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.

IF 2 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2025-04-23 DOI:10.1007/s00264-025-06542-z

Nurettin Mantı, Alişan Daylak, Yasin Erdoğan, Esra Çıvgın, Umut Öktem, Mehmet Orçun Akkurt

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引用次数: 0

Abstract

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.

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自体骨移植、无细胞透明质酸支架、骨髓抽液和纤维蛋白胶联合修复距骨软骨病变的功能和影像学结果

目的：评价脱细胞透明质酸基质支架、BMAC和自体骨移植为OLTs治疗提供生物力学支持和最佳微环境的效果。方法：回顾性分析2018 - 2021年收治的80例患者的81例踝关节。纳入标准包括距骨软骨病变（OLTs）手术并接受脱细胞透明质酸基质支架、骨髓吸液浓缩物（BMAC）纤维蛋白胶和自体骨移植的患者。排除标准包括既往踝关节手术、并发侧位不稳定手术、恶性肿瘤、代谢性骨病或相关药物。临床结果在术后至少2年通过FAOS、VAS和SF-36进行评估。术前、术后6个月和术后24个月通过MOCART评估MRI结果。按年龄（6周）分组。结果：术后FAOS评分和SF-36评分明显改善（p = 0.000）， VAS评分下降（p = 0.001）。早期FWBM（第4周）与24个月时更高的FAOS、SF-36和MOCART评分相关（p = 0.039）。与超重患者相比，体重过轻和健康个体在3个月时表现出较低的VAS （p = 0.001）和较高的SF-36评分（p = 0.000），同时在24个月时表现出较高的MOCART评分（p = 0.039）。结论：本研究强调了量身定制的方法在olt治疗中优化微环境和生物力学支持的重要性。需要进一步的研究来完善治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.