ROSM uses research-based methods to lead patients back to full function and health. Our team is dedicated to providing effective, minimally-invasive options to maintain and enhance our patients’ quality of life. Please review these studies for more information on our treatment modalities. If you have any further questions, do not hesitate to contact us.
Charles P. Hannon, M.D.; Keir A. Ross, B.S.; Christopher D. Murawski, B.S.; Timothy W. Deyer, M.D.; Niall A. Smyth, M.D.; MaCalus V. Hogan, M.D.; Huong T. Do, M.A.; Martin J. O’Malley, M.D.; and John G. Kennedy, M.D., F.R.C.S.(Orth.)
Abstract
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Purpose:
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 1⁄4 .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 1⁄4 .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.
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Youichi Yasui, MD; Andrew W. Ross, BA; and John G. Kennedy, MD, MCh, MMSc, FRCS (Orth)
Abstract
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OLT is a common orthopedic disorder. Despite high success rates following reparative and placement procedures, postoperative deterioration of the operated ankle joint over time is inevitable. Currently available basic and clinical studies suggest that the biologic agents PRP and CBMA can improve the clinical and radiological outcomes in OLT when used in conjunction with surgical modalities. However, room exists for continued development, improvement, and standardization of these techniques. Thus, further well-designed clinical trials establishing the utility of biologics in the treatment of OLT are warranted.
KEY POINTS
- Operative treatment can result in nearly 85% success rates in short-term and mid-term
outcomes in osteochondral lesions of the talus (OLT); however, the inevitable deterioration of the regenerated or grafted cartilage is now of growing concern.
- Basic science studies have shown that the use of platelet-rich plasma (PRP) and concentrated bone marrow aspirate (CBMA) can improve cartilage repair and the biological environment of the operated ankle joint; however, the clinical use of those biologics in OLT has not been well described to date.
- Bone marrow stimulation produces reparative fibrous cartilage tissue after the debridement of flapped cartilage, necrotic bone, and calcified layer of the talar lesion.
- Autologous autograft transfer is a replacement procedure that uses cylindrical autologous osteochondral graft(s) to fill the talar defect in OLT. Currently available basic and clinical evidence suggests that the use of PRP and CBMA as an adjunct to the surgical procedures used to treat OLT can improve clinical and radiological outcomes.
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Ross A. Hauser, MD and Amos Orlofsky, PhD
Abstract
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Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. These preliminary findings suggest that OA treatment with WBM injection merits further investigation.
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