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Background: Osteochondral autograft transplant (OAT) is often used to treat large osteochondral lesions of the talus and is generally associated with good outcomes. The addition of adjuncts such as cartilage extracellular matrix with bone marrow aspirate concentrate (ECM-BMAC) may further improve the OAT procedure but have not been thoroughly studied. We hypothesized that the placement of ECM-BMAC around the OAT graft would improve radiographic and patient-reported outcomes following OAT. Methods: Patients who received OAT, with ECM-BMAC or BMAC alone, were screened and their charts were reviewed. For patients who did receive ECM-BMAC, the mixture was spread around the edges of the OAT plug and into any surrounding areas of cartilage damage. Survey and radiographic data were collected. Average follow-up in both groups was over 2 years. Magnetic resonance imaging scans were scored using the Magnetic Resonance Observation of Cartilage Tissue (MOCART) system. Outcomes were compared statistically between groups. Results: Patients treated with ECM-BMAC (n = 34) demonstrated significantly greater improvement of scores in the FAOS categories Symptoms (17 vs −3; P = .02) and Sports Activities (40 vs 7; P = .02), and the MOCART category Subchondral Lamina ( P = .008) compared to those treated with BMAC alone (n = 30). They also experienced significantly lower rates of postoperative cysts (53% vs 18%, P = .04) and edema (94% vs 59%, P = .02). Conclusion: The addition of ECM-BMAC to OAT was associated with improved imaging and clinical outcomes compared to OAT with BMAC alone.

Background: Ankle fractures involving the posterior malleolus (PM) tend to result in inferior clinical outcomes compared to other ankle fractures. However, it is unclear which specific risk factors and fracture characteristics are associated with negative outcomes in these fractures. The aim of this study was to identify risk factors for poor postoperative patient-reported outcomes in patients with fractures involving the PM. Methods: This retrospective cohort study included patients who sustained ankle fractures involving the PM between March 2016 and July 2020 and had preoperative computed tomography (CT) scans. In total, 122 patients were included for analysis. One patient (0.8%) had an isolated PM fracture, 19 (15.6%) had bimalleolar ankle fractures involving the PM, and 102 (83.6%) had trimalleolar fractures. Fracture characteristics including the Lauge-Hansen (LH) and Haraguchi classifications and posterior malleolar fragment size were collected from preoperative CT scans. Patient Reported Outcome Measurement Information System (PROMIS) scores were collected preoperatively and at a minimum of 1 year postoperatively. The association between various demographic and fracture characteristics with postoperative PROMIS scores was assessed. Results: Involvement of more malleoli was associated with worse PROMIS Physical Function ( P = .04), Global Physical Health ( P = .04), and Global Mental Health ( P Conclusion: In this cohort, we found that trimalleolar ankle fractures were associated with inferior PROMIS outcomes compared with bimalleolar ankle fractures involving the PM in multiple domains. Level of Evidence: Level III, retrospective cohort study.

Category: Ankle; Arthroscopy; Trauma Introduction/Purpose: The MOCART scoring system is commonly used in both the knee and ankle literature to quantitatively assess cartilage repairs on MRI. For both the knee and ankle, MOCART scores have demonstrated little ability to correlate with clinical outcomes such as survey scores. The system also suffers from issues with repeatability and reproducibility of individual scores. This study seeks to analyze the correlation between MOCART scores and PRMOIS scores obtained from the same time period from patients undergoing surgical management of an osteochondral lesion of the talus. It also seeks to determine MOCART's intra-rater reliability by analyzing multiple independent scoring attempts by the same radiologist. We hypothesized that MOCART scores would correlate with PROMIS outcomes and be repeatable for a given rater. Methods: Patients treated for an osteochondral lesion of the talus by a single surgeon in our department were screened for the existence of preoperative and postoperative MRI and survey scores completed within five months of one another. Each MRI was scored using the MOCART system by one radiologist fellowship-trained in musculoskeletal radiology on two separate occasions, with at least one week between scoring attempts. Each MOCART category and the overall score was compared to each PROMIS category. We also compared the presence of cysts and edema, as noted by the raters, to each PROMIS category. Results: MOCART scores were found to be repeatable between scoring attempts for individual categories and especially for the overall score. Preoperative MOCART scores correlated positively to preoperative PROMIS scores for the Physical Function (r= 0.0173), Pain Interference (r=0.1093), and Depression (r=0.0812) domains. Postoperative MOCART scores correlated positively with postoperative PROMIS scores for the Physical Function (r=0.1639) and Global Physical Health (r= 0.2152) domains. Postoperative MOCART scores did not correlate positively to change in PROMIS scores nor did change in MOCART scores correlate positively to change in PROMIS scores as we had expected. One significant correlation existed between postoperative MOCART score and pre to postoperative change in PROMIS Global Mental Health, but the correlation was negative (r= -0.527; p= 0.044). The presence of cyst and edema likewise did not demonstrate any consistent pattern. Conclusion: While the MOCART score may be repeatable for a given reader, it faces significant issues with correlation to PROMIS outcomes. This has been noted before for certain surgical techniques and other outcomes measurements. We find that this pattern holds true more broadly when looking at a range of methods for the treatment of osteochondral lesions. While quantitative evaluation of MRI is important for better understanding cartilage repair techniques, problems with the MOCART system should be acknowledged and solutions considered.