Do Outcomes Differ Following Microfracture with Biologic Augmentation with Biocartilage vs Microfracture Alone for the Treatment of Osteochondral Lesions of the Talus?

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: The purpose of this study was to determine whether there is a significant difference in function and postoperative activity level in patients who underwent microfracture with extracellular cartilage matrix (ECM) versus microfracture alone, for the treatment of an osteochondral lesion of the talus (OLT), while accounting for various factors including body mass index (BMI). Our hypothesis was that patients who underwent microfracture with ECM augmentation will have similar functional levels and activity levels postoperatively, while accounting for BMI and lesion size. Methods: All patients who underwent microfracture with microfracture alone or microfracture plus ECM augmentation for the treatment of an Outerbridge grade 3 or 4 OLT, by a single surgeon between January 2013 to January 2022 were included in this study. Detailed intraoperative data were documented at the time of surgery. Patients completed a subjective questionnaire at a minimum of two years following ankle surgery. All data were collected prospectively and stored in a data registry. Regression models were utilized for the primary dependent variables Foot and Ankle Ability Measure (FAAM) and Tegner activity scale. Results: 82 patients were included; 48 in the microfracture cohort, 34 in the ECM cohort. There was no significant difference in FAAM-total score between cohorts while adjusting for BMI and OLT size (P=.331). The mean FAAM-total score for the microfracture cohort was 89.44 (SD=23.09), and 92.59 (SD=18.35) for the ECM cohort. BMI was 26.42 (SD=4.3) in the microfracture cohort and 25.16 (SD=3.4) in the ECM cohort. The mean OLT size was 35.74 mm2 (SD=52.12 mm2) in the microfracture cohort and 46.57 mm2 (SD=50.32 mm2) in the ECM cohort. As OLT size decreases, FAAM score increases (P=.177). There was no significant difference in Tegner while adjusting for BMI and OLT size (P=.062). As OLT size decreases, Tegner score increases (P=.412), and as BMI decreases, Tegner increases (P=.340). Conclusion: In this study, there were no significant differences in outcome measures in patients who underwent microfracture alone versus microfracture plus biologic augmentation for treating an articular cartilage lesion of the talus or mortise. Decreasing BMI and smaller lesion size correlated with increased postoperative patient activity level.