Histological and Inflammatory Cytokine Analysis of Osteochondral Lesions of the Talus After Failed Microfracture: Comparison With Fresh Allograft Controls.

Abstract

Background

The most common first-line treatment of osteochondral lesions of the talus (OLTs) is microfracture. Although many patients do well with this procedure, a number fail and require reoperation. The mechanism of failure of microfracture is unknown, and to our knowledge there has been no research characterizing failed microfracture regarding histological and inflammatory makeup of these lesions that may contribute to failure.

Purpose

To characterize the structural and biochemical makeup of failed microfracture lesions.

Study design

Case series; Level of evidence, 4.

Methods

Specimens from 8 consecutive patients with symptomatic OLTs after microfracture who later underwent fresh osteochondral allograft transplantation were analyzed. For each patient, the failed microfracture specimen and a portion of the fresh allograft replacement tissue were collected. The allograft served as a control. Histology of the failed microfracture and the allograft replacement was scored using the Osteoarthritis Research Society International (OARSI) system. Surface roughness was also compared. In addition, tissue culture supernatants were analyzed for 16 secreted cytokines and matrix metalloproteinases (MMPs) responsible for inflammation, pain, cartilage damage, and chondrocyte death.

Results

The OARSI grade, stage, and total score as well as surface smoothness were significantly worse in the failed microfracture sample, indicating better cartilage and bone morphology for the allografts compared with the failed microfracture lesions. Analyzed cytokines and MMPs were significantly elevated in the microfracture tissue culture supernatants when compared with fresh osteochondral tissue supernatants.

Conclusion

These data demonstrate a significantly rougher cartilage surface, cartilage and subchondral bone histology that more closely resembles osteoarthritis, and elevated inflammatory cytokines and MMPs responsible for pain, inflammation, cartilage damage, and chondrocyte death when compared with fresh osteochondral allografts used as controls.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1177/23259671211040535

Publication Info

Danilkowicz, Richard M, Nicholas B Allen, Nate Grimm, Dana L Nettles, James A Nunley, Mark E Easley and Samuel B Adams (2021). Histological and Inflammatory Cytokine Analysis of Osteochondral Lesions of the Talus After Failed Microfracture: Comparison With Fresh Allograft Controls. Orthopaedic journal of sports medicine, 9(10). p. 23259671211040535. 10.1177/23259671211040535 Retrieved from https://hdl.handle.net/10161/25653.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Nunley

James Albert Nunley

Goldner Jones Distinguished Professor of Orthopaedic Surgery

My current research interests are both clinical and basic science. Currently, in the Orthopaedic Research Laboratory, we are investigating the biomechanical properties of the deltoid ligament in the ankle. This is a clinically relevant problem and we will hopefully identify ways to improve the correction of the adult relaxed flat foot. We are also performing a preliminary investigation into the blood supply of the distal tibia to look for a vascularized bone transfer.

We have recently completed a biomechanical study looking at the strength of fixation for proximal metatarsal osteotomies in the correction of hallux valgus and that information has been submitted for publication.

Clinical projects have looked into nerve palsies after total elbow replacement and to reconstructive upper and lower extremity surgery.

Easley

Mark Erik Easley

Associate Professor of Orthopaedic Surgery

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