2021 ISAKOS Biennial Congress Paper
Long-Term Outcome Measures Following Particulated Juvenile Allograft Cartilage Implantation For Treatment Of Difficult Osteochondral Lesions Of The Talus
Cary Chapman, MD, Plantation , FL UNITED STATES
Joseph Manzi, MD, New York, NY UNITED STATES
Mathew Hamula, MD, New York, NY UNITED STATES
Dinesh Dhanaraj, MD, MSPH, Langhorne , PA UNITED STATES
Miami Orthopedics & Sports Medicine Institute, Coral Gables, FL, UNITED STATES
FDA Status Cleared
Summary
Particulated juvenile allograft articular cartiage demonstrates overall good clinical results at long term follow up (6-8 years)
Abstract
Background
Patients with symptomatic osteochondral lesions of the talus can have serious impairments in their activities of daily living and occupations. The role of particulated juvenile allograft articular cartilage (DeNovo NT®) implantation is not well elucidated in reference to long-term patient outcomes.
Methods
A total of thirteen patients with difficult to treat osteochondral lesions of the talus underwent arthroscopic assisted implantation of DeNovo NT® graft into defects from 2010-2012 by the same surgeon. Difficult lesions were defined as having some combination of the following: 1) lesions size of 1.07cm2 or greater, 2) corner/shoulder lesions, 3) patients who failed microfracture, 4) patient age over 40, or 5) patient BMI>25kg/m2. Patients were evaluated using physical examination, patient interviews, and pre and postoperative outcome score measures. Patients had follow-up at 2 years, 4 years, and between 6-9 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery.
Results
Patients (Age: 46.5±11.8years; Sex: 8 Male/5 Female; Body Mass Index: 28.5 ±6.1kg/m2) had on average, most recent follow-up of 8.0 years (range 72-113 months). Average VAS pain score decreased for patients by 3.9 points, 95% CI [2.18, 5.60], when compared to preoperative assessment. FAAM ADL and Sports scores also showed improvement from 46.5 to 80.9, 95% CI [21.35, 47.43] and from 18.8 to 57.9, 95% CI [21.05, 57.10], respectively. SF-36 physical component scores showed significant improvement by an average of 45.5 points, 95% CI [32.42, 58.50]. AOFAS scores improved from 55.2 to 80.3, 95% CI [12.459, 37.741].
Conclusion
The use of arthroscopic assisted DeNovo NT® implantation of talar osteochondral lesions provides satisfactory outcomes for difficult to treat lesions. These results demonstrate clinically positive long-term outcomes for a cohort of patients followed over the course of 6-9 years.