Arthroscopic Non-Concentrated Autologous Iliac Bone Marrow Stimulation Shows Stable Medium-Term Clinical and Radiological Outcomes for Small Cystic Talar Osteochondral Lesions.

Abstract

ObjectiveTo evaluate radiological, short-term, and medium-term clinical outcomes of arthroscopic non-concentrated iliac bone marrow stimulation (BMS) for small talar cystic osteochondral lesions of the talus (OLTs).DesignForty-three cases underwent this modified BMS between 2014 and 2019 were evaluated. Clinical outcomes were assessed by the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports Subscales (SS). Regenerated tissue was evaluated with the Magnetic Resonance Observation of Cartilage Repair Tissue scales (MOCART-2.0). Subgroup analysis based on locations and concomitant anterior talofibular ligament (ATFL) injuries.ResultsThe average diameter and depth of cysts were 6.97 ± 1.53 mm and 5.47 ± 1.10 mm, respectively. At a mean follow-up of 57.02 ± 19.61 months, FAAM-ADL and FAAM-SS improved significantly (45.65 ± 4.56 to 74.77 ± 8.03 and 12.63 ± 1.87 to 26.67 ± 3.41, respectively). From short-term to medium-term, FAAM-ADL revealed a minor decline (75.53 ± 7.76 vs. 74.77 ± 8.03, P = 0.421); FAAM-SS improved (25.37 ± 3.51 vs. 26.67 ± 3.41, P = 0.089). Medial lesions demonstrated favorable outcomes compared to lateral lesions [FAAM-ADL (77.04 ± 7.23 vs. 70.75 ± 8.10, P = 0.013), FAAM-SS (28.08 ± 2.40 vs. 24.19 ± 3.51, P < 0.001), and MOCART-2.0 (85.19 ± 11.27 vs. 71.88 ± 11.09, P < 0.001)]. Lateral lesions indicated higher rates of major hypertrophy (56.25% vs. 7.69%) and split-like defects (56.25% vs. 15.38%). The ATFL injuries did not significantly influence revision rates (15.8% vs. 4.2%, P = 0.439).ConclusionsArthroscopic non-concentrated iliac BMS demonstrated stable outcomes for small cystic OLTs. Lateral lesions were associated with inferior subjective scores and relatively higher rates of irregular fibrocartilage.