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Bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus in ankle osteoarthritis: satisfactory clinical outcome at 10 years

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate at long-term follow-up patients undergoing a one-step procedure of debridement and BMAC seeded in situ onto a scaffold for the treatment of osteochondral lesions of the talus (OLT) in ankles affected by osteoarthritis (OA), documenting the duration of the clinical benefit and its efficacy in postponing end-stage procedures.

Methods

This series included 56 consecutive patients. Patients were evaluated preoperatively and up to a mean of 10 years of follow-up with the AOFAS score and the AOS scale, including pain and disability subscales. Furthermore, patients were asked to rate the satisfaction and failures were documented as well.

Results

The AOFAS score improved from 52.3 ± 14.3 to 73.5 ± 23.1 at 10 years (p  < 0.0005); the AOS pain and disability subscales decreased from 70.9 ± 14.1 to 37.2 ± 32.7 and from 69.0 ± 14.8 to 34.2 ± 29.3, respectively (both p < 0.0005). The overall rate of satisfaction was 61.8 ± 41.2 and 68.6% of patients would undergo again the surgical procedure. A total of 17 failures was documented, for a failure rate of 33.3%. Older patients and those with more complex cases requiring previous or combined surgeries had lower outcomes, as well as those affected by grade 3 OA, who experienced a high failure rate of 71.4%.

Conclusions

This one-step technique for the treatment of OLT in OA ankles showed to be safe and to provide a satisfactory outcome, even if patients with end stage OA presented a high revision rate at 10 years. Moreover, this procedure was effective over time, with overall good results maintained up to a long-term follow-up. However, older age, more complex cases requiring previous or combined surgeries, and advanced OA led to an overall worst outcome and a significantly higher failure rate.

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Funding

The study was carried out at the Rizzoli Orthopaedic Institute—Bologna University (Bologna, Italy) in accordance with the World Medical Association.

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Authors and Affiliations

  1. I Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Francesca Vannini, Emanuele Di Quattro, Laura Ramponi & Cesare Faldini

  2. Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Giuseppe Filardo

  3. II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Sante Alessandro Altamura

  4. Clinica Ortopedica di Chieti, Ospedale Clinicizzato SS Annunziata di Chieti, Chieti, Italy

    Roberto Buda

  5. Alma Mater Studiorum-Università di Bologna, Bologna, Italy

    Sandro Giannini

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  1. Francesca Vannini
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  2. Giuseppe Filardo
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Correspondence to Sante Alessandro Altamura.

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Declaration of Helsinki and was approved by our local Ethical Committee (Prot. Number 0001879).

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Vannini, F., Filardo, G., Altamura, S.A. et al. Bone marrow aspirate concentrate and scaffold for osteochondral lesions of the talus in ankle osteoarthritis: satisfactory clinical outcome at 10 years. Knee Surg Sports Traumatol Arthrosc 29, 2504–2510 (2021). https://doi.org/10.1007/s00167-021-06494-y

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