Effect of autologous adipose-derived mesenchymal stem cell therapy in the treatment of an osteochondral lesion of the ankle

Julien Freitag, James Wickham, Kiran Shah, Abi Tenen, Julien Freitag, James Wickham, Kiran Shah, Abi Tenen

Abstract

Osteochondral lesions (OCLs) of the talus are rare but can be associated with significant morbidity and may lead to the development of osteoarthritis. An improved understanding of the action of mesenchymal stem cells (MSCs) has seen renewed interest in their role in cartilage repair, with early preclinical and clinical research showing benefits in symptomatic and structural improvement. A 42-year-old man presented with an unstable OCL of the talus and onset of early osteoarthritis with a history of multiple previous ankle arthroscopies for ankle impingement. The patient underwent arthroscopic removal of the OCL in combination with adipose-derived MSC therapy. The patient reported progressive improvement as measured by the validated Foot and Ankle Disability Index. Repeat MRI with additional T2 mapping techniques showed successful regeneration of hyaline-like cartilage. This case is the first to show the successful use of MSC therapy in the management of an ankle OCL. Trial registration: Australian New Zealand Clinical Trials Registry - ACTRN12617000638336.

Keywords: orthopaedics; osteoarthritis; sports and exercise medicine.

Conflict of interest statement

Competing interests: JF is affiliated with Magellan Stem Cells and is a member of Magellan Stem Cells Clinical and Scientific Advisory Board. KS is affiliated with Magellan Stem Cells and is the Chief Scientific Officer of Magellan Stem Cells. AT is affiliated with Magellan Stem Cells and a member of Magellan Stem Cells Clinical and Scientific Advisory Board.

© BMJ Publishing Group Limited 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Pre-treatment X-ray showing evidence of an osteochondral lesion (blue circle).
Figure 2
Figure 2
Sequential coronal and sagittal MRI images from baseline to 24 months showing progressive articular cartilage regeneration. Baseline PD fat-saturated MRI of the ankle confirmed an OCL. The area of bony oedema deep to the OCL border indicates instability (blue circle). PD coronal and sagittal images at 3, 8, 12 and 24 months of follow-up. The coronal view at 3 months indicates an area of lucency beneath the area of cartilage regeneration (black arrow). This resolves with subsequent imaging. OCL, osteochondral lesion; PD, proton density.
Figure 3
Figure 3
Sequential MRI T2 mapping of the area of cartilage regeneration over 24 months of follow-up. Values were compared against an area of native hyaline cartilage in the central talus.
Figure 4
Figure 4
Progressive improvement in the FADI score indicated significant clinical improvement over the time course of follow-up. FADI Sport assessment improved only subtly over the 24 months of follow-up. FADI, Foot and Ankle Disability Index.

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