title: Arthroscopic Bone Marrow Stimulation and Concentrated Bone Marrow Aspirate for Osteochondral Lesions of the Talus: A Case-Control Study of Functional and Magnetic Resonance Observation of Cartilage Repair Tissue Outcomes.
abstract: OBJECTIVE
  This study compares retrospective functional and magnetic resonance imaging (MRI) outcomes after arthroscopic bone marrow stimulation (BMS) with and without concentrated bone marrow aspirate (cBMA) as a biological adjunct to the surgical treatment of osteochondral lesions (OCLs) of the talus.
  
  
  METHODS
  Twenty-two patients who underwent arthroscopic BMS with cBMA (cBMA/BMS group) for an osteochondral lesion (OCL) of the talus and 12 patients who underwent arthroscopic BMS (BMS alone) for an OCL of the talus were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS) pain subscale and Short Form 12 general health questionnaire physical component summary score (SF-12 PCS) provided patient-reported outcome scores pre- and postoperatively. MRI scans were assessed postoperatively using the magnetic resonance observation of cartilage repair tissue (MOCART) score. All patients had postoperative MRI performed at the 2-year postoperative visit, and quantitative T2 mapping relaxation time values were assessed in a subset of the cBMA/BMS group.
  
  
  RESULTS
  The mean FAOS and SF-12 PCS scores improved significantly pre- to post-operatively (P < .01) at a mean follow-up of 48.3 months (range, 34 to 82 months) for the cBMA/BMS group and 77.3 months (range, 46 to 100 months) for the BMS-alone group. The MOCART score in the cBMA/BMS group was significantly higher than that in the BMS-alone group (P = .023). Superficial and deep T2 relaxation values in cBMA/BMS patients were higher in repair tissue compared with measurements in adjacent native articular cartilage (P = .030 and P < .001, respectively).
  
  
  CONCLUSIONS
  BMS is an effective treatment strategy for treatment of OCLs of the talus and results in good medium-term functional outcomes. Arthroscopic BMS with cBMA also results in similar functional outcomes and improved border repair tissue integration, with less evidence of fissuring and fibrillation on MRI.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois; Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Hannon
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Keir A
authors.initials: KA
authors.lastname: Ross
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York; Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Murawski
authors.affiliation: East River Medical Imaging, New York, New York.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Deyer
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Niall A
authors.initials: NA
authors.lastname: Smyth
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A.
authors.forename: MaCalus V
authors.initials: MV
authors.lastname: Hogan
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Huong T
authors.initials: HT
authors.lastname: Do
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: O'Malley
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, New York. Electronic address: KennedyJ@hss.edu.
authors.forename: John G
authors.initials: JG
authors.lastname: Kennedy
mesh_terms: D001182:Arthroscopy; D001707:Biopsy, Needle; D001853:Bone Marrow / Q000502:physiology*; D002358:Cartilage, Articular / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013628:Talus / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing