Evaluating Clinical Outcomes of Recombinant Human Bone Morphogenetic Protein-2 in the Treatment of Subchondral Plate Damage Associated With Ankle Osteochondral Lesions.

Overview

abstract

BACKGROUND: Cartilage lesions with concomitant subchondral plate damage are challenging pathologies for foot and ankle surgeons. Recent clinical reports suggest that recombinant human bone morphogenetic protein-2 (rhBMP-2) can restore structural integrity of the subchondral plate and promote osseous healing, potentially improving outcomes for cartilage repair procedures. This study seeks to evaluate the complication rate and patient-reported outcomes of rhBMP-2-augmented repair for ankle osteochondral lesions with subchondral involvement. METHODS: Patients who received surgical repair with rhBMP-2, extracellular matrix (ECM), and bone marrow aspirate concentrate (BMAC) for the treatment of an ankle osteochondral defect with an associated subchondral damage between January 2023 and September 2024 were retrospectively chart reviewed. Twenty-one patients who fit the criteria were included. All patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) surveys preoperatively and at minimum 1 year postoperatively. Clinical outcomes, postoperative complications, and revision surgery were recorded. RESULTS: The average time from surgery to postoperative survey follow-up was 17.9 (range, 12.0-27.3) months. Average cartilage lesion size was 88.4 (range, 36.0-120) mm². Significant pre- to postoperative improvement in Physical Function, Pain Interference, and Pain Intensity were observed among the patient cohort. Physical Function score increased by an average of 10.4 points (P < .05). Pain Interference improved by an average of 10.4 points (P < .05). Pain Intensity decreased by an average of 8.6 points (P < .05). Global Physical Health increased by an average of 8.4 points (P < .05). Global Mental Health and Depression did not change significantly. Observed changes exceeded commonly cited PROMIS minimal clinically important differences for lower-extremity populations. The complication rate was low, with only 2 patients (9.5%) reporting persistent pain requiring a return to the operating room for revision surgery. CONCLUSION: Our results suggest that this procedure is an effective treatment with a significant improvement in clinical outcomes and a low complication rate. LEVEL OF EVIDENCE: Level IV, case series.