Summary
In a comparative study to evaluate the efficacy of mBMS in comparison to PACT for the treatment of chondral and osteochondral lesions of the talus, good clinical results were observed for both treatment methods with favorable score results for mBMS compared to PACT.
Abstract
Background
Currently, no gold standard for the treatment of chondral (CL) or osteochondral lesions (OCL) of the talus exists. Matrix-associated bone marrow stimulation (mBMS) is an established and widely used method. Particulated autologous cartilage transplantation (PACT) has recently gained increasing attention.
Purpose
To compare the efficacy of mBMS in comparison to PACT for the treatment of chondral and osteochondral lesions of the talus.
Methods
This retrospective comparative study includes 52 patients treated for a CL or OCL of the talus with a minimum follow-up of twelve months (range 12-63 moths). Patients of group A (n=26) were treated with mBMS (Hyalofast, Anika Therapeutics Inc, U.S.A), Patients of group B (n=26) received PACT (Arthrex Inc, Naples, U.S.A).
As the primary outcome, the Foot and Ankle Outcome Score (FAOS) with its subscales was compared between the two groups. Furthermore, outcomes of a modified version of the Hannover-Scoring-System for the ankle (HSS) were evaluated.
Results
No significant between-group differences were observed in demographic data (age, sex, BMI, size of the lesion) and preoperative score values (Mann-Whitney U Test, p<0.05). One patient in group B underwent further operative cartilage therapy and is considered as failure, leaving 26 patients in group A and 25 patients in group B for postoperative score evaluation.
Both groups showed statistically significant improvement when comparing the pre- and postoperative score values (Wilcoxon sign rank sum test). Overall postoperative score results for the FAOS were (group A: 87,09, SD 8,82, group B: 80,95; SD 12,55) and for the subscales Symptoms (group A: 80,08, SD 17,88, group B: 71,86, SD 20,91), Pain (group A: 91,03, SD 8,29, group B: 85,78, SD 13,26), Activities of daily living (group A: 95,87, SD 5,49, group B: 91,59, SD 10,68), Function in sport and recreation (group A: 81,54, SD 19,33, group B: 70,80 , SD 19,88) and Quality of life (group A: 60,10, SD 20,85, group B: 53,50, SD 22,97). Statistically significant differences in the FAOS subscale Function in sport and recreation (Mann-Whitney-U Test, p=0.03), and the modified version of the HSS (Mann-Whitney U Test, p=0.02), with better results of treatment with mBMS were observed. No other significant differences of the score results were calculated.
Conclusion
Good clinical results were observed for both treatment methods. Favorable score results for mBMS compared to PACT were found with statistically significant differences in the FOAS subscale Function in sport and recreation and the modified version of the HSS.