Concentrated Bone Marrow Aspirate With Extracellular Matrix Grafting for Osteochondral Lesions of the Talus in Pediatric and Adolescent Patients

Treatment of osteochondral lesions of the talus (OLTs) can be challenging due to difficult access/visualization and limited healing capacity. While outcomes after concentrated bone marrow aspirate with extracellular matrix (ECM-BMAC) have been reported for adult populations, its use in pediatric/adolescent patients has not been thoroughly examined. This case series assesses clinical outcomes of ECM-BMAC grafting for young patients with OLTs. All patients ≤18 years old presenting to two surgeons between 2016-2024 who underwent primary surgery with ECM-BMAC for an OLT with minimum 1-year clinical follow-up were included. Pre-operative primary sport, concomitant procedures, lesion size/location, post-operative complications, requirement for reoperation, and post-operative sports clearance were recorded. Various Patient-Reported Outcomes Measurement Information System (PROMIS) scales were obtained from the medical record where available at minimum 9 months post-operatively. Descriptive statistics were calculated, and patient-reported outcomes (PRO) compared using Wilcoxon signed-rank tests. Sixteen patients with unilateral OLTs were included in this study. Fifty-six percent of patients were female with a mean age of 14.3 ± 1.8 years (95% confidence interval [CI] 13.4-15.3) at surgery and a mean clinical follow-up of 32.8 ± 19.5 months (95% CI 22.4-43.1). Lesions most commonly affected the medial talar dome (81%) and had mean size and depth of 103.9 ± 52.2 mm 2 and 5.4 ± 1.6 mm (95% CI 4.5-6.3), respectively. Two patients (13%) underwent concomitant modified Broström procedure for lateral ankle instability. At an average of 6.2 ± 1.6 months (95% CI 5.3-7.1), 88% of patients were cleared to return to sport. PROMIS Pain Interference scores improved on follow-up surveys (48.6 ± 7.6 vs. 56.3 ± 5.6, p=0.018) obtained at an average 28.4 ± 21.0 months post-operative. One patient (6%) required reoperation for persistent pain and radiographic abnormality. High sports clearance rates and improved PROMIS pain scores with low rates of re-operation at short-term follow-up provide early evidence that arthroscopic management with ECM-BMAC can achieve favorable outcomes for treatment of OLT in pediatric/adolescent patients. IV • A detailed surgical technique for the arthroscopic management of OLTs in young patients using ECM-BMAC is provided to achieve a more hyaline-like cartilage. • High sports clearance rates and improved PROMIS pain scores are observed at short-term after arthroscopic management of OLTs in pediatric/adolescent patients with ECM-BMAC. • ECM-BMAC for OLTs is associated with low rates of re-operation.