A medium term review of the outcomes of talar osteochondral lesions treated with matrix associated stem cell transplantation

E. Murphy, A. Faustino, M. Curran, S. Kearns

¹Galway University Hospital, Orthopaedics, Galway, Ireland

Introduction: Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognised problem in chronic ankle pain. Difficulties associated with treating OCLs include lesion location, size, chronicity and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is described for larger lesions >15mm2 or failed alternative therapies. This cohort study describes a medium term review of the outcomes of talar lesions treated with MAST.

Methods: A review of all patients treated with MAST by a single surgeon was conducted. Preoperative radiographs, MRIs and FAOS outcome questionnaire scores were conducted. Intraoperative classification was undertaken to correlate with imaging. Postoperative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment and progression to arthritis/fusion surgery. Unpaired t test on SPSS, p<0.05.

Results: 58 MAST procedures in 57 patients were identified in this cohort. The mean follow up was 5 years. There were 20 females and 37males, with a mean age of 37 years (SD 9.1). 22 patients had lateral OCLS and 35 medial OCLs. 32 patients had previous surgery and 25 had this procedure as a primary. 15 patients had one failed previous surgery, 9 patients had two, four patients had three previous surgeries and three patients had four previous surgeries. 12 patients had corrective procedures at the time of surgery. Complications: 3 patients went on to have an ankle fusion, 5 had additional arthrofibrotic debridements, 1 patient had a repeat MAST procedure, 1 patients had removal of osteotomy screws for pain, and there were 2 wound complications one at ankle and one at the iliac crest donor site.

Conclusion: MAST has demonstrated positive results in lesions which prove challenging to treat, even in a “ failed microfracture” cohort. RCT still lacking in field of orthobiologics for MAST. Longer term follow up required to evaluate durability

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