Age Greater Than 45, Preop Symptom Duration, and Bone Marrow Edema Depth Negatively Impact Long‐Term Outcomes After Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Purpose To evaluate the long‐term effect of age on clinical and radiological outcomes after bone marrow stimulation (BMS) for osteochondral lesions of the talus with ≥10‐year follow‐up and to identify prognostic factors in older patients. Methods Patients undergoing BMS for symptomatic, magnetic resonance imaging‐confirmed osteochondral lesions of the talus (lesion size <150 mm 2 ) between 2009 and 2015 with a minimum 10‐year follow‐up were included and stratified into 3 age groups (<30, 30‐45, and >45 years). Clinical outcomes were assessed using the Foot and Ankle Outcome Score, American Orthopaedic Foot & Ankle Society score, Tegner activity scale, and visual analog scale. Cartilage repair was assessed with Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) and MOCART 2.0 scores on magnetic resonance imaging. Results A total of 103 patients were included. At a minimum 10‐year follow‐up (mean, 11.8 years; range, 10.2‐15.1), all groups showed significant improvements in pain, function, quality of life (QoL), and magnetic resonance imaging‐assessed cartilage repair compared with baseline. Patients <30 years achieved the best outcomes (Foot and Ankle Outcome Score‐QoL 91.0 [85.0, 91.0], American Orthopaedic Foot & Ankle Society 92.0 [86.0, 96.0], and Tegner 6.0 [4.8, 6.3]), followed by those aged 30 to 45 and >45 years (all P < .001). American Orthopaedic Foot & Ankle Society minimal clinically important difference was achieved in 96.7%, 81.1%, and 72.2%, respectively ( P = .032), and QoL minimal clinically important difference was achieved in 96.7%, 70.3%, and 52.8%, respectively ( P < .001). MOCART and MOCART 2.0 scores were significantly higher in patients <45 years than in those >45 years ( P = .031 and .035). In patients >45 years, symptom duration >25.5 months (area under the curve = 0.788; sensitivity, 82.4%; specificity, 78.9%) and baseline bone marrow edema depth >10.5 mm (area under the curve = 0.772; sensitivity, 70.6%; specificity, 84.2%) were thresholds predictive of failure to achieve QoL minimal clinically important difference. Conclusions Age may negatively influence the long‐term outcomes of BMS for osteochondral lesions of the talus. In patients >45 years, a preoperative symptom duration longer than 25.5 months and baseline bone marrow edema depth greater than 10.5 mm were associated with unfavorable outcomes after BMS. Level of Evidence Level III, retrospective comparative study.