An instructional vide created by a team of Baptist Health orthopedic surgeons, in south Florida, received the Foot and Ankle award at the 2022 American Academy of Orthopaedic Surgeons Conference.

The video, which illustrated the arthroscopic treatment of osteochondral lesions of the talus (OCLT) using particulated juvenile allograft cartilage, was submitted to the AAOS’s Orthopaedic Video Theater. Of 150 accepted videos, eight were chosen for the “award winning” category by peers for having exceptional quality and content.

The Baptist Health orthopedic team’s 16-minute video is permanently housed in the ASOS Orthopaedic Video Theater collection. It can be viewed by AAOS members for .75 CME credits.

The team also submitted a poster presentation that illustrated the procedure to the AAOS conference. Dr. Cary Chapman, a fellowship-trained foot and ankle orthopedic surgeon with Baptist Health, led the team.

Study demonstrates improved OCLT outcomes

Dr. Chapman co-authored a prospective cohort study that examined the quality-of-life metrics of OCLT patients treated with particulated juvenile allograft cartilage implantation. It was published in the journal Foot and Ankle International in 2021.

The study followed 13 patients for an average of eight years.

For purposes of the study, “difficult to treat” was defined as having at least three of the following features or two, if both variables described lesion characteristics:

• Lesions of 107 mm² or greater
• Shoulder lesions
• Patients who failed microfracture
• Patients older than 40
• Patients with body mass index greater than 25

Study participants were evaluated using physical examination, patient interviews and outcome score measures. They had follow-up visits at two years, four years, and between six and 10 years. The goal was to compare functional outcome scores before and after the surgery.

Outcomes were as follows:

• Compared to the preoperative assessment, patients’ pain scores decreased by 3.9 points on a visual analog scale.
• Patients’ Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) scores increased from 46.5 to 80.9, and sports subscores increased from 18.8 to 57.9.
• Short Form–36 Health Survey physical component scores showed significant improvement by an average of 45.5 points.
• American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores improved from 55.2 to 80.3.

Clear benefits for appropriate candidates

While not every OCLT patient will qualify for particulated juvenile allograft cartilage implantation, Dr. Chapman says there are clear benefits to this approach for some.

Traditionally, initial operative management consists of arthroscopic removal of loose bodies and bone marrow stimulation techniques, including debridement, microfracture, abrasion chondroplasty, curettage, and antegrade or retrograde drilling. These are effective for smaller lesions, but the method can cause fibrocartilage with predominantly type 1 collagen. This can lead to unpredictable histologic structure, wear properties, and ultimately, unpredictable longevity compared with normal hyaline cartilage.

Surgical approaches for larger lesions require bone grafts, open surgeries and osteotomies. For example, osteochondral autograft transfer (OATS) requires harvesting bone and intact articular cartilage from the patient’s knee to fill the talus lesion. In many cases, the patient’s ankle must be broken to implant the bone graft. This often requires two separate surgeries, lengthens patients’ recovery time and increases postoperative pain.

Particulated juvenile allograft cartilage implantation can be completed entirely arthroscopically and does not require harvesting bone grafts from the patient. Rather, particulated juvenile articular cartilage is used. The prepackaged articular cartilage allograft contains viable chondrocytes and hyaline cartilage and comes from donors younger than 13. Studies have shown good results using this material in microfractures, refractory lesions and larger lesions unlikely to respond to bone marrow stimulation techniques.

Findings expand consideration of using particulated juvenile allograft cartilage implants

Prior to this study, Dr. Chapman said no mid-to-long-term research had been conducted on patients who underwent particulated juvenile allograft cartilage implantation for osteochondral lesions of the talus, but it should be considered for a specific group of patients who are not candidates for other surgical approaches.

“Our findings suggest allograft transplantation is an effective long-term treatment option for patients with talar osteochondral lesions and should be a part of the orthopedics’ armamentarium,” the authors wrote in the study.

Baptist Health Orthopedic Care is committed to providing innovative treatments and pioneering research. Comprised of highly specialized, board-certified and fellowship-trained orthopedic physicians, our orthopedic team leverages the power of Baptist Health’s expert clinicians, compassionate caregivers and leading-edge technology.