Introduction
and Aim
Osteochondral talar dome lesion has a strong impact in the sports practice and is one of the greatest challenges for an orthopedic surgeon. Bone marrow stimulation is one of the therapies that has more consensus regarding the treatment of small lesions (<15mm2) but hasn’t for larger lesions. Size is the key point for providing a matrix to fill the lesions or not. In recent years, the emergence of artificial matrix, such as ACI and MACI, have led to an exponential increase of therapies for the treatment of OCL. Recently, our group has described a surgical technique consisting of a novel autologous-made matrix using hyaline cartilage chips and platelet-rich plasma for focal lesions.
The objective of this study is to evaluate the clinical evolution after one year of follow-up of a series of cases treated using this technique.
M&M
Of a total of 38 patients who underwent surgery consisting of hyaline cartilage chips and platelets-rich plasma matrix placement over the focal injury, 35 met the criteria and were included in the study. The inclusion criteria consisted of an osteochondral lesion greater than 15mm2, symptomatic injury, refractory to a conservative treatment for 3 months, and with a minimum follow up of 1 year. All data was collected for sex, age, sports activity, Tegner, and onset of symptoms preoperatively and functional tests (VAS, AOFAS and FADI) preoperatively and at 6 and 12 months postoperatively. The patients were informed, giving their consent for the intervention.
Results
The 35 patients included underwent surgery between 2015 and 2021, with a mean age of 28.84 ± 10.63 years, a male:female ratio of approximately 2.5:1, a mean weight of 69.33 ± 10.36 kg, a height of 172 ± 0.1 m, and a BMI of 23.37 ± 1.98. All the lesions studied were located in the talus with a mean lesional surface greater than 1 cm2, 23 right and 10 left ankles (2 tibia), with lesions predominantly located on the medial side (Raikin 4 and 7). All the patients had an inability to participate in sports, 1/5 of the patients had a progressive limp and 76.8% of the patients had concomitant pain.
The preoperative VAS was 5.88 ± 0.21, decreasing to 3.2 ± 0.36 at 6m and to 2 ± 1.42 at one year follow-up (p<0.05). Significant differences in FADI at one year were also found, with a return to play rate (32.15 ± 5.56 weeks after surgery) of 80%, although only 2/3 of them at the same pre-injury Tegner level.
Conclusion
- The use of an autologous-made matrix using hyaline cartilage chips and platelet-rich plasma is a simple, effective, reproducible, and cheap technique compared to other techniques in the treatment of talar osteochondral lesions.
- The results at one year follow-up are acceptable in terms of patient satisfaction during follow-up.