Autologous Osteochondral Transplantation Research Articles

Outcomes Following Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review

Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiographic outcomes in patients who received extracellular matrix cartilage allograft (EMCA) during surgical intervention for osteochondral lesions of the talus (OLT). Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who received EMCA during surgical intervention for osteochondral lesions of the talus. Data regarding lesion characteristics, surgical characteristics, subjective clinical outcomes, radiographic outcomes, complication rates, failure rates and secondary surgical procedure rates were extracted and analysed. In total, 5 clinical studies were included in this review. Results: In total, 162 patients received EMCA during surgical intervention for OLT at a weighted mean follow-up of 23.8 ± 4.2 months. The weighted mean lesion area was 77.9 ± 42.6 mm2. Overall, 111 (68.5%) of OLTs were located medially, 45 (27.8%) of OLTs were located laterally and 6 (3.7%) OLTs were located centrally. Four studies performed arthroscopic debridement and bone marrow stimulation with ECMA, 3 studies utilized concentrated bone marrow aspirate and 1 study performed autologous osteochondral transplantation. Improvements were noted in AOFAS, FAOS and VAS scores following surgical intervention. The weighted mean post-operative MOCART score was 76.3 ± 2.9. In total, 17 (10.5%) complications were reported across the 5 studies. Twelve failures (7.4%) were recorded, all of which required further surgical intervention. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes and radiological outcomes at short-term follow-up following surgical intervention for OLTs augmented with ECMA. A low failure rate and moderate complication rate was noted. However, there was marked heterogeneity between the included studies with regards to surgical technique utilized, lesion size and patient cohort size. Further research is warranted to determine the optimal role of ECMA in the management of OLT.

Next Generation approaches for knee cartilage repair and joint preservation

IntroductionArticular cartilage plays a crucial role in preserving the knee joint's structural integrity. Damage can manifest as focal chondral defects or progressive osteoarthritis. Treatment options for knee cartilage damage are multifaceted, encompassing surgical and nonsurgical interventions to repair defects, alleviate symptoms, restore function, and slow disease progression. ObjectivesGain insight and summarize the latest available evidence of knee joint preservation techniques. MethodsThe indications, outcomes, and biological characteristics of operative and nonoperative knee cartilage repair and joint preservation therapies were summarized. ResultsOsteochondral autologous transplantation and osteochondral allograft transplantation offer durable solutions with excellent long-term outcomes. Autologous chondrocyte implantation and matrix-induced autologous chondrocyte implantation are advanced, cell-based therapies effective for larger defects, especially in younger, active individuals. Non-operative therapies such as hyaluronic acid provide symptomatic relief for knee osteoarthritis. Bone marrow aspirate concentrate and platelet-rich plasma show efficacy in alleviating symptoms and improving joint function, presenting a minimally invasive approach with promising results for knee preservation and cartilage repair. ConclusionThe use of minimally invasive and nonsurgical interventions in addressing focal cartilage defects, osteoarthritis, and overall joint preservation has yielded varied results. Although recent literature has exhibited encouraging findings, the existing body of high-level evidence remains limited. The emerging evidence inspires optimism for the future, as medical practitioners shift focus to the next wave of knee cartilage repair and joint preservation methodologies. However, comprehensive research is essential to establish conclusive insights into outcomes, safety profiles, and comparative effectiveness among the diverse available treatments.

A Prospective Randomized Controlled Trial Investigating Quadriceps Versus Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction

Background: Numerous graft options are available when undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although a lack of high-quality evidence exists comparing quadriceps (QT) and hamstring (HT) autografts. Purpose: To investigate patient outcomes in patients undergoing HT versus QT ACLR. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: After recruitment and randomization, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed pre- and postoperatively (6 weeks and 3, 6, 12, and 24 months), with a range of patient-reported outcome measures (PROMs), graft laxity (KT-1000 arthrometer; primary outcome variable), active knee flexion and extension range of motion (ROM), peak isokinetic knee extensor and flexor strength, and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated for strength and hop measures. Secondary procedures, ACL retears, and contralateral ACL tears were reported. Results: All PROMs and knee ROM measures significantly improved (P < .0001), and no other group differences (P > .05) were observed—apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score, which was significantly better in the HT group at 3 (P = .008), 6 (P = .010), and 12 (P = .014) months. No significant changes were observed in side-to-side laxity from 6 to 24 months (P = .105), and no group differences were observed (P = .487) at 6 (HT mean, 1.2; QT mean, 1.3), 12 (HT mean, 1.1; QT mean, 1.3), and 24 (HT mean, 1.1; QT mean, 1.2) months. While the HT group demonstrated significantly greater (P < .05) quadriceps strength LSIs at 6 and 12 months, the QT group showed significantly greater (P < .05) hamstring strength LSIs at 6, 12, and 24 months. The HT group showed significantly greater (P < .05) LSIs for the single horizontal (6 months), lateral (6 and 12 months), and medial (6 months) hop tests for distance. Up until 24 months, 1 patient (QT at 22 months) had a retear, with 2 contralateral ACL tears (QT at 19 months; HT at 23 months). Secondary procedures included 5 in the HT group (manipulation under anesthesia, notch debridement, meniscal repair, and knee arthroscopy for scar tissue) and 6 in the QT group (notch debridement, meniscal repair, knee arthroscopy for scar tissue, tibial tubercle transfer, and osteochondral autologous transplantation). Conclusion: Apart from the ACL-RSI, the 2 autograft groups compared well for PROMs, knee ROM, and laxity. However, greater hamstring strength LSIs were observed for the QT cohort, with greater quadriceps strength (and hop test) LSIs in the HT cohort. The longer-term review will continue to evaluate return to sports and later-stage reinjury between the 2 graft constructs. Registration: ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry).

