Arthroscopic treatment of osteochondral lesions of the talus: Nanofracture versus hyaluronic acid-based cell-free scaffold with concentration of autologous bone marrow aspirate

Abstract

Purpose: We aimed to evaluate the early clinical and radiological outcomes of arthroscopic one-stage treatment with hyaluronic acid-based cell-free scaffold (HACS) in combination with a concentration of autologous bone marrow aspirate (CBMA) technique compared to nanofracture (NF). Methods: A retrospective evaluation was made of all the patients with focal osteochondral lesions of the talus that were treated between January 2012 and January 2015. Ninety-eight patients met the criteria and were enrolled in the study. Forty-six patients (group 1) were treated with arthroscopic one-stage treatment with CBMA in combination with an HACS. Fifty-two patients (group 2) were treated with NF. Patient demographics and cartilage defect characteristics, the AOFAS and VAS scoring systems were compared between groups. In the evaluation of cartilage repair tissue, the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used. Results: No significant differences were determined between the two groups in terms of age (p = 0.874), body mass index (p = 0.621), defect size (p = 0.485), defect depth (p = 0.674), follow-up time (p = 0.512). A significant clinical difference was determined between the two groups according to the AOFAS and VAS scores (p = 0.028, p = 0.046, respectively). The mean MOCART score of group 1 was significantly higher (p = 0.041). Conclusions: Both NF and HACS with CBMA techniques are beneficial in treatment of osteochondral lesions of the talus. Better clinical and radiological results, in addition to higher cartilage quality, could be obtained with HACS with CBMA technique compared to NF.