Summary

This retrospective study evaluates the effectiveness of bone marrow stimulation in the treatment of osteochondral defects of the talus, demonstrating significant improvement in function and joint cartilage structure by MRI and clinical assessments at 6, 12, and 24 months after treatment, highlighting its effectiveness as a first-line surgical option.

Abstract

Introduction

Osteochondral defects of the talus (OCD) pose serious challenges in orthopedic treatment, potentially leading to chronic pain and joint dysfunction. One commonly used treatment is bone marrow stimulation, which involves the formation of multiple connections to the subchondral bone after prior lysing of the affected area. The aim of this study was to retrospectively evaluate the effectiveness of this method, using magnetic resonance imaging (MRI) and clinical evaluation of patients at 3, 6, 12 and 24 months after treatment.

Materials And Methods

This retrospective study included 25 of patients with osteochondral lesions of the ankle joint who underwent bone marrow stimulation treatment. Most patients had grade III or IV lesions according to the Berndt and Harty classification, although grade I and II lesions were also present. The size of the lesions did not exceed 2 cm in diameter. The procedure involved drilling or microfracturing to remove the mineralized zone and open connections to the subchondral bone, leading to the formation of a fibrin clot, the growth of new blood vessels and the introduction of bone marrow cells into the damaged area. Evaluation of treatment results included follow-up MRI scans and clinical assessment using the AOFAS Ankle-Hindfoot Scale at 6, 12 and 24 months.

Results

The results of the study showed that all of patients achieved positive treatment outcomes. They were pain free at final evaluation (after 2 years), and had a significant reduction in bone marrow oedema.

Conclusions

Bone marrow stimulation has proven to be an effective, minimally invasive, and relatively inexpensive method of treating osteochondral injuries of the ankle joint. Based on the available evidence, this procedure should be considered as the preferred first surgical treatment option for patients with symptomatic osteochondral ankle joint injuries. The results of the study confirm a significant improvement in cartilaginous structure and joint function, making this technique a valuable and effective therapeutic strategy.