title: One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction.
abstract: BACKGROUND
  A recent one-step arthroscopic technique based on bone marrow-derived cell transplantation has achieved good results in repairing osteochondral lesions of the talus (OLTs), overcoming some of the drawbacks of older techniques.
  
  
  OBJECTIVE
  To report the results after 4 years of a series of patients who underwent a one-step repair of osteochondral lesions of the talar dome, as well as the capability of magnetic resonance imaging (MRI) using a T2-mapping sequence to predict the clinical outcome.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Forty-nine patients (age [mean ± SD], 28.08 ± 9.51 y) underwent a one-step repair of OLTs. Patients were evaluated clinically by American Orthopaedic Foot and Ankle Society (AOFAS) scores and radiographs and underwent MRI preoperatively and during postoperative follow-ups at predetermined times. In all patients, the cells were harvested from the iliac crest, concentrated, and loaded on a scaffold that was implanted arthroscopically.
  
  
  RESULTS
  The overall AOFAS score (mean ± SD) improved from 63.73 ± 14.13 preoperatively to 82.19 ± 17.04 at 48 ± 6.1 months (P < .0005), with best results at the 24-month follow-up. A significant decrease in the clinical score was observed between 24 and 36 months postoperatively (P = .001) and between 24 and 48 months (P < .005). The T2-mapping analysis showed regenerated tissue with T2 values of 35 to 45 milliseconds, similar to hyaline cartilage, in a mean of 78% ± 16% of the repaired lesion area. The time between the occurrence of trauma and surgery was found to negatively affect the clinical outcome at the latest follow-up; patient's age and lesion size influenced the early clinical results but did not affect the outcome at final follow-up. The stability of clinical results over time and the percentage of tissue with values similar to hyaline cartilage evidenced by MRI T2 mapping showed a tendency to correlate at the last follow-up (r = 0.497, P = .06).
  
  
  CONCLUSIONS
  One-step repair of OLTs had good clinical results that were durable over time, even though there was a slight decrease in AOFAS score at the latest follow-up. The quality of the regenerated tissue detected by MRI T2 mapping directly correlated with the clinical results.
authors.affiliation: II Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.forename: Roberto
authors.initials: R
authors.lastname: Buda
authors.forename: Milva
authors.initials: M
authors.lastname: Battaglia
authors.forename: Marco
authors.initials: M
authors.lastname: Cavallo
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruffilli
authors.forename: Laura
authors.initials: L
authors.lastname: Ramponi
authors.forename: Gherardo
authors.initials: G
authors.lastname: Pagliazzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Vannini
mesh_terms: D000328:Adult; D000367:Age Factors; D001182:Arthroscopy; D001854:Bone Marrow Cells; D002358:Cartilage, Articular / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D002478:Cells, Cultured / Q000637:transplantation; D019902:Chondrocytes / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000031:analogs & derivatives; D008279:Magnetic Resonance Imaging; D008297:Male; D010006:Osteoblasts / Q000637:transplantation*; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012038:Regeneration; D013628:Talus / Q000293:injuries / Q000473:pathology / Q000601:surgery*; D061665:Time-to-Treatment; D054457:Tissue Scaffolds; D014182:Transplantation, Autologous; D055675:Viscosupplements
chemical_list: D055675:Viscosupplements; C086358:hyaluronic acid benzyl ester; D006820:Hyaluronic Acid