Intermediate-Term Clinical Outcomes after Autologous Osteochondral Transplantation for Lateral Osteochondral Lesions of the Talus

Intermediate-Term Clinical Outcomes after Autologous Osteochondral Transplantation for Lateral Osteochondral Lesions of the Talus

Limited evidence in support of bone marrow aspirate concentrate as an additive to the bone marrow stimulation for osteochondral lesions of the talus: a systematic review and meta‐analysis

AbstractPurposeBone marrow aspirate concentrate can be used as an additive to surgical treatment of osteochondral lesions of the talus. This systematic literature review aims to study the effect of the additional use of bone marrow aspirate concentrate on top of a surgical treatment for osteochondral lesions of the talus on clinical outcomes compared to surgical treatment alone.MethodsAn online literature search was conducted using PubMed (Medline), Embase (Ovid), and the Cochrane library for all studies comparing a surgical intervention with bone marrow aspirate concentrate, with a surgical intervention without bone marrow aspirate concentrate. The methodological quality was rated according to the methodological index for non‐randomised studies checklist. The primary outcome measure were clinical outcomes. Secondary outcome measures consisted of revision rate, complication rate, radiographic outcome measures and histological analyses. Subgroups were created based on type of surgical intervention used in the studies. If multiple articles were included in a subgroup, a linear random‐effects model was used to compare the bone marrow aspirate concentrate‐augmented group with the control group.ResultsOut of 1006 studies found, eight studies with a total of 718 patients were included. The methodological quality, assessed according to the methodological index for non‐randomised studies checklist, was weak. A significantly better functional outcome measures (p &lt; 0.05) was found in the subgroup treated with bone marrow stimulation + bone marrow aspirate concentrate compared to the group treated with bone marrow stimulation alone, based on three non‐blinded studies. No significant differences regarding clinical outcomes were found in the subgroups comparing matrix‐induced autologous chondrocyte implantation with matrix‐induced bone marrow aspirate concentrate, osteochondral autologous transplantation alone with osteochondral autologous transplantation + bone marrow aspirate concentrate and autologous matrix‐induced chondrogenesis plus peripheral blood concentrate vs. matrix‐associated stem cell transplantation bone marrow aspirate concentrate.ConclusionThere is insufficient evidence to support a positive effect on clinical outcomes of bone marrow aspirate concentrate as an additive to surgical treatment of osteochondral lesions of the talus. However, based on the safety reports and initial results, sufficiently powered, patient‐ and researcher‐blinded, prospective randomised controlled trials are justified and recommended. Until then, we advise not to implement a therapy (addition of bone marrow aspirate concentrate) without clinical evidence that justifies the additional costs involved.Level of evidenceLevel III.

Treatment of Articular Cartilage Defects: A Descriptive Analysis of Clinical Characteristics and Global Trends Reported from 2001 to 2020.

To evaluate the clinical characteristics and global trends in the surgical treatment of articular cartilage defects. Studies in English published between January 1, 2001 and December 31, 2020 were retrieved from MEDLINE, WOS, INSPEC, SCIELO, KJD, and RSCI on the "Web of Science." Patient data were extracted, including age, sex, defect location and laterality, duration of follow-up and symptoms, and body mass index (BMI). Data were further stratified according to the surgical method, lesion location, procedural type and geographical area, and time period. A comparative analysis was performed. Overall, 443 studies involving 26,854 patients (mean age, 35.25 years; men, 60.5%) were included. The mean lesion size and patient BMI were 3.51 cm2 and 25.61 kg/m2, respectively. Cartilage defects at the knees, talus, and hips affected 20,850 (77.64%), 3,983 (14.83%), and 1,425 (5.31%) patients, respectively. The numbers of patients who underwent autologous chondrocyte implantation, arthroscopic debridement/chondroplasty, osteochondral allograft (OCA), osteochondral autologous transplantation, and microfracture were 7,114 (26.49%), 5,056 (18.83%), 3,942 (14.68%), 3,766 (14.02%), and 2,835 (10.56%), respectively. European patients were the most numerous and youngest. North American patients had the largest defects. The number of patients increased from 305 in 2001 to 3,017 in 2020. In the last 5 years, the frequency of OCAs showed a greatly increasing trend. Clinical characteristics and global trends in the surgical treatment of articular cartilage defects were revealed. The choice of operation should be based on the patient characteristics and defect location, size, and shape, as well as the patient's preference.

Autologous Costal Osteochondral Transplantation for Cystic Osteochondral Lesions of the Talus: Feasible and Effective.

Osteochondral lesions of the talus (OLT) is a common and clinically challenging disease. The optimal management is still under debate. The purpose of this prospective study was to investigate the feasibility and clinical outcomes of autologous costal osteochondral transplantation (ACOT) for the treatment of cystic OLT. From November 2021 to April 2023, five patients underwent autologous costal osteochondral transplantation (ACOT) for cystic OLT. The demographic data was described, including age, gender, lesion size and location. We prospectively evaluated their functional and imaging outcomes of the five patients for 12 months postoperatively, including numeric rating score (NRS) for pain when walking, Tegner score, American Orthopedic Foot & Ankle Society (AOFAS) score and Foot and Ankle Ability Measure (FAAM) score, and imaging results. A paired t-test was used for preoperative and postoperative comparison of the paired-design dataset. The average age was 36.6 ± 11.1 years. The average diameter of chondral lesions was 14.95 ± 2.71 mm, the average diameter of subchondral cysts was 10.66 ± 1.84 mm, and their average depth was 10.40 ± 1.86 mm. At 12 months postoperatively, the clinical function indexes improved significantly, including NRS (from 5.2 ± 2.3 to 0), Tegner score (from 3.2 ± 0.4 to 5.8 ± 0.4), AOFAS score (from 72.8 ± 10.0 to 98.2 ± 4.0), and FAAM score (FAAM/ADL from 61.2 ± 24.7 to 99.3 ± 1.6; FAAM/Sports from 32.5 ± 13.73 to 96.3 ± 8.4). Their magnetic resonance observation of cartilage repair tissue (MOCART) scores reached 78.0 ± 7.6 points. ICRS scores of three patients were nearly normal (10 or 11 points). The biopsy of the surviving grafts showed plenty of hyaline cartilage matrix and scattered chondrocytes histologically. No major severe complications were reported during the 12 months follow-up. ACOT could significantly relieve the symptoms of patients with OLT and improve their clinical function at short-term follow-up. ACOT might be a feasible and useful method for repairing OLT with subchondral cysts.

