R. Vellinga (Van Nuys, US)
Southern California Orthopedic InstitutePresenter Of 1 Presentation
23.1.3 - Prospective Evaluation of Particulated Juvenile Articular Cartilage Allograft in the Treatment of Osteochondral Lesions of the Talus
Abstract
Purpose
To prospectively evaluate the clinical efficacy of minimally invasive single stage treatment of osteochondral lesions of the talus (OLT) with arthroscopic application of “particulated” juvenile articular cartilage allograft transplantation (PJACAT), also known as DeNovo NT for lesions >1cm2 or failed prior cartilage restoration procedure. Post-operative MRI used to evaluate structural characteristics of the chondral repair non-invasively.
Methods and Materials
A single surgeon series of ankle arthroscopies were evaluated prospectively for treatment of OLT with “particulated” juvenile articular cartilage allograft transplantation (PJACAT) using DeNovo NT. Demographic data and operative variables were recorded. MRI was utilized to determine the size of the lesion pre-and post-operatively, the extent of integration with adjacent articular cartilage, integration with subchondral bone, and the presence of subchondral marrow edema and cystic lesions. Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), Short Form Health Survey (SF-36) version were collected.
Results
18 patients are enrolled with mean follow up of 24.8 months (range 1-44 months). 14 of the 18 patients have at least 24 months follow up. The OLT lesion was medial talar dome in 13 (72.2%) of patients. 5 (27.7%) of the 18 patients had undergone prior OLT treatment, 4 (77.7%) of which were treated with prior microfracture. 2 patients (11%) had symptoms of ankle instability prior to OLT surgical intervention. FAOS, FAAM, and SF-36 surveys markedly improved in every subscale category, with some subscales reaching significance of p < 0.05. Average MOCART score was 55 (range 40-90), with an average OCAMRISS score of 7 (range 4-9).
Conclusion
Our findings confirm clinical efficacy of minimally invasive single-stage treatment of OLT with arthroscopic application of DeNovo NT in patients with lesion size >1cm2 or failed prior cartilage restoration procedure. These findings also demonstrate better correlation of OCAMRISS over MOCART, which appears to be better suited to radiographically evaluate OLT lesions following PJACAT.