Orthobiologics: Can They Be Effective For Osteochondral Lesions?

By Gary Lepow, DPM, MS, FACFAS, Dustin Smith, DPM, and Matthew Sheedy, DPM

Given the prevalence of hallux abducto valgus deformity, these authors offer a prmer on micro-and macrobiological fundamentals involving the first metatarsophalangeal joint (MPJ) and the impact of joint surface deterioration. They also examine an emergine implant for repair of first MPJ osteochondral lesions. It has been estimated that 209,000 patients undergo surgery for hallux abducto valgus correction each year in the United States.1 The National Center for Health Statistics states that hallux abducto valgus affects 1 percent of the adult population in the U.S.2    Hallux abducto valgus (HAV) deformities have traditionally been classified as ranging from mild to severe. A recent study by Engel correlated the relationship of subchondral bone cyst formation of the first metatarsophalangeal joint (MPJ) and the severity of HAV deformity.3 The intraoperative repair of subchondral defects is imperative during the surgical correction of HAV for articular force distribution during propulsion and to circumvent progression of the osteolytic lesion.    Current orthobiological options offer an alternative to the traditional microfracture or marrow stimulating technique (MST). New orthobiological implantable materials have demonstrated evidence of resurfacing the articular surface with hyaline-like soft tissue that adheres to the osteoconductive, bioabsorbable substrate.

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