from baseline (59.6 ± 13.9) to the final follow-up (82.3 ± 14.2) (p < 0.0005). A significant reduction in the AOFAS score was found from 2 to 10 years (p < 0.0005). The NRS for pain changed from 7.0 ± 1.3 at baseline to 3.9 ± 2.7 at the final follow-up (p < 0.0005). A significant worsening was documented between 5 years and the final follow-up (p < 0.0005). The Tegner score improved from the preoperative value of 2.0 (range 1–7) to 3.0 (range 1–7) at the final follow-up (p < 0.0005), although it remained lower as compared to the preinjury level of 4.0 (range 1–9) (p < 0.0005). Better results were documented in male and younger patients with smaller lesions, without the previous surgery, and without the previous ankle fractures or osteoarthritis. At the final follow-up, 85 patients considered their general health status “satisfactory” and 84 patients reported feeling “better” than the preoperative condition. Five patients were considered failures and underwent prosthetic ankle replacement or repeated the same surgery.

Conclusion

This one-step technique showed to be an effective procedure for the treatment of OLT, providing a low failure rate and offering durable clinical improvements up to a minimum of 10 years of follow-up. However, this technique demonstrated a small yet significant decrease over the years in terms of pain and function and poor results in terms of sports activity level.

Level of evidence

Level IV.
Literature
1.
Barbier O, Amouyel T, de l’Escalopier N, Cordier G, Baudrier N, Benoist J et al (2021) Osteochondral lesion of the talus: what are we talking about? Orthop Traumatol Surg Res 107:103068CrossRefPubMed
2.
Buckwalter JA, Mow VC, Ratcliffe A (1994) Restoration of injured or degenerated articular cartilage. J Am Acad Orthop Surg 2:192–201CrossRefPubMed
3.
4.
5.
Hintermann B, Boss A, Schafer D (2002) Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 30:402–409CrossRefPubMed
6.
Hu CY, Lee KB, Song EK, Kim MS, Park KS (2013) Comparison of bone tunnel and suture anchor techniques in the modified Brostrom procedure for chronic lateral ankle instability. Am J Sports Med 41:1877–1884CrossRefPubMed
7.
Kibler WB (1996) Arthroscopic findings in ankle ligament reconstruction. Clin Sports Med 15:799–804CrossRefPubMed
8.
Taga I, Shino K, Inoue M, Nakata K, Maeda A (1993) Articular cartilage lesions in ankles with lateral ligament injury. An arthroscopic study. Am J Sports Med 21:120–126 (Discussion 126-127)CrossRefPubMed
9.
Anwander H, Vetter P, Kurze C, Farn CJ, Krause FG (2022) Evidence for operative treatment of talar osteochondral lesions: a systematic review. EFORT Open Rev 7:460–469CrossRefPubMedPubMedCentral
10.
11.
Moran ME, Kim HK, Salter RB (1992) Biological resurfacing of full-thickness defects in patellar articular cartilage of the rabbit. Investigation of autogenous periosteal grafts subjected to continuous passive motion. J Bone Joint Surg Br 74:659–667CrossRefPubMed
12.
Basad E, Ishaque B, Bachmann G, Sturz H, Steinmeyer J (2010) Matrix-induced autologous chondrocyte implantation versus microfracture in the treatment of cartilage defects of the knee: a 2-year randomised study. Knee Surg Sports Traumatol Arthrosc 18:519–527CrossRefPubMed
13.
14.
Gugjoo MB, Amarpal SGT, Aithal HP, Kinjavdekar P (2016) Cartilage tissue engineering: role of mesenchymal stem cells along with growth factors & scaffolds. Indian J Med Res 144:339–347CrossRefPubMedPubMedCentral
15.
16.
Johnstone B, Alini M, Cucchiarini M, Dodge GR, Eglin D, Guilak F et al (2013) Tissue engineering for articular cartilage repair–the state of the art. Eur Cell Mater 25:248–267CrossRefPubMed
17.
Oreffo RO, Cooper C, Mason C, Clements M (2005) Mesenchymal stem cells: lineage, plasticity, and skeletal therapeutic potential. Stem Cell Rev 1:169–178CrossRefPubMed
18.
Buda R, Vannini F, Cavallo M, Grigolo B, Cenacchi A, Giannini S (2010) Osteochondral lesions of the knee: a new one-step repair technique with bone-marrow-derived cells. J Bone Joint Surg Am 92(Suppl 2):2–11CrossRefPubMed
19.
Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B (2009) One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res 467:3307–3320CrossRefPubMedPubMedCentral
20.
Buda R, Vannini F, Cavallo M, Baldassarri M, Natali S, Castagnini F et al (2013) One-step bone marrow-derived cell transplantation in talarosteochondral lesions: mid-term results. Joints 1:102–107CrossRefPubMed
