The role of bone marrow edema on osteochondral lesions of the talus

Background: To assess the functional and radiological outcomes after arthroscopic talus autologous matrix-induced chondrogenesis (AT-AMIC®) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for symptomatic osteochondral talar lesion. Clinical and radiological parameters were evaluated with VAS score for pain, AOFAS and SF-12 at T0 (preoperatively), T1 (6 months), T2 (12 months), T3 (24 months) and MRI and CT-scan at T0, T1, T2 and T3. Results: No patients were lost to the final follow-up. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points (p < 0.001). In GNE, AOFAS improved significantly at each follow-up (p < 0.05); while CT and MRI showed a significant reduction in lesion size between T1 and T2 and T2 and T3 (p < 0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3 (p < 0.05); lesion size, measured with CT, decreased between T1 and T2 (p < 0.05), while with MRI the lesion showed a reduction at each follow-up (p < 0.05). Lesion size was significantly higher both in MRI and CT in GE compared to GNE (p < 0.05). In GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusions: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.