Concentrated Bone Marrow Aspirate With Extracellular Matrix Grafting for Osteochondral Lesions of the Talus in Pediatric and Adolescent Patients
Year: 2026
Type: article
Abstract: Treatment of osteochondral lesions of the talus (OLTs) can be challenging due to difficult access/visualization and limited healing capacity. While outcomes after concentrated bone marrow aspirate with extracellular matrix (ECM-BMAC) have been reported for adult populations, its use in pediatric/adolescent patients has not been thoroughly examined. This case series assesses clinical outcomes of ECM-BMAC grafting for young patients with OLTs. All patients ≤18 years old presenting to two surgeons between 2016-2024 who underwent primary surgery with ECM-BMAC for an OLT with minimum 1-year clinical follow-up were included. Pre-operative primary sport, concomitant procedures, lesion size/location, post-operative complications, requirement for reoperation, and post-operative sports clearance were recorded. Various Patient-Reported Outcomes Measurement Information System (PROMIS) scales were obtained from the medical record where available at minimum 9 months post-operatively. Descriptive statistics were calculated, and patient-reported outcomes (PRO) compared using Wilcoxon signed-rank tests. Sixteen patients with unilateral OLTs were included in this study. Fifty-six percent of patients were female with a mean age of 14.3 ± 1.8 years (95% confidence interval [CI] 13.4-15.3) at surgery and a mean clinical follow-up of 32.8 ± 19.5 months (95% CI 22.4-43.1). Lesions most commonly affected the medial talar dome (81%) and had mean size and depth of 103.9 ± 52.2 mm 2 and 5.4 ± 1.6 mm (95% CI 4.5-6.3), respectively. Two patients (13%) underwent concomitant modified Broström procedure for lateral ankle instability. At an average of 6.2 ± 1.6 months (95% CI 5.3-7.1), 88% of patients were cleared to return to sport. PROMIS Pain Interference scores improved on follow-up surveys (48.6 ± 7.6 vs. 56.3 ± 5.6, p=0.018) obtained at an average 28.4 ± 21.0 months post-operative. One patient (6%) required reoperation for persistent pain and radiographic abnormality. High sports clearance rates and improved PROMIS pain scores with low rates of re-operation at short-term follow-up provide early evidence that arthroscopic management with ECM-BMAC can achieve favorable outcomes for treatment of OLT in pediatric/adolescent patients. IV • A detailed surgical technique for the arthroscopic management of OLTs in young patients using ECM-BMAC is provided to achieve a more hyaline-like cartilage. • High sports clearance rates and improved PROMIS pain scores are observed at short-term after arthroscopic management of OLTs in pediatric/adolescent patients with ECM-BMAC. • ECM-BMAC for OLTs is associated with low rates of re-operation.
Institution: Hospital for Special Surgery
Language: English
Topic: Foot and Ankle Surgery
Subfield: Orthopedics and Sports Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,500
OpenAlex ID: W7126026387