Concentrated Bone Marrow Aspirate With Extracellular Matrix Grafting for Osteochondral Lesions of the Talus in Pediatric and Adolescent Patients.
Academic Article
Overview
abstract
BACKGROUND: Treatment of osteochondral lesions of the talus (OLTs) can be challenging due to difficult access/visualization and limited healing capacity. While outcomes after concentrated extracellular matrix combined with bone marrow aspirate concentrate (ECM-BMAC) have been reported for adult populations, its use in pediatric/adolescent patients has not been thoroughly examined. This case series assesses clinical outcomes of ECM-BMAC grafting for young patients with OLTs. METHODS: All patients ≤18 years of age presenting to two surgeons between 2016 and 2024 who underwent primary surgery with ECM-BMAC for an OLT with minimum 1-year clinical follow-up were included. Preoperative primary sport, concomitant procedures, lesion size/location, postoperative complications, requirement for reoperation, and postoperative sports clearance were recorded. Various Patient-Reported Outcomes Measurement Information System (PROMIS) scales were obtained from the medical record, where available at minimum 9 months postoperatively. Descriptive statistics were calculated, and patient-reported outcomes (PROs) were compared using Wilcoxon signed-rank tests. RESULTS: Sixteen patients with unilateral OLTs were included in this study. Fifty-six percent of patients were female with a mean age of 14.3 ± 1.8 years (95% confidence interval [CI]: 13.4-15.3) at surgery, and the mean clinical follow-up was 32.8 ± 19.5 months (95% CI: 22.4-43.1). Lesions most commonly affected the medial talar dome (81%) and had mean size and depth of 103.9 ± 52.2 mm2 and 5.4 ± 1.6 mm (95% CI: 4.5-6.3), respectively. Two patients (13%) underwent concomitant modified Broström procedure for lateral ankle instability. At an average of 6.2 ± 1.6 months (95% CI: 5.3-7.1), 88% of patients were cleared to return to sport. PROMIS Pain Interference scores improved on follow-up surveys (48.6 ± 7.6 vs. 56.3 ± 5.6, P = .018) obtained at an average 28.4 ± 21.0 months postoperatively. One patient (6%) required reoperation for persistent pain and radiographic abnormality. CONCLUSIONS: High sports clearance rates and improved PROMIS pain scores with low rates of reoperation at short-term follow-up provide early evidence that arthroscopic management with ECM-BMAC can achieve favorable outcomes for treatment of OLTs in pediatric/adolescent patients. KEY CONCEPTS: (1)A detailed surgical technique for the arthroscopic management of osteochondral lesions of the talus (OLTs) in young patients using extracellular matrix combined with bone marrow aspirate concentrate (ECM-BMAC) is provided to achieve a more hyaline-like cartilage.(2)High sports clearance rates and improved Patient-Reported Outcomes Measurement Information System (PROMIS) pain scores are observed at short-term after arthroscopic management of OLTs in pediatric/adolescent patients with ECM-BMAC.(3)ECM-BMAC for OLTs is associated with low rates of re-operation. LEVEL OF EVIDENCE: IV.
