Cath Lab Digest

In Conclusion

Presently, there are an increasing amount of options that are available to treat osteochondral lesions of the talus. Foot and ankle surgeons should determine the size and depth of the lesion with a CT scan before deciding on the procedure that would best benefit the patient. The foot and ankle surgeon must evaluate the advantages and disadvantages of each procedure, and determine which procedure is best for each case.

   Classically, surgeons would employ microfracture surgery for small osteochondral lesions and perform the osteochondral allograft transplant system procedure for larger osteochondral lesions. The development of new grafts and new procedures can help augment the healing of these lesions.

   In particular, the results of using bone marrow aspirate to treat and augment the treatment of these lesions are very encouraging. The main disadvantage of microfracture surgery is the formation of fibrocartilage, which has poorer biomechanical properties in comparison to hyaline cartilage. By adding the bone marrow aspirate injection to microfracture surgery, there may be improved healing options. The osteochondral allograft transplant system procedure does replace the lesion with hyaline cartilage but it is a very invasive procedure, and requires the use of an allograft that must be a specific match for the patient. It can also be a very technically demanding procedure as the allograft plug needs to accurately match the contour of the patient’s talus.

   When it comes to the treatment of osteochondral lesions, new techniques and developments such as bone marrow aspirate and DeNovo graft have increased the number of options available. These new techniques are easier to perform and have a lower patient morbidity in comparison to an osteochondral allograft transplant system procedure. Both techniques help to stimulate hyaline cartilage in osteochondral defects and one may use them in conjunction with one another to augment healing. To my knowledge, there are not many high-powered studies of bone marrow aspirate or the DeNovo graft.

   Further studies are needed to determine if these treatments are effective over a broader range of patients, and if they augment or speed up the healing of these osteochondral lesions.

   Dr. Baravarian is an Assistant Clinical Professor at the UCLA School of Medicine. He is the Chief of Podiatric Foot And Ankle Surgery at the Santa Monica UCLA Medical Center and Orthopedic Hospital, and is the Director of the University Foot and Ankle Institute in Los Angeles.

   Dr. Yau is a Fellow at the University Foot and Ankle Institute in Los Angeles.

References