Concentrated Bone Marrow Aspirate in the Treatment of Osteochondral Lesions of the Talus: A Systematic Review of Outcomes by Surgical Approach.

Background: Concentrated bone marrow aspirate (CBMA) has become increasingly popular in the management of osteochondral lesions of the talus (OLT) due to its rich content of mesenchymal stem cells (MSCs) and bioactive substances that promote chondrogenesis and articular cartilage repair. However, comprehensive evaluations of clinical outcomes regarding the use of CBMA in OLT have yet to be published. The purpose of this review is to provide an evidence-based overview of clinical outcomes following the utilization of CBMA in the surgical management of OLT.

Methods: Using the search terms: ([CBMA] OR [concentrated bone marrow aspirate] OR [bone marrow aspirate] OR [bone marrow-derived mesenchymal stem cells]) AND ([talus] OR [ankle] OR [osteochondral lesion]), we systematically reviewed PubMed/Medline, Scopus, and Cochrane databases in February 2025. Inclusion criteria consisted of clinical studies published in English within the past 10 years that examined ankle pain or functional outcomes after treating OLT in adults with CBMA. Animal studies and studies including patients aged <18 years were excluded, as were systematic reviews and meta-analyses.

Results: Fifteen articles met inclusion criteria. CBMA showed beneficial effects in functional and pain outcomes across different applications: as a standalone therapy, in conjunction with debridement, and alongside reparative or replacement techniques. However, results varied, with some studies noting superior outcomes with CBMA compared to controls, while others found no significant differences. Radiologic outcomes assessed by Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring and complications were also mixed, suggesting benefits in some reparative techniques but not in others.

Conclusions: CBMA shows promise in the management of OLT, particularly when used as an adjunct to surgical intervention. However, the evidence is limited by the predominance of non-randomized studies. The heterogeneity in study design, follow-up, and outcome measures across the literature highlights the need for more standardized research protocols to definitively assess CBMA's efficacy and optimize its clinical use.Level of Evidence: III.