Comparison of Intermediate-Term Clinical Outcomes Between Medial and Lateral Osteochondral Lesions of the Talus Treated With Autologous Osteochondral Transplantation.

The conventional operative method to treat an osteochondral lesion of the talus (OLT) is through bone marrow stimulation (BMS). Autologous osteochondral transplantation (AOT) is being used as an alternative option in cases with a large OLT, accompanying subchondral cyst, and/or failed BMS. We aimed to compare the intermediate-term clinical and radiologic results between medial and lateral OLTs after an AOT procedure. Among the patients who underwent AOT, 45 cases with at least 3 years' follow-up were included in this retrospective study. We had 15 cases of lateral lesions and selected 30 cases of medial lesions matched for age and gender. Lateral lesions were resurfaced without an osteotomy; medial lesion resurfacing was combined with a medial malleolar osteotomy. Clinical assessment was performed using the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). Radiographic assessment included the irregularity of articular surface (subchondral plate), the progression of degenerative arthritis, and the change of the talar tilt. The mean FAOS and FAAM scores significantly improved after surgery in both groups. Up to 1 year postoperatively, there was significant difference in FAAM scores between the both groups (mean 75.3 points in medial group and 87.2 points in lateral group, P < .001). Delayed union or malunion of the malleolar osteotomy was found in 4 cases (13%) in the medial group. In addition, the progression of joint degeneration was observed in 3 cases (10%) in the medial group. There were no significant differences in the irregularity of articular surface and the change of talar tilt between both groups. A comparison between medial and lateral OLTs treated with AOT demonstrated comparable intermediate-term clinical outcomes. However, patients with medial OLT required a longer period to restore ability for daily and sport activities. In addition, we found more complications and higher rate of progression in the radiologic arthritis grade after medial malleolar osteotomy. Level IV, retrospective comparative study.

Cartilage Tissue Engineering in Practice: Preclinical Trials, Clinical Applications, and Prospects.

Articular cartilage defects significantly compromise the quality of life in the global population. Although many strategies are needed to repair articular cartilage, including microfracture, autologous osteochondral transplantation, and osteochondral allograft, the therapeutic effects remain suboptimal. In recent years, with the development of cartilage tissue engineering, scientists have continuously improved the formulations of therapeutic cells, biomaterial-based scaffolds, and biological factors, which have opened new avenues for better therapeutics of cartilage lesions. This review focuses on advances in cartilage tissue engineering, particularly in preclinical trials and clinical applications, prospects, and challenges.

Realignment Surgery for Failed Osteochondral Autologous Transplantation in Osteochondral Lesions of the Talus Associated With Malalignment.

While osteochondral autologous transplantation (OAT) offers favorable results in most patients with osteochondral lesions of the talus (OLT), some patients continue to experience persistent pain following the procedure. Information regarding the etiology of this pain and outcomes of revision surgery are limited. This study aimed to report results of revision surgery with realignment procedures in patients with failed OAT who demonstrated concomitant malalignment at the distal tibia or hindfoot. Eight patients (8 ankles), who had been experiencing persistent pain for more than 1 year following OAT, underwent realignment procedures during revision surgery. All patients underwent primary OAT for the treatment of medial OLTs. Patients were divided into 2 groups based on the main location of deformity: the supramalleolar realignment group (SRG, 5 ankles) and the hindfoot realignment group (HRG, 3 ankles). No direct procedure was performed on the osteochondral lesion at the time of revision surgery. Ankle and hindfoot alignment were evaluated using 6 parameters in weightbearing radiographs. Computed tomography (CT) was used to assess for medial gutter narrowing, spur formation, and cyst volume around transplanted osteochondral plug preoperatively and postoperatively. Clinical outcomes were assessed using Foot Function Index and Visual Analogue Scale. All patients had medial gutter narrowing or spur formation, which are early signs of ankle arthritis. The SRG had varus distal tibial alignment with a median medial distal tibial angle of 85.7 degrees (interquartile range [IQR], 3.2). The HRG had valgus hindfoot alignment and a lower medial longitudinal arch with a median hindfoot moment arm of 8.4 mm (IQR, 6.1) and a median Meary's angle of 11.8 degrees (IQR, 1.4). Spontaneous restoration of the osteochondral lesion was observed after realignment surgery, with cyst volume decreasing from 0.2592 to 0.0873 cm3 (P < .05). Clinical scores improved in all patients. The current study demonstrates the effectiveness of realignment surgery in a selected patient group who experienced persistent pain and showed radiographic evidence of malalignment after primary OAT. Our study provides evidence supporting the use of realignment procedures in these cases, with results indicating improved patient-reported outcomes and spontaneous restoration of osteochondral lesions. Level IV: Case series.

Femoral head fracture with large crushed defect in weight-bearing area treated with autologous osteochondral transplantation (repositionplasty): A case report

Femoral head fracture is a rare type of fracture commonly associated with hip dislocation. Femoral head fracture treatments include conservative treatment, fragment excision, open reduction, internal fixation, and arthroplasty. In cases of young patients, open reduction and internal fixation are preferred over arthroplasty. Pipkin type 2 fractures are treated with open reduction and internal fixation in most cases because the fracture line extends upward of the fovea and includes the femoral head-acetabular weight-bearing joint surface. However, if the fracture is severely comminuted or crushed, good results are difficult to obtain with open reduction and internal fixation. A 23-years-old male patient presented to the emergency room with right hip pain after 4-m fall. In initial image work up, he was diagnosed with right posterior hip dislocation and a Pipkin type 2 femoral head fracture with an ipsilateral superior ramus fracture. After manual reduction, simple radiography and computed tomography showed reduction of the hip joint and a large osteochondral defect of approximately 6 cm2 in the weight-bearing area on the superomedial side of the femoral head. This was treated with a novel surgery named autologous osteochondral transplantation (repositionplasty), devised by the authors. The congruent reduction was confirmed by radiography and computed tomography immediately after the surgery. At 5 years postoperatively, the Harris Hip Score was 100 points and no discomfort, femoral head collapse, osteonecrosis, or traumatic arthritis were observed on follow-up radiographs. We think this method "repositionplasty" will be a good treatment method for young patients with a large defect in the weight-bearing part of the femoral head who cannot undergo open reduction and internal fixation.