21.
Giannini S, Buda R, Battaglia M, Cavallo M, Ruffilli A, Ramponi L et al (2013) One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med 41:511–518CrossRefPubMed
22.
Giannini S, Buda R, Grigolo B, Vannini F (2001) Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int 22:513–517CrossRefPubMed
23.
Park JH, Park KH, Cho JY, Han SH, Lee JW (2021) Bone marrow stimulation for osteochondral lesions of the talus: are clinical outcomes maintained 10 years later? Am J Sports Med 49:1220–1226CrossRefPubMed
24.
Biant LC, Bentley G, Vijayan S, Skinner JA, Carrington RW (2014) Long-term results of autologous chondrocyte implantation in the knee for chronic chondral and osteochondral defects. Am J Sports Med 42:2178–2183CrossRefPubMed
25.
Brulc U, Drobnic M, Kolar M, Strazar K (2022) A prospective, single-center study following operative treatment for osteochondral lesions of the talus. Foot Ankle Surg 28:714–719CrossRefPubMed
26.
Filardo G, Andriolo L, Sessa A, Vannini F, Ferruzzi A, Marcacci M et al (2017) Age is not a contraindication for cartilage surgery: a critical analysis of standardized outcomes at long-term follow-up. Am J Sports Med 45:1822–1828CrossRefPubMed
27.
Peterson L, Vasiliadis HS, Brittberg M, Lindahl A (2010) Autologous chondrocyte implantation: a long-term follow-up. Am J Sports Med 38:1117–1124CrossRefPubMed
28.
Hunt KJ, Ebben BJ (2022) Management of treatment failures in osteochondral lesions of the talus. Foot Ankle Clin 27:385–399CrossRefPubMed
29.
Lenz CG, Tan S, Carey AL, Ang K, Schneider T (2020) Matrix-induced autologous chondrocyte implantation (MACI) grafting for osteochondral lesions of the talus. Foot Ankle Int 41:1099–1105CrossRefPubMed
30.
Choi SW, Lee GW, Lee KB (2020) Arthroscopic microfracture for osteochondral lesions of the talus: functional outcomes at a mean of 6.7 years in 165 consecutive ankles. Am J Sports Med 48:153–158CrossRefPubMed
31.
Briggs KK, Steadman JR, Hay CJ, Hines SL (2009) Lysholm score and tegner activity level in individuals with normal knees. Am J Sports Med 37:898–901CrossRefPubMed
32.
Kwak SK, Kern BS, Ferkel RD, Chan KW, Kasraeian S, Applegate GR (2014) Autologous chondrocyte implantation of the ankle: 2- to 10-year results. Am J Sports Med 42:2156–2164CrossRefPubMed
33.
Vannini F, Filardo G, Altamura SA, Di Quattro E, Ramponi L, Buda R et al (2021) Bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus in ankle osteoarthritis: satisfactory clinical outcome at 10 years. Knee Surg Sports Traumatol Arthrosc 29:2504–2510CrossRefPubMed
34.
35.
Centeno CJ, Berger DR, Money BT, Dodson E, Urbanek CW, Steinmetz NJ (2022) Percutaneous autologous bone marrow concentrate for knee osteoarthritis: patient-reported outcomes and progenitor cell content. Int Orthop 46:2219–2228CrossRefPubMed
36.
Previtali D, Boffa A, Di Martino A, Deabate L, Delcogliano M, Filardo G (2022) Recall bias affects pain assessment in knee osteoarthritis: a pilot study. Cartilage 13:50–58CrossRefPubMedPubMedCentral
Metadata
Title
Hyaluronic scaffold transplantation with bone marrow concentrate for the treatment of osteochondral lesions of the talus: durable results up to a minimum of 10 years
Authors
Francesca Vannini
Luca Berveglieri
Angelo Boffa
Giuseppe Filardo
Valentina Viglione
Roberto Buda
Sandro Giannini
Cesare Faldini
Publication date
17-06-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07490-0

Other articles of this Issue 10/2023

Knee Surgery, Sports Traumatology, Arthroscopy 10/2023 Go to the issue

KNEE

Poorer patient-reported outcome and increased risk of revision at a 5-year follow-up among patients with septic arthritis following anterior cruciate ligament reconstruction: a register-based cohort study of 23,075 primary anterior cruciate ligament reconstructions

SHOULDER

High degree of consensus on diagnosis and management of rotator cuff tears: a Delphi approach

KNEE

High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet-rich plasma as conservative treatment for meniscal lesions

KNEE

Meniscal repair failure following concurrent primary anterior cruciate ligament reconstruction: results from the New Zealand ACL Registry

KNEE

Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy

KNEE

Machine learning can accurately predict risk factors for all-cause reoperation after ACLR: creating a clinical tool to improve patient counseling and outcomes