Live Date:
July 18, 2023
7:15 PM CST

Osteochondral lesions of the talus are common injuries in the ankle joint often resulting in early-onset osteoarthritis if left untreated. The avascular nature of articular cartilage limits healing capacity; therefore, surgical strategies are typically used in the treatment of these injuries. These treatments often result in the production of fibrocartilage rather than the native hyaline cartilage, which has decreased mechanical and tribological properties. Strategies to improve the ability of fibrocartilage to be more hyaline-like and thus more mechanically robust have been widely investigated. Biologic augmentation, including concentrated bone marrow aspirate, platelet-rich plasma, hyaluronic acid, and micronized adipose tissue, has been used in the augmentation of cartilage healing, with studies demonstrating promise. This article provides an overview and update on the various biologic adjuvants used in the treatment of cartilage injuries in the ankle joint.

Learning Objectives

• Biologic augmentation including concentrated bone marrow aspirate (CBMA), platelet-rich plasma (PRP), hyaluronic acid (HA), and micronized adipose tissue (MAT) have demonstrated promising results as an adjunctive therapy for cartilage healing.
• CBMA is comprised of growth factors, mesenchymal stem cells, and interleukin receptor antagonist protein that prevents the activation of inflammatory cytokines and promotes cell turnover.
• PRP contains a concentrated volume of platelets, cytokines, and growth factors that increase cell viability and chondrocyte synthesis, upregulates type II collagen matrix formation, and is chemoattractive to mesenchymal stem cells for cell proliferation.
• A growing interest in the use of adipose derived stem cells has been demonstrated with the ability for differentiation into bone, cartilage, and muscle.
• The evidence for the use of orthobiologics in the management of cartilage injury is promising and future studies should attempt to focus on standardizing the optimal formulations and indications.