In patients with osteochondral lesions of the talus, osteochondral fragment fixation can offer superior clinical outcomes when compared to bone marrow stimulation, even for small lesions, according to a new study out of Japan.
Osteochondral Fragment Fixation Vs. Bone Marrow Stimulation
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Secondary#bonemarrow#osteochondralfracturefixation#osteochondrallesions
The study, “Clinical Outcomes of Osteochondral Fragment Fixation Versus Microfracture Even for Small Osteochondral Lesions of the Talus,” was published online on July 28, 2022 in The American Journal of Sports Medicine.
Typically, bone marrow stimulation is performed when the lesion size is less than 100 mm2. The lesion is covered with fibrocartilage. While initial outcomes are good, they deteriorate over time. With osteochondral fragment fixation, the native articular surface can be restored, but the difference in clinical outcomes between the two procedures hasn’t been clear until now.
The researchers analyzed the outcomes of the two procedures in 62 ankles, 59 patients with osteochondral lesions of the talus. For 26 ankles, bone marrow stimulation was performed and for 36 ankles, osteochondral fragment fixation was performed instead.
For each ankle, they measured clinical outcomes, including the American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale and bone marrow edema.
The research team compared outcomes for both procedure groups and found that the American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale scores were higher in the fixation group (97.3 ± 4.3 points) compared with the scores of the bone marrow stimulation group, even when the lesion size was small.
In the bone marrow stimulation group, those ankles with bone marrow edema, had significantly lower scores than those without it (p < .05). The researchers also found that lesions with bone marrow edema in the sagittal plane were more centrally located than those without bone marrow edema in the bone marrow stimulation group.
In the fixation group, however, there were no significant differences in the American Orthopaedic Foot & Ankle Society Ankle Hindfoot Scale scores and location of lesion in ankles with or without bone marrow edema.
“Fixation is recommended even for small lesions, especially for more centralized lesions in the medial and lateral sides of the talus,” the researchers wrote.
Study authors include Tomoyuki Nakasa, M.D., Ph.D., Yasunari Ikuta, M.D., Ph.D., Junichi Sumii, M.D., Akinori Nekomoto, M.D., Shingo Kawabata, M.D., and Nobuo Adachi, M.D., Ph.D., all of Hiroshima University, Hiroshima, Japan.
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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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