Combination of autologous osteochondral and periosteum transplantation effectively promotes fibrocartilage regeneration at the tendon-bone junction of the rotator cuff in rabbits.

Rotator cuff tendon-bone healing often leads to scarring and low biomechanical strength, resulting in a tendency to re-tear. This study examined whether combining autologous osteochondral transplantation and periosteum transplantation increases fibrocartilage transition zone regeneration and improves biomechanical fixation. A total of 48 New Zealand white rabbits were divided into the periosteum, autologous osteochondral, combination of autologous osteochondral and periosteum, and control groups. The supraspinatus tendon was cut from the greater tuberosity and repaired by different transplants. A total of 12 rabbits were used for histological examination (haematoxylin and eosin staining, Masson's staining and Safranin-O staining) at 4, 8 and 12weeks after the repair, and 36 rabbits were used for biomechanical tests (maximal failure load and stiffness). At 4weeks following the operation, each group had a large tendon-bone gap with a small number of disordered collagen fibres. At 8weeks, the tendon-bone gap was smaller than that before the operation, and the tendon-bone gap in each experimental group was smaller with neater and denser collagen fibres and chondrocytes than in the control group, with the osteochondral combined periosteum group having the best results. At 12weeks, the typical tendon-bone transitional structure was observed in the osteochondral combined periosteum group, and more collagen fibres and chondrocytes were generated in each group. The osteochondral combined periosteum group had the largest staining area and the largest amount of cartilage. The maximum tensile strength and stiffness of each group increased over time. There was no significant difference in each group's maximum tensile strength and stiffness at 4weeks after the operation. However, the maximum tensile strength and stiffness of the osteochondral combined periosteum group at 8 and 12weeks after operation were significantly higher than those of other groups (P < 0.05). Histological and biomechanical results show that autologous osteochondral transplantation combined with periosteum transplantation can effectively promote the regeneration of fibrous cartilage in the tendon-bone junction of the rotator cuff. It is concluded that this technique is a new treatment method to promote tendon-bone healing in the rotator cuff.

Favorable long-term clinical and radiologic outcomes with high survivorship after autologous osteochondral transplantation of the talus

PurposeTo evaluate long-term clinical and radiologic outcomes of patients undergoing autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLT) and to perform a correlation analysis between clinical and radiologic outcomes.MethodsThirty-five patients with a mean age of 32.2 ± 8.9 years undergoing AOT for OLT between 1997 and 2003 were available for follow-up after an average of 19.1 ± 1.4 years. Demographic, surgical, and injury-related data were collected. After a minimum 18-year follow-up, patient-reported outcome scores (PROs) were collected, including the American Orthopaedic Foot & Ankle Society (AOFAS) score, the Foot and Ankle Outcome Score (FAOS), Tegner Activity Scale, and Visual Analogue Scale (VAS) for pain of the ankle. The Lysholm Score and VAS for pain of the knee were collected to assess donor-site morbidity. Magnetic resonance imaging scans were obtained to conduct an assessment of the replaced cartilage using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 scoring system. Any revision surgery (except symptomatic hardware removal and arthroscopic debridement) was defined as clinical failure.ResultsFavorable clinical and radiologic (MOCART score, 73.7 ± 16.7 points) outcomes without any donor-site morbidities were observed. Twenty-three (65.7%) patients were satisfied or very satisfied with the surgical treatment. Fourteen (40.0%) and 25 (71.4%) patients had no or minor limitations in their athletic and working performance, respectively. A significant correlation between the MOCART and the FAOS Sport and Recreational activities subscale was found (rs, 0.491; p = 0.033). Six (17.1%) patients met the criteria for clinical failure an average of 12.2 ± 6.6 years after AOT. Survival analysis demonstrated a mean estimated time of survival of 21.3 years (95% CI [19.55, 22.96]) and a 20-year survival rate of 77.9%.ConclusionAutologous osteochondral transplantation to treat OLT achieves high patient satisfaction and favorable PROs with a 20-year survival rate of almost 80%. Given the high clinical efficacy of AOT, this procedure can be recommended as a safe and promising technique for the long-term therapy of OLT.Level of evidenceLevel IV.

Comparison of Effect of Three Different Surgical Procedures on Ankle Joint Function Rehabilitation of Patients with Hepple V Talus Osteochondral Injury.

Objective To discuss and compare the effects of three different surgical procedures on ankle function rehabilitation of patients with Hepple V talus osteochondral injury. Methods A total of 60 patients with Hepple V talus osteochondral injury admitted to our hospital from January 2020 to January 2021, among which 17 patients in study group 1 received microfracture surgery, 20 patients in study group 2 received osteochondral autologous transplantation, and 23 patients in study group 3 received with periosteal iliac bone transplantation. The range of motion (ROM) of the patients' angle was evaluated by the goniometer before and after the treatment. The ankle function was evaluated by the ankle-hindfoot score of American Orthopedic Foot and Ankle Society (AOFAS). The ankle joint pain was evaluated by visual analogue score (VAS). The surgical efficacy was evaluated 12 months after surgery, and complications and nursing satisfaction were observed and recorded. Results There was no significant difference in ROM, AOFAS score, and VAS score among the three groups before the treatment (P > 0.05). ROM and AOFAS score of the three groups were improved, and VAS score was decreased at 6 months and 12 months after treatment (P < 0.05). ROM and AOFAS score of group 2 and group 3 were higher than those of group 1, while the VAS score was lower than that of group 1, indicating significant difference (P < 0.05). There was no significant difference in ROM, AOFAS, and VAS score between group 2 and group 3 (P > 0.05). The surgical efficacy of group 2 and group 3 was higher than that of group 1, indicating statistical significance (P < 0.05), while there was no significant difference in the surgical significance between group 2 and group 3 (P > 0.05). There was no significant difference in complication rate among the three groups (P > 0.05), and the treatment satisfaction of group 2 and group 3 was higher than that of group 1, indicating statistical significance (P < 0.05), but there was no significant difference between group 2 and group 3 (P > 0.05). Conclusion Three different surgical procedures have good therapeutic effect for Hepple V talus osteochondral injury. Osteochondral autologous transplantation and periosteal iliac bone transplantation can reduce the pain of ankle joint, promote the effect of ankle joint function recovery, which can effectively improve patient satisfaction. It is suggested to choose the surgical procedure according to the actual situation of patients.

