Osteochondral Lesions of the Ankle Treated with Bone Marrow Concentrate with Hyaluronan and Fibrin: A Single-Centre Study.

Sameera Abas,Jan Herman Kuiper,Helen Mccarthy,Bernhard Tins,Nilesh Makwana,Sally Roberts,Mike Williams,Andrew Bing

doi:10.3390/cells11040629

Sameera Abas, Jan Herman Kuiper + Show 6 more

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https://doi.org/10.3390/cells11040629

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Abstract

Osteochondral defects of the ankle (OCD) are being increasingly identified as a clinically significant consequence of injury to the ankle, with the potential to lead to osteoarthritis if left untreated. The aim of this retrospective cohort study was to evaluate a single-stage treatment of OCD, based on bone marrow aspirate (BMA) centrifuged to produce bone marrow concentrate (BMC). In a dual syringe, the concentrate was mixed with thrombin in one syringe, whereas hyaluronan and fibrinogen were mixed in a second syringe. The two mixtures were then injected and combined into the prepared defect. Clinical outcome and quality of life scores (MOXFQ and EQ-5D) were collected at baseline and yearly thereafter. Multilevel models were used to analyse the pattern of scores over time. Ninety-four patients were treated between 2015 and 2020. The means of each of the three components of the MOXFQ significantly improved between baseline and 1 year (p < 0.001 for each component), with no further change from year 1 to year 3. The EQ-5D index also improved significantly from baseline to 1 year, with no evidence for further change. Our results strongly indicate that this BMC treatment is safe for, and well tolerated by, patients with OCD of the ankle as both primary treatment and those who have failed primary treatment. This technique provides a safe, efficacious alternative to currently employed cartilage repair techniques, with favourable outcomes and a low complication rate at 36 months.

Highlights

An osteochondral defect (OCD) is broadly defined as a defect involving both the articular cartilage and adjacent subchondral bone [1]
There is some debate about the true definition of osteochondral defects, with other authors expanding the definition of osteochondral lesions as a lesion of any origin involving the articular cartilage and/or adjacent subchondral bone, expanding the definition to include lesions limited to cartilage, limited to bone, and affecting both [2]
bone marrow concentrate (BMC) with hyaluronan and fibrin is a safe treatment in patients undergoing primary treatment for OCDs of the ankle, and importantly for those whose primary treatment has failed

Summary

Introduction

An osteochondral defect (OCD) is broadly defined as a defect involving both the articular cartilage and adjacent subchondral bone [1]. There is some debate about the true definition of osteochondral defects, with other authors expanding the definition of osteochondral lesions as a lesion of any origin involving the articular cartilage and/or adjacent subchondral bone, expanding the definition to include lesions limited to cartilage, limited to bone, and affecting both [2]. The most reported cause of OCDs of the ankle is trauma, recurrent ankle sprains. Osteochondral lesions of the ankle are increasingly being recognized as a clinical problem, as the likely consequence is osteoarthritis of the ankle if left untreated, with subsequent significant loss of function for the patient. The prevalence of osteochondral lesions of the talus is. Explain the scientific background and rationale for the investigation being reported

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