Functional and radiographic outcomes of talar osteochondral lesions repaired with a combination of autologous bone graft, cell-free hyaluronic acid-based scaffold, bone marrow aspirate concentrate (BMAC) and fibrin glue.

PURPOSE

To evaluate the efficacy of acellular hyaluronic acid matrix scaffold, BMAC, and autologous bone graft in providing biomechanical support and optimal microenvironment for OLTs treatment.

METHODS

A retrospective analysis of 81 ankles from 80 patients treated between 2018 and 2021 was conducted. The inclusion criteria included patients who underwent surgery for osteochondral lesions of the talus (OLTs) and received acellular hyaluronic acid matrix scaffold, bone marrow aspirate concentrate (BMAC) fibrin glue, and autologous bone graft. The exclusion criteria included prior ankle surgery, concurrent lateral instability surgery, malignancy, metabolic bone disease, or related medication. Clinical outcomes were assessed with FAOS, VAS, and SF-36 at a minimum of two years postoperatively. MRI findings were evaluated preoperatively, at six months, and 24 months postoperatively via MOCART. Subgroups were formed on the basis of age (< 45 vs. ≥45), BMI, and full weight bearing mobilization (FWBM) timing (4, 5, 6, or > 6 weeks).

RESULTS

Postoperative FAOS and SF-36 scores significantly improved (p = 0.000), whereas VAS scores decreased (p = 0.001). Early FWBM (4th week) was associated with superior FAOS, SF-36, and MOCART scores at 24 months (p = 0.039). Underweight and healthy individuals exhibited lower VAS (p = 0.001) and higher SF-36 scores (p = 0.000) at three months, alongside higher MOCART scores at 24 months compared to overweight patients (p = 0.039).

CONCLUSIONS

This study highlights the importance of a tailored approach to optimize the microenvironment and biomechanical support in OLTs treatment. Further research is required to refine therapeutic strategies.