medical student researcher working with Dr. Kennedy out of NYU Langone Orthopedic Hospital. And I'll be speaking about AOT augmentation with EMCA. So osteochondral lesions of the talus or OLTs are injuries of the articular cartilage, subchondral bone and subchondral plate and subchondral bone of the talus. Several factors are used in determining the surgical approach to OLTs, including size, containment, and previous bone marrow stimulation procedure. And as my colleague just indicated, the mainstay of treatment for smaller OLT is microfracture. Uncontained irregular lesions might open a possible role for augmentation with EMCA. Concentrated bone marrow aspirate, or CBMA, has a role in the biologic treatment of OLT. CBMA taken from the iliac crest has beneficial stem cells, growth fractures, and anti-inflammatories, and is a possible adjuvant for AOT. So we ultimately wanted to know whether augmentation of AOT and CBMA with EMCA, a brand name biocartilage, for treating OLT was better than AOT and CBMA alone. Our hypothesis was that this augmentation would enhance plug infill at the graft host interface, and that there would be improved MOCART and functional scores at a minimum of two-year follow-up. So we performed a retrospective comparative study of all patients with OLT receiving AOT operated on by our senior surgeon between the years 2012 and 2018. Also to reiterate, starting in 2016, EMCA was added to this procedure. A blinded investigator looked at the FAOS and MOCART scores, and all MRIs were evaluated by a board-certified musculoskeletal radiologist. Here pictured from left to right are the CBMA collection technique, and also coronal and axial views of the graft host interface. Standard statistical analysis was performed. We had 34 patients in the AOT and CBMA group, and 26 patients in the EMCA augmented group. So as for the lesion location, the first and second most common anatomic zones were L4 and L7, which were the medial and posteromedial, respectively. And we also found that more than 92% of the lesions in the EMCA augmented group were uncontained, and this was statistically significant. Mean FAOS scores significantly increased in both groups, but the difference in increase was not significant. MOCART scores did not significantly differ between the two treatment arms as well. As for complications, in the AOT-CBMA group, there was one re-op, while for the EMCA augmented group, there were three arthroscopic debridements and three hardware removals. As for postoperative cysts, in the AOT-CBMA group, there were 10 cases, and in the EMCA augmented group, there were eight. So the main limitation was the retrospective nature of the study design. Also, there were different follow-up times for each group, but we tried to standardize this by assessing MRIs at equal times postoperatively. Additionally, 92% of the lesions were uncontained in the EMCA group, compared to 73%. Finally, to conclude, AOT-CBMA augmented with EMCA was an effective surgical treatment for OLT. Biologic augmentation with CBMA may be sufficient to augment bone healing and cartilagin incorporation at the interface. EMCA may have a role in irregularly-shaped lesions. And finally, CBMA with EMCA augmentation did not appear to be a better physiologic route than CBMA alone. Thank you.

osteochondral lesions of the talus

surgical approaches

EMCA

CBMA

AOT-CBMA