So, good afternoon, thanks for staying around. My name is Owen Hurley and I'm talking about bone marrow stimulation because I can't say the M word because apparently it's a dirty word. So osteochondral lesions of the talus are a commonly occurring ankle pathology and due to the limited regenerative potential of adult cartilage, the mainstay treatment for small lesions is bone marrow stimulation, not the other word, which releases pluripotent bone marrow stem cells to the defect by exposing the subchondral bone, allowing local bleeding to the defect, creating fiber cartilage over the first 12 to 24 months. This is different molecular and physical properties than native highline cartilage and is thus susceptible to deterioration over time. So extracellular matrix cartilage allograft, EMCA, or biocartilage has been explored as a potential adjuvant treatment for osteochondral lesions of the talus as it contains type two collagen, proteoglycans, and cartilaginous growth factors native to the highline articular cartilage. The predominant theory is that it helps facilitate chondrogenesis by functioning as a tissue network, thus promoting cell interaction, and Dr. Fortier's group has shown in equine models that it improves cartilage repair compared to bone marrow stimulation alone. So the purpose of this study was to evaluate the effectiveness of biocartilage as an adjuvant to bone marrow stimulation compared to bone marrow stimulation alone in the treatment of osteochondral lesions of the talus. So a retrospective study was carried out, and just to note, there was a change in timeline between the senior surgeon's practice where he started to use biocartilage after 2015. Surgical technique was identical, with the exception of adding the biocartilage at the end, and of note, concentrated bone marrow aspirate was used in both groups, and in the biocartilage group, it was mixed with CBMA prior to injection. The primary outcomes were the FAOS score and MoCART score. Standard statistical analysis was performed. Ultimately, 48 patients, 24 in either group, where 87% were followed up. Just to note, those in the control group had a longer follow-up, but they had a lower rate of prior revision surgery. So firstly, there was no significant difference in any measure of the postoperative FAOS score, and according to our MCID analysis, there was no significant difference in clinical function scoring between either group and the percent of patients who achieved the MCID. In terms of the MoCART score, the mean MoCART score for the bone marrow stimulation plus biocartilage group was 76, which was 10 points higher than the bone marrow stimulation alone. However, this was not statistically significant. But there were several subcategories which were a significant difference, including the improvement of complete infill of the defect, complete integration with the border zone, and less fissuring and fibrillation with the MCA. There was no significant difference in patients who demonstrated hypertrophy of the repair tissue between the two groups, which is a theoretical concern with biocartilage. Additionally, there was no significant difference in the revision rate, with it being low in both groups. And there were several limitations to our study, the biggest being the difference in patient follow-up times and history of prior bone marrow stimulation. However, the seven-month follow-up difference is unlikely to be clinically significant, even if it's statistically significant. And while bone marrow stimulation has been shown to degrade over time, the clinical results typically remain stable until four-year follow-up. However, the history of prior bone marrow stimulation being higher in the EMCA group may confound the results, as this has been shown to be a strong risk factor for negative outcomes. Finally, another limitation is the small numbers of subjects in either group, which may have changed the results if more patients were added. So in conclusion, bone marrow stimulation with biocartilage is an effective treatment strategy for the treatment of osteochondral lesions and provides better cartilage infill and the defect on MRI. However, this did not translate to improved functional outcomes compared to bone marrow stimulation alone in the short term. And additionally, according to the EMCA DNA analysis, there was no significant difference in clinical function scoring between either group postoperatively. So thank you all for your attention, and thank you for my co-authors. And unfortunately, Nate Mercer was unable to present this today, but thank you to him for allowing me to do it instead.

bone marrow stimulation

osteochondral lesions

EMCA

cartilage infill

functional outcomes