2025 ISAKOS Biennial Congress ePoster
Treatment Of Osteochondral Talar Dome Lesions Using Autologous Plasma Rich In Growth Factors Clot Mixed With Healthy Chondral Chips. Clinical And Radiological Outcomes After 1-Year Follow-Up.
David Barastegui, MD, PhD, MSc, L'hospitalet De Llobregat, BARCELONA SPAIN
Alessandro Malatesta, MD, Treviso, Treviso ITALY
Alfred Ferré-Aniorte, PT, Barcelona, Barcelona SPAIN
Patricia Laiz Boada, BSc, Barcelona SPAIN
Roberto Seijas-Vazquez, MD, PhD, Prof., Barcelona SPAIN
Eduard Alentorn-Geli, MD, PhD, MSc, FEBOT, FACGME, Barcelona SPAIN
Pedro Alvarez-Diaz, MD, PhD, Prof., Barcelona SPAIN
Montserrat Garcia Balletbo, MD, PhD, Barcelona, Catalunya SPAIN
Ramon Cugat Bertomeu, MD, PhD, Barcelona, Barcelona SPAIN
Instituto Cugat. Hospital Quironslaud Barcelona, Barcelona, SPAIN
FDA Status Not Applicable
Summary
The use of PACI-PRP in has shown good radiological results in the treatment of athletes with osteochondral talar dome injuries
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Abstract
Introduction
Osteochondral talar dome injuries are relatively common among clinical practice and represent a notable repercussion for the athlete and a challenge for the surgeon. The most effective treatment approach remains a topic of debate among physicians. Even though bone marrow stimulation is the preferred therapy in cases of small injuries (< 15 mm2), its effectivity in larger chondral defects is still controversial.
Recently, new surgical techniques have emerged consisting on particulated articular cartilage implantation (PACI) and the use of biological and regenerative therapies such as autologous platelet-rich plasma (PRP). Good results have been reported after the use of PACI-PRP in the treatment of large osteochondral knee defects. However, its effectivity in talar dome lesions remains unclear. Thus, the aim of the aim of this study is to describe the radiological evolution of a cohort of athletes with osteochondral talar dome lesions after the treatment with autologous chondrocyte implantation with PRP.
Material And Methods
This study was designed as a retrospective analysis of a prospective patient database. All patients with osteochondral injuries treated in a single private medical institution were approached for eligibility. For the purpose of this study, only those athletes with osteochondral talar dome injuries larger that 15 mm2 were included.
Surgical procedure was performed by the same medical and nursing team. Firstly, an ankle arthroscopy was performed through the classical portals, identifying the injury site and performing an initial debridement until a healthy base of subchondral bone was reached. The viable hyaline cartilage obtained during such procedure were cut into small pieces. Then, it was mixed with autologous leucocyte poor PRP (BTI Biotechnology institute, Alava, Spain) and let it for 30 minutes until a semisolid matrix was obtained. The final matrix was reshaped according to the osteochondral injury area and placed inside the joint covering entirely the osteochondral defect.
The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 was used by an external examiner to analyze pre-operative MRI exams and the last post-operative exams available.
Results
A final sample of 12 athletes (8 males and 4 females) were included in this analysis. Mean ± SD age at injury was 30.08 ± 12.35 years with a mean ± SD body mass index (BMI) of 21.56 ± 2.10. Among the subjects, they were Six soccer players, three runners, one basketball player, one handball player, and one skate athlete. A non-significant tendency towards MOCART improvement was found between pre-operative and post-operative values, with mean ± SD values of 35.42 ± 17.38 and 51.25 ± 16.67 respectively (p = 0.065).
Conclusion
The use of PACI-PRP in athletes with osteochondral talar dome injuries has shown promising radiological results. Further studies with larger cohorts with extended clinical data in order to confirm the tendences showed in the present study.