Concentrated Bone Marrow Aspirate With Extracellular Matrix Grafting for Osteochondral Lesions of the Talus in Pediatric and Adolescent Patients.

BACKGROUND

Treatment of osteochondral lesions of the talus (OLTs) can be challenging due to difficult access/visualization and limited healing capacity. While outcomes after concentrated extracellular matrix combined with bone marrow aspirate concentrate (ECM-BMAC) have been reported for adult populations, its use in pediatric/adolescent patients has not been thoroughly examined. This case series assesses clinical outcomes of ECM-BMAC grafting for young patients with OLTs.

METHODS

All patients ≤18 years of age presenting to two surgeons between 2016 and 2024 who underwent primary surgery with ECM-BMAC for an OLT with minimum 1-year clinical follow-up were included. Preoperative primary sport, concomitant procedures, lesion size/location, postoperative complications, requirement for reoperation, and postoperative sports clearance were recorded. Various Patient-Reported Outcomes Measurement Information System (PROMIS) scales were obtained from the medical record, where available at minimum 9 months postoperatively. Descriptive statistics were calculated, and patient-reported outcomes (PROs) were compared using Wilcoxon signed-rank tests.

RESULTS

Sixteen patients with unilateral OLTs were included in this study. Fifty-six percent of patients were female with a mean age of 14.3 ± 1.8 years (95% confidence interval [CI]: 13.4-15.3) at surgery, and the mean clinical follow-up was 32.8 ± 19.5 months (95% CI: 22.4-43.1). Lesions most commonly affected the medial talar dome (81%) and had mean size and depth of 103.9 ± 52.2 mm2 and 5.4 ± 1.6 mm (95% CI: 4.5-6.3), respectively. Two patients (13%) underwent concomitant modified Broström procedure for lateral ankle instability. At an average of 6.2 ± 1.6 months (95% CI: 5.3-7.1), 88% of patients were cleared to return to sport. PROMIS Pain Interference scores improved on follow-up surveys (48.6 ± 7.6 vs. 56.3 ± 5.6, P = .018) obtained at an average 28.4 ± 21.0 months postoperatively. One patient (6%) required reoperation for persistent pain and radiographic abnormality.

CONCLUSIONS

High sports clearance rates and improved PROMIS pain scores with low rates of reoperation at short-term follow-up provide early evidence that arthroscopic management with ECM-BMAC can achieve favorable outcomes for treatment of OLTs in pediatric/adolescent patients.

KEY CONCEPTS: (1)A detailed surgical technique for the arthroscopic management of osteochondral lesions of the talus (OLTs) in young patients using extracellular matrix combined with bone marrow aspirate concentrate (ECM-BMAC) is provided to achieve a more hyaline-like cartilage.(2)High sports clearance rates and improved Patient-Reported Outcomes Measurement Information System (PROMIS) pain scores are observed at short-term after arthroscopic management of OLTs in pediatric/adolescent patients with ECM-BMAC.(3)ECM-BMAC for OLTs is associated with low rates of re-operation.

LEVEL OF EVIDENCE: IV.