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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EOsteochondral lesions of the talus can be repaired using bone marrow stimulation. However, clinical outcomes may be less than desirable in older patients or those with very large defects. Direct injection of mesenchymal stem cells as an adjunct to bone marrow stimulation may offer a reasonable alternative for these patients.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Etalus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eosteochondral lesions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ebone marrow stimulation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Emesenchymal stem cells\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Efoot \u0026amp; ankle conditions\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003EOsteochondral lesions of the talus (OLTs) are injuries to the talus that involve both the bone and the overlying articular cartilage. These lesions can occur after a single traumatic injury or as a result of repeated trauma; common symptoms include prolonged pain, swelling, catching, and\/or instability of the ankle joint. While the exact incidence of symptomatic OLTs is unknown, they are a significant source of ankle morbidity.\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003EWhile many OLTs can be treated nonoperatively, there are a number of available options for patients who require surgery, including bone marrow stimulation (BMS). Stimulation of the bone marrow results in the recruitment of mesenchymal stem cells (MSCs). These cells initiate an inflammatory response, subsequent release of cytokines and growth factors, and stimulation of tissue healing that then fills in the cartilage defect with fibrocartilage [Walther M et al. \u003Cem\u003EOper Orthop Traumatol\u003C\/em\u003E. 2014]. However, there is some controversy as to which patients are optimal candidates for BMS, as data suggest that patients who are older or have larger defects may experience less desirable outcomes [Chuckpaiwong B et al. \u003Cem\u003EArthroscopy\u003C\/em\u003E. 2008]. Therefore, there is some interest in learning whether these patients would be better served by an injection of MSCs directly into the OLT alongside BMS.\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003ETo further elucidate that hypothesis, Yong Sang Kim, MD, Yonsei Sarang Hospital, Seoul, Republic of Korea, presented data from a study designed to compare clinical and radiographic outcomes between 2 groups of patients with OLT. One group received an MSC injection as an adjunct to BMS; the other group underwent BMS alone (conventional group). There were no significant differences between the 2 groups relative to baseline characteristics or follow-up times (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16275\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16275\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16275\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EComparison of the 2 Groups\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-9\u0022\u003EThree measures were used to evaluate clinical outcomes: the visual analog scale for pain, the American Orthopaedic Foot \u0026amp; Ankle Society Ankle-Hindfoot Scale, and the Tegner Activity Scale. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score measured radiographic evaluations.\u003C\/p\u003E\n\u003Cp id=\u0022p-10\u0022\u003EIn both groups, improvements were noted in all 3 clinical outcomes as well as the radiographic outcome. All clinical and imaging outcomes improved significantly in the MSC group compared with the conventional group (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/7\/5\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Improvements in Clinical and Radiographic OutcomesAOFAS, American Orthopaedic Foot \u0026amp;amp; Ankle Society; MOCART, Magnetic Resonance Observation of Cartilage Repair Tissue; MSC, mesenchymal stem cell; VAS, visual analog scale. Reproduced with permission from YS Kim, MD.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1345583414\u0022 data-figure-caption=\u0022Improvements in Clinical and Radiographic OutcomesAOFAS, American Orthopaedic Foot \u0026amp;amp;amp; Ankle Society; MOCART, Magnetic Resonance Observation of Cartilage Repair Tissue; MSC, mesenchymal stem cell; VAS, visual analog scale. Reproduced with permission from YS Kim, MD.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/7\/5\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/7\/5\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/15\/7\/5\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16274\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EImprovements in Clinical and Radiographic Outcomes\u003C\/p\u003E\n\u003Cp id=\u0022p-12\u0022\u003EAOFAS, American Orthopaedic Foot \u0026amp; Ankle Society; MOCART, Magnetic Resonance Observation of Cartilage Repair Tissue; MSC, mesenchymal stem cell; VAS, visual analog scale. Reproduced with permission from YS Kim, MD.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-13\u0022\u003EThere was a significant correlation between the MOCART score and clinical outcomes in both groups (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.05). Patient age (\u2265\u200546.1 years), larger lesion size (\u2265\u2005151.2 mm\u003Csup\u003E2\u003C\/sup\u003E), and the presence of a subchondral cyst were all associated with worse MOCART scores in the conventional group (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.015, .004, and .013, respectively) but not in the MSC group.\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003EProf Kim summarized these findings as encouraging and suggested that injection of MSCs alongside BMS might be an additional therapeutic option for patients with OLT who are likely to have a poor prognosis with BMS alone.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/7\/5.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlpg1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlpg1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlpg1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}