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Category: Ankle; Arthroscopy; Basic Sciences/Biologics Introduction/Purpose: Historically, microfracture has been used to treat small talar osteochondral lesions (OLTs) with good results, while osteochondral autologous transplantation (OAT) has proven superior for the treatment of larger lesions. It is not clear which method is more effective for medium-sized lesions, around the critical size of 150 mm2 above which microfracture outcomes tend to be poor. While OAT carries the risk of co-morbidity at the knee and often requires a malleolar osteotomy, it is thought to result in superior repair tissue compared to microfracture by introducing native hyaline cartilage to the ankle. Microfracture, in contrast, results in the formation of structurally inferior fibrocartilage. The purpose of this study was to determine the relative benefits of OAT and microfracture in the treatment of medium-sized OLTs. Methods:: Patients treated for an OLT with OAT or microfracture by a single surgeon fellowship-trained in foot and ankle orthopedics between 2015 and 2018 were screened. Both OAT and microfracture techniques were augmented with a mixture of extracellular matrix and bone marrow aspirate concentrate (ECM-BMAC) for every case included in this study. Patients treated without ECM-BMAC were excluded. Only patients with a lesion size between 80 and 165 mm 2 were included. Minimum follow-up was 12 months. Clinical outcomes were collected in the form of FAOS or PROMIS scores, depending on departmental standards at the time of treatment. MRIs were collected for radiographic analysis of cartilage repair tissue. MRIs were scored using the MOCART system by a fellowship trained radiologist and were also evaluated for the presence of cysts and edema. Patient charts were reviewed to determine rates of revision surgery and therapeutic injection for pain. Results:: 52 patients were identified who fit inclusion criteria. 27 of these patients received microfracture and 25 received OAT. The average lesion size for all patients was 117.5 mm2. Patients treated with OAT had significantly higher average total MOCART scores (69 vs. 55, p = 0.04) and significantly lower rates of cyst (14% vs. 55%, p

Category: Ankle Introduction/Purpose: Use of hamstring tendon (gracilis and/or semitendinosus) autografts with limited morbidity and positive outcomes has been well reported in knee ligament reconstructions as well as in foot and ankle applications including chronic Achilles rupture or Achilles tendinosis augmentations. Advantages of hamstring autograft reconstruction when compared to alternative procedures such as local tendon transfers, synthetic grafts, or allografts are better healing and reduced morbidity within the foot and ankle. In this study, we examined the effect of Achilles tendon reconstruction using hamstring autografts on strength and functional outcomes. We hypothesized patients would experience positive outcomes following repair evidenced by significant outcome score improvements and limited ankle plantarflexor and knee flexor strength deficits when compared to patients’ contralateral side and dorsiflexion and extension strength respectively. Methods: Patients who underwent Achilles repair with a hamstring autograft by a fellowship-trained sports medicine and foot and ankle surgeon since 2011 were evaluated for inclusion. Patients younger than 18 or with history of contralateral lower extremity pathology were excluded. Thirty-one potential participants were identified. Patients, average age 38 ± 10.9, had strength testing at an average of 19 months post-operatively (range 15-28 months). Isokinetic testing was completed with a Biodex dynamometer under supervision of a physical therapist blinded to surgical side. Peak plantarflexion and dorsiflexion torque and toque at 30 degrees of plantarflexion were measured at speeds of 60 and 120 degrees/sec. Peak flexion and extension torque and torque at 30, 70, and 90 degrees of flexion were measured at speeds of 180 and 300 degrees/sec. Pre- and post-operative FAOS scores were reviewed retrospectively. Comparisons were completed using Student’s T-tests. Results: All patients except one have reported being very satisfied or satisfied with their surgery. The remaining patient reported being neither satisfied nor dissatisfied. One case reported pain at the harvest site. No additional surgeries were required and all patients would recommend their surgery to someone else. The only significant difference (p

Category: Arthroscopy Introduction/Purpose: With reported incidence rates ranging from 40% to 70% post ankle sprains and fractures, osteochondral lesions of the talus (OLT) are not uncommon. However, management of such defects remains challenging. Microfracturing is considered the standard treatment for symptomatic OLTs.Larger lesions however typically require more invasive restorative procedures such as autologous osteochondral transplantation. Microfracture results are variable due to the fact that the resulting reparative fibrocartilage is weaker and biomechanically inferior to native hyaline cartilage. In this study, we examine the functional and radiological outcomes following use of a new arthroscopic technique utilizing a mixture of micronized allograft cartilage matrix (BioCartilage) (Arthrex, Naples, FL) soaked in Bone Marrow Aspirate Concentrate (BMAC) to fill OLTs. Methods: Eighty-six consecutive patients treated for OLT using arthroscopic debridement and BioCartilage matrix soaked in BMAC were identified. All patients were treated by a single fellowship-trained sports medicine and foot and ankle surgeon. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS). This information was obtained from a prospective registry at the authors’ institution. Wilcoxon signed rank tests were used to determine statistical significance between pre and postoperative clinical scores. Additionally, an attending radiologist assessed the reparative cartilage morphology on postoperative MRI scans. This was evaluated and scored using a modified magnetic resonance observation of cartilage tissue (MOCART) scoring system. Results: Thirty-one patients (19 Females; 12 Males) with a mean age of 37.8 years (Range 15–54) had a minimum follow-up duration of 12 months and were thus included in this review. Mean follow-up duration was 15.8 months (Range 12 –25.7). The mean patient BMI was 27.4 (Range 19.6 – 39.4), while the average osteochondral lesion size was 85.9 mm2 (Range 35 – 220). The Physical Function domain of the PROMIS score, demonstrated statistically significant change, improving from 40.63 ±8.31 to 48.31 ±10.07 (p=0.02). The Pain Intensity domain also improved significantly from 49.06 ±9.32 to 42.14 ±9.38 (p=0.03). The Pain Interference domain and FAOS scores did improve but not reaching statistical significance. The mean MRI MOCART score was 69 ±13.34 with 13.3 months average follow-up duration. Conclusion: Achieving the longest duration possible of symptom-free functioning postoperatively is the main goal of any cartilage repair procedure. Augmentation of an articular lesion’s infill with BioCartilage and BMAC may help enhance the biomechanical properties of the reparative fibrocartilage construct and its longevity. Our initial findings demonstrate favorable patient-reported outcomes. Moreover, postoperative MRIs demonstrate the majority of the lesions showed either complete or hypertrophic infill, complete or hypertrophic integration, homogenous repair tissue, and isointense signals. Long-term studies prospectively assessing the effectiveness of this technique in maintaining pain-free-function of the ankle joint are warranted.