Effectiveness of Autograft and Allograft Transplants in Treating Athletic Patients With Osteochondral Lesions of the Talus.

Osteochondral lesions of the talus (OLTs) represent 50% of ankle sprains and are most common in athletes who play competitive sports or are on active military duty. OLTs can cause significant physical damage if left untreated and may inflict financial burdens and mental health issues. Over the years, replacement surgeries, mainly autologous osteochondral transplantation (AOT) and osteochondral allograft transplantation (OAT), have become instrumental in treating OLTs. However, these procedures’ effectiveness in returning to full fitness to resume competitive sports or active duty has not been well-established. This systematic review attempts to help this population cohort better understand OLTs and highlight the existing clinical evidence on AOT and OAT effectiveness in treating such patients. We performed a literature search between March 2022 through September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Of eligible studies evaluating surgical outcomes of AOT and OAT in sportspeople and active-duty military personnel, 86% of patients who received AOT returned to competitive sports or active duty compared to 61% who received OAT. Additionally, on average, patients who underwent AOT returned to full fitness in five months rather than in 16 months for those who underwent OAT. As highlighted in this review, the limited evidence indicates that AOT may lead sportspeople and active-duty military personnel to return to pre-injury levels and resume athletic activities sooner. It is challenging to assume the same for OAT, given the limited studies in athletic cohorts with OLTs. Nevertheless, AOT and OAT are crucial surgical options that can significantly benefit competitive sportspeople and military personnel in resuming their careers.

Clinical Outcomes of Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus: An Age-Based Multivariable Analysis

Category: Sports; Ankle; Hindfoot; Other Introduction/Purpose: Osteochondral lesions of the talus (OLT) are common injuries that are often found in patients with chronic disabling pain after ankle sprains. While OLT is becoming increasingly prevalent in the younger active population, there is disagreement and a lack of strong evidence about the impact of age on outcomes. The purpose of this study is to perform an Age- Based multivariate analysis to evaluate the clinical outcomes of Autologous Osteochondral Transplantation (AOT) for the treatment of OLT. The goals of this study are to examine trends in patient characteristics and clinical outcomes that occur with age as a statistical variable when performing AOT for the treatment of OLT. Methods: All study protocols were approved by the Institutional Review Board at the senior author's institution. A retrospective cohort study using chart review for AOT procedures on approximately 80 patients from 2006 to 2019 performed by a single surgeon. Clinical outcomes of patients were evaluated via FAOS scores for Symptoms, Pain, Activities of Daily Living, Sports and Quality of Life. A multivariable linear regression was used to assess the independent factors predictive of the first post-operative FAOS after AOT. The independent variables included in the model were pre-operative FAOS, age, defect size, whether the lesion was a shoulder lesion, cystic lesion, or a result of a traumatic injury, and whether the patient had a prior microfracture surgery. A p-value &lt;.05 was considered significant and 95% confidence limits (95% CL) for regression coefficient estimates (est.) were calculated. Results: 78 patients were included in the analysis with an average age of 35.5 +- 13.6. The average follow-up was 54.4 months +- 18.9 months, average pre-operative FAOS was 54.3 +- 19.4 and the average post-operative FAOS was 83.4 +- 13.6. The average defect size was 109.3 mm2 (std. dev. = 62.4 mm). 56 patients had a shoulder lesion, 24 had a prior microfracture surgery, 42 had a cystic lesion, and 27 had a prior traumatic injury. The multivariable linear regression showed that the pre-operative FAOS was associated with a higher post-operative FAOS (est., 95% CL: 0.16, 0.012 - 0.307; p=0.034). Defect size (est., 95% CL: -0.05, -0.097 - -0.003; p=0.0358), having a shoulder lesion (est., 95% CL: -9.068, -15.448 - -2.688; p=0.006), or having a prior microfracture surgery (est., 95% CL: -7.07, -13.118 - -1.021; p=0.0226) were associated with a lower post-operative FAOS. Conclusion: The main finding of this study is patient age was not an independent risk factor for inferior clinical outcomes after AOT for OLT. Additionally, having a cystic lesion, or having a lesion because of a traumatic injury were not significantly associated with post-operative FAOS. Having a shoulder lesion had the largest marginal effect on post-operative FAOS. These findings provide important information for providers when counseling and selecting patients for AOT procedure for treatment of OLT.

Ретроспективный анализ результатов оперативного лечения пациентов с остеохондральными повреждениями блока таранной кости

Introduction Differences in the reported results lead to the lack of comprehension of whether the size of osteochondral lesion of talar dome is too big for successful usage of arthroscopic microfracturing and osteochondral autologous transplantation would be more preferrable. Aim To elicit the rate and causes of poor results after using two most common methods of operative treatment of patients with osteochondral lesions of the talus (OCLT) for elaboration of indications for surgical method of choice for this category of patients. Materials and methods This was a retrospective study that included analysis of archive data and subsequent examination of 80 patients (80 ankle joints), who underwent treatment for symptomatic OCL of the talus from 2014 to 2020. Mean time from the operation to examination was 20.5 ± 19.8 months. Results A significant increase in the results of FAOS, AOFAS and VAS scales after operative treatment were observed, as well as a significant decrease in lesion sizes (р &lt; 0.05). Overall patient satisfaction and intensity of preoperative pain syndrome showed strong positive correlation with the sizes of lesions on preoperative CT scans, especially with relative sizes. The data analysis revealed the borderline values of relative OCLT sizes, thus allowing us to divide the results of treatment into predictably poor and predictably good. Discussion The elicited borderline values of relative OCLT sizes as well as elicited correlations can be used to specify indications for choosing the method of operative treatment for this group of patients, but further prospective evaluation should be carried out. Conclusion The borderline values of the relative OCLT sizes were found that allow for division into predictably good and poor treatment outcomes.

