Summary
The study demonstrates that using a collagen membrane with bone marrow aspirate concentrate (BMAC) effectively treats osteochondral lesions of the talus (OLT) over the long term, significantly improving pain and function. While many patients return to some level of sports, only a small percentage regain their pre-injury activity level.
Abstract
Background
The aim of this study was to evaluate the long-term clinical outcomes of a one-step arthroscopic procedure or open surgical approach involving the implantation of a collagen membrane augmented with bone marrow aspirate concentrate (BMAC) for the treatment of osteochondral lesions of the talus (OLT).
Methods
A total of 84 patients (51 men, 33 women; mean age 34.7) were evaluated with a minimum follow-up of 8 years (122.8 ± 11.8 months). The mean lesion size was 182.65 mm² with a depth of 5.769 mm. Among the patients, 46 had post-traumatic lesions, 10 had a history of ankle fractures, and 28 had ankle osteoarthritis. Clinical evaluations were conducted at baseline, and at 1, 2, 5, and a minimum of 8 years post-treatment, using the AOFAS score, NRS for pain, Tegner score, PASS, and EQ-5D. An analysis of the ability to return to sport and pre-injury activity levels was also conducted.
Results
The AOFAS score significantly improved from baseline (58.2 ± 14.2) to the final follow-up (85.2 ± 12.1) (p < 0.005). Pairwise comparisons showed significant improvements in AOFAS scores from baseline to each follow-up interval (p < 0.001), with no significant differences between the 1-, 2-, and 5-year follow-ups and the final assessment. The mean NRS pain score decreased from 7.5 ± 1.2 at baseline to 2.8 ± 2.4 at 1 year, with a slight further decrease to 2.3 ± 2.3 at 5 years and 2.9 ± 2.6 at the final follow-up. Significant reductions in pain were observed at all follow-up intervals compared to baseline (p < 0.001). The Tegner activity score, recorded only at baseline and final follow-up, showed a slight decrease from 4.7 ± 2.1 at baseline to 3.8 ± 1.7 at the final follow-up. Patients who underwent an open surgical approach or had associated fractures tended to have lower AOFAS scores (p < 0.005). Among those involved in sports before the injury, 59.5% returned to some level of sports postoperatively, though only 25% returned to their pre-injury level. The ability to return to the same sport and activity level was significantly correlated with the absence of arthrosis, with patients without arthrosis more likely to return to their sport and previous activity level (p < 0.005). At the final follow-up, 66 patients considered their general health status satisfactory.
Conclusion
The use of a collagen membrane augmented with bone marrow aspirate concentrate (BMAC) provides effective long-term treatment for osteochondral lesions of the talus (OLT), offering sustained pain relief and clinical improvement. While many patients return to some level of sports, only a small percentage regain their pre-injury activity level.