title: A Comparison of Outcomes of Particulated Juvenile Articular Cartilage and Bone Marrow Aspirate Concentrate for Articular Cartilage Lesions of the Talus.
abstract: BACKGROUND
  Articular cartilage lesions of the talus remain a challenging clinical problem because of the lack of natural regeneration and limited treatment options. Microfracture is often the first-line therapy, however lesions larger than 1.5 cm2have been shown to not do as well with this treatment method.
  
  
  METHODS
  The objective of this retrospective study was to evaluate the outcomes of iliac crest bone marrow aspirate concentrate/collagen scaffold (ICBMA) and particulated juvenile articular cartilage (PJAC) for larger articular cartilage lesions of the talus. Fifteen patients undergoing ICBMA or PJAC for articular cartilage lesions of the talus from 2010 to 2013 were reviewed. Twelve patients, 6 from each treatment option, were included in the study. American Orthopaedic Foot and Ankle Surgeons (AOFAS), Foot and Ankle Ability Measure (FAAM), and Short Form-12 (SF-12) outcome scores were collected for each patient.
  
  
  RESULTS
  The mean age was 34.7 ± 14.8 years for ICBMA and 31.5 ± 7.4 years for PJAC. Lesion size was 2.0 ± 1.1 cm2for ICBMA and 1.9 ± 0.9 cm2for PJAC. At a mean follow-up of 25.7 months (range, 12-42 months), the mean AOFAS score was 71.33 for ICBMA and 95.83 for PJAC (  P = .019). The FAAM activities of daily living subscale mean was 77.77 for ICBMA and 97.02 for PJAC (   P = .027). The mean FAAM sports subscale was 45.14 for ICBMA and 86.31 for PJAC (  P = .054). The SF-12 physical health mean was 47.58 for ICBMA and 53.98 for PJAC (  P = .315). The SF-12 mental health mean was 53.25 for ICBMA and 57.8 for PJAC (  P = .315). One patient in treated initially with ICBMA underwent revision fixation for nonunion of their medial malleolar osteotomy, which ultimately resulted in removal of hardware and tibiotalar arthrodesis at 2 years from the index procedure.
  
  
  CONCLUSIONS
  In the present analysis, PJAC yields better clinical outcomes at 2 years when compared with ICBMA for articular cartilage lesions of the talus that were on average greater than 1.5cm2.
  
  
  METHODS
  Therapeutic, Level IV: Retrospective, Case series.
authors.affiliation: Department of Orthopaedics, University of Virginia, Charlottesville, Virginia.
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Lanham
authors.affiliation: Department of Orthopaedics, University of Virginia, Charlottesville, Virginia.
authors.forename: John J
authors.initials: JJ
authors.lastname: Carroll
authors.affiliation: Department of Orthopaedics, University of Virginia, Charlottesville, Virginia.
authors.forename: Minton T
authors.initials: MT
authors.lastname: Cooper
authors.affiliation: Department of Orthopaedics, University of Virginia, Charlottesville, Virginia.
authors.forename: Venkat
authors.initials: V
authors.lastname: Perumal
authors.affiliation: Department of Orthopaedics, University of Virginia, Charlottesville, Virginia.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Park
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation; D002356:Cartilage / Q000637:transplantation*; D002358:Cartilage, Articular / Q000293:injuries* / Q000601:surgery*; D005260:Female; D006801:Humans; D007085:Ilium; D008297:Male; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D013628:Talus / Q000293:injuries / Q000601:surgery*
keywords: articular cartilage lesion; osteochondral lesion; talus