Clinical and MRI Donor-Site Outcomes After Autograft Harvesting From the Medial Trochlea for Talar Osteochondral Lesions: Minimum 5-Year Clinical Follow-up.

Background:Autologous osteochondral transplantation (AOT) is a treatment option for large or cystic osteochondral lesions of the talus (OLTs), with promising clinical results. However, donor-site morbidity (DSM) has always been a concern with this procedure.Purpose:To investigate the clinical and radiological outcomes of autograft harvesting from the medial trochlea for OLTs.Study Design:Case series; Level of evidence, 4.Methods:A total of 46 consecutive patients were included after AOT procedures for OLTs, with donor autografts (single or double plugs) harvested from the medial trochlea of the ipsilateral knee. Lysholm scores were collected postoperatively at 12-month intervals to assess clinical outcomes. Postoperative magnetic resonance imaging (MRI) was used to assess the donor site using the MOCART (magnetic resonance observation of cartilage repair tissue) score. DSM was evaluated at 12-month intervals. Statistical analysis was performed to compare patients treated with single-plug and double-plug AOT procedures and establish whether there was any correlation between MOCART and Lysholm scores.Results:The mean follow-up period was 98.3 months (range, 67-144 months). The Lysholm scores for all patients were 92.5 ± 6.1 and 99.9 ± 0.2 at the 12-month and final follow-ups, respectively. MRI of the donor sites was taken at an average of 93.8 ± 20.5 (range, 61-141) months postoperatively, and the mean MOCART score was 76.2 ± 4.9. The overall incidence of DSM in this study was 4.3% at 12 months, postoperatively, which decreased to 0% at the 24-month follow-up. There was no significant difference in either the Lysholm score (P = .16) or the MOCART score (P = .83) between the single-plug and double-plug groups at the final follow-up. There were no significant correlations between MOCART and Lysholm scores and patient age, number of grafts, or body mass index.Conclusion:According to the study findings, the DSM of donor autografts harvested from the medial trochlea was low, and the number (single or double) of grafts did not affect the functional outcome.

The Emerging Use of ASC/Scaffold Composites for the Regeneration of Osteochondral Defects.

Articular cartilage is composed of chondrocytes surrounded by a porous permeable extracellular matrix. It has a limited spontaneous healing capability post-injury which, if left untreated, can result in severe osteochondral disease. Currently, osteochondral (OC) defects are treated by bone marrow stimulation, artificial joint replacement, or transplantation of bone, cartilage, and periosteum, while autologous osteochondral transplantation is also an option; it carries the risk of donor site damage and is limited only to the treatment of small defects. Allografts may be used for larger defects; however, they have the potential to elicit an immune response. A possible alternative solution to treat osteochondral diseases involves the use of stromal/stem cells. Human adipose-derived stromal/stem cells (ASCs) can differentiate into cartilage and bone cells. The ASC can be combined with both natural and synthetic scaffolds to support cell delivery, growth, proliferation, migration, and differentiation. Combinations of both types of scaffolds along with ASCs and/or growth factors have shown promising results for the treatment of OC defects based on in vitro and in vivo experiments. Indeed, these findings have translated to several active clinical trials testing the use of ASC-scaffold composites on human subjects. The current review critically examines the literature describing ASC-scaffold composites as a potential alternative to conventional therapies for OC tissue regeneration.

Osteochondral lesions of the talar dome in the athlete: what evidence leads to which treatment

