Comparison of Bone Marrow Stimulation and Particulated Autologous Cartilage Transplantation for Osteochondral Lesions of the Talus With a 2-Year Follow-up

Abstract

Background: Osteochondral lesions of the talus (OLTs) are a common cause of disability and chronic ankle pain. Many surgical treatment methods are currently used to treat OLTs, including particulated autologous cartilage transplantation (PACT). Nonetheless, the relative outcomes of PACT for OLTs are unclear. Purpose: To compare the short-term efficacy of bone marrow stimulation (BMS) and PACT in patients with OLTs. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive symptomatic patients with OLT who underwent BMS or PACT from March 2015 to December 2022 were retrospectively evaluated for at least 2 years. Preoperative radiography and magnetic resonance imaging (MRI) were performed in all patients. Follow-up second-look arthroscopy and MRI were performed approximately 1 year postoperatively. Clinical outcomes were assessed using the pain visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Foot and Ankle Outcome Score (FAOS). The quality of regenerated cartilage was evaluated using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores and International Cartilage Repair Society (ICRS) grades and scores. Continuous variables were compared using independent t tests. A P value <.05 was considered statistically significant. Results: A total of 48 and 16 patients (48 and 16 ankles) were enrolled in the BMS and PACT groups, respectively. No significant differences existed in demographic characteristics between the groups. Preoperatively, some clinical parameters were significantly worse in the PACT group (VAS 5.2 +/- 2.3 vs 6.4 +/- 0.8, P = .003; AOFAS score 70.0 +/- 7.1 vs 62.1 +/- 11.0, P = .015; FAOS symptom 64.7 +/- 17.1 vs 53.3 +/- 17.9, P = .036). However, 1-year FAOS quality of life scores (55.8 +/- 21.1 vs 75.5 +/- 23.1, P = .006) and 2-year AOFAS scores were significantly higher in the PACT group (84.9 +/- 11.4 vs 91.4 +/- 8.6, P = .021). Postoperative MOCART scores were significantly higher in the PACT group (55.3 +/- 24.0 vs 66.3 +/- 20.6, P = .048). Moreover, second-look arthroscopy revealed that ICRS scores (9.7 +/- 0.5 vs 10.0 +/- 0.5, P = .037) and grades (P = .001) were significantly better in the PACT group. Conclusion: Our study demonstrated that PACT achieved significantly superior morphologic cartilage regeneration compared with BMS in OLTs at 1-year follow-up. However, the differences in clinical outcomes between the 2 treatments were not significant. Notwithstanding, additional follow-up studies are needed to assess the effects of PACT on long-term outcomes.