Return to Sports After Bone Marrow-Derived Cell Transplantation for Osteochondral Lesions of the Talus

Abstract

Objective: Arthroscopic "one-step" technique based on bone marrow-derived cell transplantation (BMDCT) have achieved good results in repairing osteochondral lesions of the talus (OLT), overcoming important drawbacks of older techniques. It may be particularly adequate for the treatment of athletes in order to permit a safe and stable return to sports. The aim of this study was to report the results at 48 months of a series of athletes and the factors influencing the return to sports.

Design: Case series. A total of 140 athletes underwent a "one-step" BMDCT repair of OLT. All the patients had the cells harvested from the iliac crest, condensed and loaded on a scaffold, and then implanted. Patients were evaluated clinically by the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Halasi score.

Results: AOFAS score improved from 58.7 ± 13.5 preoperatively to 90.6 ± 8.6 (P < 0.005) at 24 months, and to 90.9 ± 10.7 at 48 months. Halasi score was 6.88 ± 1.8 preinjury, 4.08 ± 1.7 preoperatively, and 5.56 ± 2.0 at final follow-up. At the final follow-up, all the patients (beside 1 failure and 3 lost) were able to return to activity and 72.8% were able to resume sports at preinjury level.

Conclusions: "One-step" BMDCT repair of OLT had good clinical results that was durable over time in athletes, permitting a return to sports at preinjury level in the majority of patients. The preoperative presence of impingement and articular degeneration were the main negative prognostic factors.

Keywords: ankle; articular cartilage; cartilage repair; mesenchymal stem cells; sports injury.

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

Graph showing the pattern of the mean American Orthopaedic Foot and Ankle Society (AOFAS) score evaluated at established follow-up up to 72 months.

Figure 2.

Graph showing the pattern of Halasi score evaluated at pre-injury time, before surgery and at last follow-up.

Figure 3.

Graph showing the rate of patients and the time returning to the same level of sport activities.

Figure 4.

Graph showing the rate of patients and the time returning to the same level of sport activities shared into 2 groups: athletes with and without arthritis. Lower number of patients with arthritis in their ankle resumed sports after surgery at same level of activity.