J Korean Foot Ankle Soc.  2023 Dec;27(4):148-153. 10.14193/jkfas.2023.27.4.148.

Bony Union of Osteochondral Lesion of the Talus after Bone Marrow Aspirate Concentrate and Matrix-Induced Chondrogenesis: A Case Report

• Song TH
• Suh JS
• Choi JY

• KMID: 2553008
• DOI: http://doi.org/10.14193/jkfas.2023.27.4.148

Abstract

Traditionally, arthroscopic microfracture and autologous osteochondral autograft transplantation have been the primary surgical treatments for osteochondral lesions of the talus. On the other hand, recent advancements have introduced alternative approaches, such as autologous chondrocyte transplantation, matrix-derived autologous chondrocyte transplantation, intra-articular injection of concentrated bone marrow aspirate concentrate, and the use of fibrin glue to address chondral defects. Furthermore, some studies have explored a combination of bone marrow aspirate and matrix-derived chondrogenesis. In light of these developments, this report presents a case study of a young male patient in his early twenties with a relatively large osteochondral lesion exceeding 1.5 cm 2 on the medial talar dome. Instead of removing the osteochondral lesion, a surgical approach was employed to retain the lesion while addressing the unstable cartilage in the affected area. This approach involved a combination of bone marrow aspirate concentrate and matrix-derived chondrogenesis. The treatment yielded favorable clinical outcomes and ultimately successfully induced the bony union of osteochondral lesions. This paper reports the author’s experience with this innovative approach with a review of the relevant literature.

Keyword

Talus; Osteochondral lesion; Osteochondritis dissecans; Bone marrow aspirate concentrate; Autologous matrix-induced chondrogenesis

Figure

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  Figure 1 In order to identify the precise cause of pain three weeks after the injury, a left ankle magnetic resonance imaging examination was performed. Both T1 and T2-weighted images revealed the presence of an osteochondral lesion measuring 10×18 mm2 on the medial talar dome.

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  Figure 2 On the weight-bearing anteroposterior and lateral radiographs (A), the osteochondral lesion on the medial talar dome was confirmed. Follow-up magnetic resonance imaging showed slight signal intensity changes observed within the osteochondral lesion, but no significant difference compared to images obtained seven months earlier (B). Computed tomography scans in the coronal, sagittal, and axial planes also revealed that the osteochondral lesion was completely separated from the talar body, and there were signs of sclerosis in the separated interface (C).

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  Figure 3 Initially, 50 mL of bone marrow was aspirated from the right anterosuperior iliac spine (A) and subsequently centrifuged to obtain 6 mL of concentrated bone marrow aspirate (B, C). Subsequently, partial medial malleolar osteotomy was performed (D) to access the osteochondral lesion on the medial talar dome. Without removing the osteochondral lesion, the severely unstable peripheral cartilage was meticulously debrided (E). Using a template to match the contour of the excised defect (F), a Chondro-Gide membrane (Geistlich Pharma AG, Wolhusen, Switzerland) was precisely cut to match the template shape (G). After that, the concentrated bone marrow aspirate was evenly applied to the Chondro-Gide membrane (H). The Chondro-Gide membrane, coated with bone marrow aspirate, was then securely affixed to the debrided subchondral area (I) and anchored using fibrin glue (J).

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  Figure 4 At the 12-month postoperative follow-up, radiographic images revealed complete union of the osteochondral lesion on the medial talar dome, in addition to the partial medial malleolar osteotomy site (A). Subsequent computed tomography scans also demonstrated the complete bony union of osteochondral lesion (B).

Reference

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