Arthroscopic Treatment of Osteochondral Lesions of the Talus With Allograft Cartilage Matrix

Abstract

Background: This prospective study evaluated the intermediate-term outcomes of operatively treating primary osteochondral lesions of the talus (OLT) of 1.5 cm2 or smaller with arthroscopic excision, microfracture, and allograft cartilage extracellular matrix (ECM). Methods: Between 2012 and 2015, 30 consecutive patients received allograft cartilage ECM at their microfractured OLT of 1.5 cm2 or smaller after failing nonoperative treatment. Preoperative and postoperative function and pain were graded using the Foot and Ankle Ability Measure (FAAM) and a visual analog scale (VAS), respectively. Postoperative imaging was assessed for osteochondral healing and degenerative changes. This included computed tomography (CT) at 6 months from surgery. Data regarding postoperative complications were recorded. All 30 patients that received allograft cartilage ECM for their OLT were evaluated for final follow-up at a mean of 20.2 months. Results: Mean FAAM increased from 51.4 preoperatively to 89.3 of 100 at final follow-up. Mean VAS decreased from 8.1 preoperatively to 1.7 of 10 at final follow-up. These differences between preoperative and postoperative function and pain were statistically significant ( P < .05). At 6 months from surgery, 2 patients (6.7%) received CT scans that revealed incomplete chondral formation at their OLT. At 19 months after surgery, a separate patient (3.3%) developed ankle arthritic changes. Conclusion: Treating OLTs with allograft cartilage ECM has not been previously reported. Using allograft cartilage ECM resulted in a high rate of improvement in ankle function and pain in patients with OLTs. These findings are important as allograft cartilage ECM could be of significant benefit for patients with OLTs. Level of Evidence: Level III, prospective comparative series.