Osteochondral lesions of the talar dome (OLT) are common injuries that involve cartilage and subchondral bone. These injuries appear in up to 42% of professional soccer players on magnetic resonance imaging (MRI). Typically, patients are 20 35-yearold male athletes experiencing chronic ankle pain, decreased range of motion, and joint effusion, especially during or after sports activities, and compromised quality of life. The low regeneration potential of chondrocytes and the recent findings revealing subchondral bone architecture's role in cartilage homeostasis, repair durability, and overall clinical outcomes make OLT treatment a challenging topic in orthopedics. The aim of this narrative review was to outline a surgical treatment algorithm for OLT management in the athlete. Debridement and bone marrow stimulation techniques remain the first-line treatment of OLT with satisfactory short- to long-term outcomes, a high return to sports (RTS) rate, and a rapid RTS, with improved results when augmented with PRP. Still, considering the controversy of its potential disadvantages, debridement should be limited to the International Cartilage Repair Society (ICRS) grade I-II injuries regardless of its size and with or without additional bone marrow stimulation (BMS)in ICRS III < 1.0 cm2 injuries. In the presence of larger lesions and subchondral plate and bone involvement, the benefits and disadvantages of osteochondral autologous transplantation system (OATS)/mosaicplasty and scaffold-based techniques should be considered for a tailored treatment approach either as a primary procedure or as an off-season procedure for better cartilage tissue quality, functional outcomes, and potentially increasing the player's professional career length. Osteochondral lesions of the talar dome (OLT) are common injuries that involve cartilage and subchondral bone. These injuries appear in up to 42% of professional soccer players on magnetic resonance imaging (MRI). Typically, patients are 20 35-yearold male athletes experiencing chronic ankle pain, decreased range of motion, and joint effusion, especially during or after sports activities, and compromised quality of life. The low regeneration potential of chondrocytes and the recent findings revealing subchondral bone architecture's role in cartilage homeostasis, repair durability, and overall clinical outcomes make OLT treatment a challenging topic in orthopedics. The aim of this narrative review was to outline a surgical treatment algorithm for OLT management in the athlete. Debridement and bone marrow stimulation techniques remain the first-line treatment of OLT with satisfactory short- to long-term outcomes, a high return to sports (RTS) rate, and a rapid RTS, with improved results when augmented with PRP. Still, considering the controversy of its potential disadvantages, debridement should be limited to the International Cartilage Repair Society (ICRS) grade I-II injuries regardless of its size and with or without additional bone marrow stimulation (BMS)in ICRS III < 1.0 cm2 injuries. In the presence of larger lesions and subchondral plate and bone involvement, the benefits and disadvantages of osteochondral autologous transplantation system (OATS)/mosaicplasty and scaffold-based techniques should be considered for a tailored treatment approach either as a primary procedure or as an off-season procedure for better cartilage tissue quality, functional outcomes, and potentially increasing the player's professional career length. Osteochondral lesions of the talar dome (OLT) are common injuries that involve the cartilage and subchondral bone. These injuries appear in up to 42% of professional soccer players on magnetic resonance imaging (MRI) (Figs. 1 and 2).1Bezuglov E. Khaitin V. Lazarev A. et al.Asymptomatic foot and ankle abnormalities in elite professional soccer players.Orthop J Sports Med. 2021; 9 (Published 2021 Jan 29)2325967120979994https://doi.org/10.1177/2325967120979994Crossref PubMed Scopus (3) Google Scholar, 2Brulc U. Drobnič M. Kolar M. Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus [published online ahead of print, 2021 Aug 26].Foot Ankle Surg. 2021; S1268-7731 (00179-X)https://doi.org/10.1016/j.fas.2021.08.008Crossref Google Scholar, 3Badekas T. Takvorian M. Souras N. Treatment principles for osteochondral lesions in foot and ankle.Int Orthop. 2013; 37: 1697-1706https://doi.org/10.1007/s00264-013-2076-1Crossref PubMed Scopus (81) Google Scholar The etiology is diverse, including trauma, ischemia, avascular necrosis, ossification disorders, endocrine/metabolic diseases, genetic factors, and idiopathic causes.4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar Traumatic injuries can occur in up to 70% of ankle fractures and sprains and are usually located in the anterolateral talar dome, in contrast to the posteromedial ischemic injuries.2Brulc U. Drobnič M. Kolar M. Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus [published online ahead of print, 2021 Aug 26].Foot Ankle Surg. 2021; S1268-7731 (00179-X)https://doi.org/10.1016/j.fas.2021.08.008Crossref Google Scholar,4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar, 5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar, 6Hannon C.P. Smyth N.A. 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Usuelli F.G Relationship between symptomatic osteochondral lesions of the talus and quality of life, body mass index, age, size and anatomic location.Foot Ankle Surg. 2018; 24: 365-372https://doi.org/10.1016/j.fas.2017.04.011Crossref PubMed Scopus (22) Google ScholarFig. 2Ankle coronal view magnetic resonance imaging showing a delaminated cartilage injury of the talar dome and subchondral edema. Asterisk (*) showing detail.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Due to the chondrocytes' low regeneration potential and the recent findings revealing subchondral bone architecture's role in cartilage homeostasis, repair durability, and overall clinical outcomes,11Shimozono Y. Coale M. Yasui Y. O'Halloran A. Deyer T.W. Kennedy J.G. 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Fraser E.J. et al.The effect of different bone marrow stimulation techniques on human talar subchondral bone: a Micro-Computed Tomography Evaluation.Arthroscopy. 2016; 32: 2110-2117https://doi.org/10.1016/j.arthro.2016.03.028Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar OLT treatment remains a challenging topic in orthopedics.4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar,9Camurcu Y. Ucpunar H. Yapici F. et al.Clinical and magnetic resonance imaging outcomes of microfracture plus chitosan/blood implant vs Microfracture for Osteochondral Lesions of the Talus.Foot Ankle Int. 2020; 41: 1368-1375https://doi.org/10.1177/1071100720942173Crossref PubMed Scopus (4) Google Scholar,18Tahta M. Akkaya M. Gursoy S. Isik C. Bozkurt M. 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Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar, 20Shimozono Y. Coale M. Yasui Y. O'Halloran A. Deyer T.W. Kennedy J.G. Subchondral bone degradation after microfracture for osteochondral lesions of the talus: an MRI analysis.Am J Sports Med. 2018; 46: 642-648https://doi.org/10.1177/0363546517739606Crossref PubMed Scopus (45) Google Scholar, 21Vannini F. Costa G.G. Caravelli S. Pagliazzi G. Mosca M. Treatment of osteochondral lesions of the talus in athletes: what is the evidence?.Joints. 