Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus
Introduction: Microfracture has been widely published as a treatment for osteochondral lesions of the talus (OLT). Little is known about the outcome predictors following microfracture for smaller sized OLT. Objectives: This study sought to define the outcome predictors for small OLT treated with mic...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2021-06-01
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| Series: | Journal of Cartilage & Joint Preservation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667254521000081 |
| _version_ | 1818733837732020224 |
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| author | Yoshiharu Shimozono John F. Dankert Timothy W. Deyer Nathaniel P. Mercer John G. Kennedy |
| author_facet | Yoshiharu Shimozono John F. Dankert Timothy W. Deyer Nathaniel P. Mercer John G. Kennedy |
| author_sort | Yoshiharu Shimozono |
| collection | DOAJ |
| description | Introduction: Microfracture has been widely published as a treatment for osteochondral lesions of the talus (OLT). Little is known about the outcome predictors following microfracture for smaller sized OLT. Objectives: This study sought to define the outcome predictors for small OLT treated with microfracture and concentrated bone marrow aspirate (CBMA). Our hypothesis was that lesion uncontainment and the presence of cysts were predictors of poor outcomes following microfracture with CBMA for OLT. Methods: A retrospective cohort study investigating patients who received microfracture for OLT (<10 mm or 100 mm2) between 2008 and 2017 was conducted. Multivariate regression models were used to evaluate factors affecting Foot and Ankle Outcome Scores (FAOS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Kaplan-Meier survival curves were constructed and endpoint was defined as revision surgery requirement. Results: Eighty-seven patients were included in the study. The mean FAOS pain significantly improved from 60.4 ± 14.8 preoperatively to 79.3 ± 12.8 at final follow-up (P< .001). Patients with uncontained-type OLT had an approximately 9-point worse FAOS pain compared to contained-type OLT (P= .036). Patients with cystic OLT also had an approximately 9-point worse FAOS pain compared to noncystic OLT (P= .026). Patients with larger lesion size had worse postoperative MOCART scores (P= .012). Both Uncontained-Cyst and Uncontained-Noncyst groups had significantly worse FAOS pain than the Contained-Noncyst group (P< .001, P= .026). Survival rates in uncontained and contained lesions were 51.5% and 84.4%, respectively (P= .616). Conclusions: Lesion uncontainment and the existence of cysts are independent predictors of poor clinical outcomes following microfracture with CBMA for smaller sized OLT. |
| first_indexed | 2024-12-17T23:55:49Z |
| format | Article |
| id | doaj.art-ad294e372a974e289158d4b818392a04 |
| institution | Directory Open Access Journal |
| issn | 2667-2545 |
| language | English |
| last_indexed | 2024-12-17T23:55:49Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cartilage & Joint Preservation |
| spelling | doaj.art-ad294e372a974e289158d4b818392a042022-12-21T21:28:04ZengElsevierJournal of Cartilage & Joint Preservation2667-25452021-06-0112100008Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talusYoshiharu Shimozono0John F. Dankert1Timothy W. Deyer2Nathaniel P. Mercer3John G. Kennedy4NYU Langone Health, New York, NY, USANYU Langone Health, New York, NY, USAEast River Medical Imaging, New York, NY, USA; Weill Cornell Medicine, New York, NY, USANYU Langone Health, New York, NY, USANYU Langone Health, New York, NY, USA; Correspondence to: John G. Kennedy, 171 Delancey Street, 2nd Floor, New York, NY 10002.Introduction: Microfracture has been widely published as a treatment for osteochondral lesions of the talus (OLT). Little is known about the outcome predictors following microfracture for smaller sized OLT. Objectives: This study sought to define the outcome predictors for small OLT treated with microfracture and concentrated bone marrow aspirate (CBMA). Our hypothesis was that lesion uncontainment and the presence of cysts were predictors of poor outcomes following microfracture with CBMA for OLT. Methods: A retrospective cohort study investigating patients who received microfracture for OLT (<10 mm or 100 mm2) between 2008 and 2017 was conducted. Multivariate regression models were used to evaluate factors affecting Foot and Ankle Outcome Scores (FAOS) and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scores. Kaplan-Meier survival curves were constructed and endpoint was defined as revision surgery requirement. Results: Eighty-seven patients were included in the study. The mean FAOS pain significantly improved from 60.4 ± 14.8 preoperatively to 79.3 ± 12.8 at final follow-up (P< .001). Patients with uncontained-type OLT had an approximately 9-point worse FAOS pain compared to contained-type OLT (P= .036). Patients with cystic OLT also had an approximately 9-point worse FAOS pain compared to noncystic OLT (P= .026). Patients with larger lesion size had worse postoperative MOCART scores (P= .012). Both Uncontained-Cyst and Uncontained-Noncyst groups had significantly worse FAOS pain than the Contained-Noncyst group (P< .001, P= .026). Survival rates in uncontained and contained lesions were 51.5% and 84.4%, respectively (P= .616). Conclusions: Lesion uncontainment and the existence of cysts are independent predictors of poor clinical outcomes following microfracture with CBMA for smaller sized OLT.http://www.sciencedirect.com/science/article/pii/S2667254521000081MicrofractureOsteochondral lesionsOutcome predictorsSubchondral cystsTalusUncontained lesions |
| spellingShingle | Yoshiharu Shimozono John F. Dankert Timothy W. Deyer Nathaniel P. Mercer John G. Kennedy Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus Journal of Cartilage & Joint Preservation Microfracture Osteochondral lesions Outcome predictors Subchondral cysts Talus Uncontained lesions |
| title | Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus |
| title_full | Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus |
| title_fullStr | Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus |
| title_full_unstemmed | Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus |
| title_short | Predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus |
| title_sort | predictors of outcomes of microfracture with concentrated bone marrow aspirate for osteochondral lesions of the talus |
| topic | Microfracture Osteochondral lesions Outcome predictors Subchondral cysts Talus Uncontained lesions |
| url | http://www.sciencedirect.com/science/article/pii/S2667254521000081 |
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