A new multicenter study has ruled out a newer allograft technology in the fight against cartilage injuries.
Talar Lesions…Allograft No Better Than Microfracture?
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Secondary#osteochondrallesions#foot#allogenousarticularcartilage
The study, “Comparison of Juvenile Allogenous Articular Cartilage and Bone Marrow Aspirate Concentrate Versus Microfracture With and Without Bone Marrow Aspirate Concentrate in Arthroscopic Treatment of Talar Osteochondral Lesions,” is published in the April 2018 edition of Foot & Ankle International.
Mark Drakos, M.D., foot and ankle surgeon at New York’s Hospital for Special Surgery and co-author, said to OTW, “Cartilage injuries continue to be challenging issues to treat for orthopedic surgeons. The current treatment of microfracture (MF) has several shortcomings including mixed long-term outcomes. We were looking to improve upon the current standard of care by using some of the newer allograft technologies.”
In their study, the authors treated 30 patients with microfracture and treated another 20 patients with received DeNovo NT for juvenile allogenic chondrocyte implantation (ACI) with autologous bone marrow aspirate (BMAC) between 2006 and 2014.
The researchers also gave 17 of the microfracture patients supplemental bone marrow aspirate treatment.
According to the authors, “Both the microfracture and juvenile allogenic chondrocyte implantation with autologous bone marrow aspirate patents showed significant pre- to postoperative improvements in all Foot and Ankle Outcome Score subscales.”
“Visual Analog Scale scores also showed improvement in both groups, but only reached a level of statistical significance in the microfracture group. There were no significant differences in patient reported outcomes between groups….”
Dr. Drakos told OTW, “The most important results were that there was no difference in either clinical outcome or radiographic appearance between using the juvenile particulate cartilage allograft and the conventional microfracture technique.”
The authors wrote, “ACI-BMAC and MF resulted in improved functional outcomes. However, while the majority of patients improved, functional outcomes and quality of repair tissue were still not normal.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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