Results of Arthroscopic Talar Osteochondral Lesions Treatment with BST-CarGel

Abstract

Osteochondral lesions (OCLs) are a diverse group of articular cartilage lesions with or without a subchondral component. They often result from ankle injuries in the young population. Lateral talar dome lesions are encountered more frequently in trauma. Bone marrow stimulation with microfracture is an established form of treatment for symptomatic OCL in the literature; however, reparative fibrocartilaginous tissue has inferior wear characteristics to hyaline cartilage, and clinical symptoms have been found to recur in 2 years. Recalcitrant OCL already treated with microfracture presents a considerable challenge to clinicians. Results of microfracture combined with chitosan-based biomaterial have been reported favorably in hip and knee. Chitosan glycerol phosphate has cationic properties that enhance clot adhesiveness within the space of an OCL and prevent blood clot retraction. Greater volume and better quality of reparative tissue using chitosan have been demonstrated in randomized controlled trials and in vivo studies. We prospectively report chitosan blood implant with microfracture results in patients with recalcitrant talar OCLs who were previously treated with microfracture alone in a single-surgeon study. We found a statistically significant improvement in Foot and Ankle outcome score (FAOS) and EQ-5D, with an average follow-up of >2 years.