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Bone Marrow Aspirate Concentrate (BMAC) as a Biological Adjunct to the Surgical Treatment of Osteochondral Lesions of the Talus

Murawski, Christopher D.*; Duke, Gavin L. MD; Deyer, Timothy W. MD; Kennedy, John G. MD, FRCS (Orth)*

Techniques in Foot & Ankle Surgery: March 2011 - Volume 10 - Issue 1 - p 18–27
doi: 10.1097/BTF.0b013e31820b4c2f
Special Focus: Bioadjuvant Healing in Foot and Ankle Surgery

Osteochondral lesions of the talus are common injuries, particularly in athletes. Traditional surgical treatment paradigms for osteochondral lesions include reparative and restorative techniques. The concern with reparative techniques (ie, microfracture and drilling) is that the fibrocartilaginous infill may ultimately fail over time, thereby causing recurrence in symptoms and a progression of arthritis. The current authors have developed a treatment algorithm whereby reparative techniques are reserved for lesions ≤8 mm in diameter, beyond which replacement strategies (ie, autologous osteochondral plug transplantation) comprise the preferred treatment strategy. In an effort to address the concerns of fibrocartilage degradation over time, the authors are currently studying the use of bone marrow aspirate concentrate (BMAC) as a means of improving the tissue quality and collagen fiber architecture of the differentiated repair cartilage. When used as an adjunct to the autologous osteochondral plug transplantation procedure, BMAC may facilitate infill of the graft-host bone and cartilage, thereby reducing the theoretical potential of synovial fluid inflow under normal joint hydrostatics, which could undermine the graft over an extended period. This article will evaluate the use of BMAC in the surgical treatment of osteochondral lesions of the talus.

*Hospital for Special Surgery, Department of Foot and Ankle Surgery

East River Medical Imaging, New York, NY

Address correspondence and reprint requests to Christopher D. Murawski, Hospital for Special Surgery, New York, NY. e-mail: murawskic@hss.edu.

© 2011 Lippincott Williams & Wilkins, Inc.