2016; 4 (Published 2016 Aug 18): 111-120https://doi.org/10.11138/jts/2016.4.2.111Crossref PubMed Scopus (8) Google Scholar and can be summarized in four strategical categories2,22:1.No treatment, in which incidentally found cartilage injuries are left in place without further intervention;2.Palliative, represented by cartilage debridement and irrigation, providing pain and mechanical symptoms relief;3.Reparative, profiting from intrinsic repairability of the cartilage tissue through bone marrow stimulation (BMS), including microfracture, nanofractures, drilling, and abrasion arthroplasty;4.Restorative, wherein the cartilage defect is filled or replaced, including osteochondral grafting or substitution, and scaffold and/or cell-based therapies. Despite success rates ranging from 76% to89%, there is limited evidence defining the ideal OLT surgical treatment.19Becher C. Malahias M.A. Ali M.M. Maffulli N. Thermann H. Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar,23Zengerink M. Struijs P.A. Tol J.L. van Dijk C.N. Treatment of osteochondral lesions of the talus: a systematic review.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 238-246https://doi.org/10.1007/s00167-009-0942-6Crossref PubMed Scopus (408) Google Scholar However, the defect location, size, depth, and subchondral bone status are recognized as critical in the treatment decision-making and outcomes.2Brulc U. Drobnič M. Kolar M. Stražar K. A prospective, single-center study following operative treatment for osteochondral lesions of the talus [published online ahead of print, 2021 Aug 26].Foot Ankle Surg. 2021; S1268-7731 (00179-X)https://doi.org/10.1016/j.fas.2021.08.008Crossref Google Scholar,4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar,5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar,19Becher C. Malahias M.A. Ali M.M. Maffulli N. Thermann H. Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar,24Ramponi L. Yasui Y. Murawski C.D. et al.Lesion Size Is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review.Am J Sports Med. 2017; 45: 1698-1705https://doi.org/10.1177/0363546516668292Crossref PubMed Scopus (118) Google Scholar,25Park J.H. Park K.H. Cho J.Y. Han S.H. Lee J.W. Bone marrow stimulation for osteochondral lesions of the talus: are clinical outcomes maintained 10 years later?.Am J Sports Med. 2021; 49: 1220-1226https://doi.org/10.1177/0363546521992471Crossref PubMed Scopus (5) Google Scholar The aim of this narrative review was to outline a surgical treatment algorithm for OLT management in the athlete. Debridement alone or in combination with BMS techniques is the most common cartilage procedure performed in OLT treatment (Figs. 3 and 4).5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar,26Lee Y.K. Young K.W. Kim J.S. Lee H.S. Cho W.J. Kim H.N. Arthroscopic microfracture with atelocollagen augmentation for osteochondral lesion of the talus: a multicenter randomized controlled trial.BMC Musculoskelet Disord. 2020; 21 (Published 2020 Nov 3): 716https://doi.org/10.1186/s12891-020-03730-3Crossref PubMed Scopus (8) Google Scholar,27Marín Fermín T. Hovsepian J.M. D'Hooghe P. Papakostas E.T Arthroscopic debridement of osteochondral lesions of the talus: a systematic review.Foot (Edinb). 2021; 49101852https://doi.org/10.1016/j.foot.2021.101852Crossref PubMed Scopus (1) Google Scholar Debridement of a cartilage defect comprises the smoothening of the cartilage surface in the presence of fibrillation, flaps, or loose bodies and creating stable margins using a shaver or curette. Thus, improving mechanical symptoms and synovial inflammation.27Marín Fermín T. Hovsepian J.M. D'Hooghe P. Papakostas E.T Arthroscopic debridement of osteochondral lesions of the talus: a systematic review.Foot (Edinb). 2021; 49101852https://doi.org/10.1016/j.foot.2021.101852Crossref PubMed Scopus (1) Google Scholar Additionally, the defect's bed can be perforated with a wide variety of instruments to allow an influx of bone marrow, initiating a signaling cascade with the ulterior filling by fibrocartilage tissue.5Eren T.K. Ataoğlu M.B. Eren A. Geylan D.E. Öner A.Y. Kanatlı U. Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions.Eklem Hastalik Cerrahisi. 2019; 30: 97-105https://doi.org/10.5606/ehc.2019.64401Crossref PubMed Scopus (7) Google Scholar,9Camurcu Y. Ucpunar H. Yapici F. et al.Clinical and magnetic resonance imaging outcomes of microfracture plus chitosan/blood implant vs Microfracture for Osteochondral Lesions of the Talus.Foot Ankle Int. 2020; 41: 1368-1375https://doi.org/10.1177/1071100720942173Crossref PubMed Scopus (4) Google Scholar,27Marín Fermín T. Hovsepian J.M. D'Hooghe P. Papakostas E.T Arthroscopic debridement of osteochondral lesions of the talus: a systematic review.Foot (Edinb). 2021; 49101852https://doi.org/10.1016/j.foot.2021.101852Crossref PubMed Scopus (1) Google ScholarFig. 4Chondral injury of the talar dome after bone marrow stimulation.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Until recently, debridement and BMS techniques were considered the initial treatment of OLT9Camurcu Y. Ucpunar H. Yapici F. et al.Clinical and magnetic resonance imaging outcomes of microfracture plus chitosan/blood implant vs Microfracture for Osteochondral Lesions of the Talus.Foot Ankle Int. 2020; 41: 1368-1375https://doi.org/10.1177/1071100720942173Crossref PubMed Scopus (4) Google Scholar,19Becher C. Malahias M.A. Ali M.M. Maffulli N. Thermann H. Arthroscopic microfracture vs arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 2731-2736https://doi.org/10.1007/s00167-018-5278-7Crossref PubMed Scopus (30) Google Scholar This approach is relatively quick, easy, and inexpensive; patients can return to sports (RTS) quicker with a faster rehabilitation time, making it of particular interest for OLT management in athletes.4Doğar F. Uzun E. Gürbüz K. et al.Comparison of arthroscopic treatment methods in talar osteochondral lesions: a Multicenter, Prospective, Randomized Clinical Trial.J Am Podiatr Med Assoc. 2021; 111 (Article): 5https://doi.org/10.7547/20-218Crossref Scopus (1) Google Scholar,21Vannini F. Costa G.G. Caravelli S. Pagliazzi G. Mosca M. Treatment of osteochondral lesions of the talus in athletes: what is the evidence?.Joints. 2016; 4 (Published 2016 Aug 18): 111-120https://doi.org/10.11138/jts/2016.4.2.111Crossref PubMed Scopus (8) Google Scholar,27Marín Fermín T. Hovsepian J.M. D'Hooghe P. Papakostas E.T Arthroscopic debridement of osteochondral lesions of the talus: a systematic review.Foot (Edinb). 2021; 49101852https://doi.org/10.1016/j.foot.2021.101852Crossref PubMed Scopus (1) Google Scholar However, the poor mechanical properties of the fibrocartilage tissue, its deterioration, and worsening of clinical outcomes over time have raised concern among orthopedic surgeons.26Lee Y.K. Young K.W. Kim J.S. Lee H.S. Cho W.J. Kim H.N. Arthroscopic microfracture with atelocollagen augmentation for osteochondral lesion of the talus: a multicenter randomized controlled trial.BMC Musculoskelet Disord. 2020; 21 (Published 2020 Nov 3): 716https://doi.org/10.1186/s12891-020-03730-3Crossref PubMed Scopus (8) Google Scholar,28Dahmen J. Lambers K.T.A. Reilingh M.L. van Bergen C.J.A. Stufkens S.A.S. Kerkhoffs G.M.M.J. No superior treatment for primary osteochondral defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2142-2157https://doi.org/10.1007/s00167-017-4616-5Crossref PubMed Scopus (76) Google Scholar A systematic review by Dahmen et al28Dahmen J. Lambers K.T.A. Reilingh M.L. van Bergen C.J.A. Stufkens S.A.S. Kerkhoffs G.M.M.J. No superior treatment for primary osteochondral defects of the talus.Knee Surg Sports Traumatol Arthrosc. 2018; 26: 2142-2157https://doi.org/10.1007/s00167-017-4616-5Crossref PubMed Scopus (76) Google Scholar reported a success rate of 82% after BMS in OLT. 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