Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus

Abstract

IntroductionMicrofracture has been widely published as a treatment for osteochondral lesions of the talus (OLT). Little is known about the outcome predictors following microfracture for smaller sized OLT. ObjectivesThis study sought to define the outcome predictors for small OLT treated with microfracture and concentrated bone marrow aspirate (CBMA). Our hypothesis was that lesion uncontainment and the presence of cysts were predictors of poor outcomes following microfracture with CBMA for OLT. MethodsA retrospective cohort study investigating patients who received microfracture for OLT (<10 mm or 100 mm2) between 2008 and 2017 was conducted. Multivariate regression models were used to evaluate factors affecting Foot and Ankle Outcome Scores (FAOS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Kaplan-Meier survival curves were constructed and endpoint was defined as revision surgery requirement. ResultsEighty-seven patients were included in the study. The mean FAOS pain significantly improved from 60.4 ± 14.8 preoperatively to 79.3 ± 12.8 at final follow-up (P< .001). Patients with uncontained-type OLT had an approximately 9-point worse FAOS pain compared to contained-type OLT (P= .036). Patients with cystic OLT also had an approximately 9-point worse FAOS pain compared to noncystic OLT (P= .026). Patients with larger lesion size had worse postoperative MOCART scores (P= .012). Both Uncontained-Cyst and Uncontained-Noncyst groups had significantly worse FAOS pain than the Contained-Noncyst group (P< .001, P= .026). Survival rates in uncontained and contained lesions were 51.5% and 84.4%, respectively (P= .616). ConclusionsLesion uncontainment and the existence of cysts are independent predictors of poor clinical outcomes following microfracture with CBMA for smaller sized OLT.