Treating OCD Talus with Bone Marrow Aspirate Concentrate

Is platelet-rich plasma beneficial in the treatment of OCD talus?

OCD Talus, more technically osteochondral defect or lesion of the talus, describes an injury to the talus, which is one of the three bones that make up the ankle joint. The other two bones that come together in the ankle are the tibia and fibula. The talus serves as a base for the tibia and is located directly above the calcaneus (heel bone). Trauma, which is typically the cause of the injury, results in an injury to the area around the upper part of the talus where the bone and cartilage have been damaged. 

While trauma is most often the cause of OCD talus, this condition may also develop gradually from the ankle being out of alignment or from repetitive stress. In most cases, your orthopedic specialist will be able to tell the underlying cause from the location of the damage. If the damage is on the inside of the top of the talus, stress from misalignment or repetitive pressure is likely the cause, while damage on the outside top of the talus indicates trauma. 

OCD Talus Symptoms

There may be damage to the talus for quite some time before you are even aware of it. If the blood supply has been compromised, sooner or later the bone and cartilage around the talus will start to die. The cartilage may soften and break apart and there may be bits and pieces of bone fragments that have detached. When this happens, symptoms will usually begin to develop, including:

  • Dull, aching pain that is present all of the time
  • Deep, sharper pain that is experienced while walking and for some time following activity that puts weight on the affected ankle
  • Swelling around the ankle
  • Stiffness
  • Weakness

OCD Talus Treatment Options

Treatment options for OCD talus will vary for each individual and be determined based on the severity of the injury, as well as the age, weight and goals of the patient. Children and those with only minor damage may opt for conservative methods. These will usually include some combination of:

  • immobilization 
  • brace
  • medication for reducing pain and inflammation
  • physical therapy 

While nonsurgical methods are the preferred course whenever possible, they are often unsuccessful in the case of OCD talus in adults. This is especially true if there is extensive damage that includes fragments of bone and cartilage that are moving around inside the joint. 

Surgical procedures to address the damage may consist of some or all of the following:

  • removing all fragments
  • restoring blood flow and accelerating healing by drilling into the bone to create new pathways
  • stabilizing damage with pins and screws
  • addressing major damage with a graft of bone and cartilage

Bone Marrow Aspirate to Enhance Healing

Professional athletes have been reporting success in adding bone marrow aspirate concentrate(BMAC) to their treatment plans for years. Studies involving damage to the talus are showing favorable outcomes for reducing pain and enhancing the healing process. 

What is BMAC? Bone marrow aspirate concentrate is blood derived from the marrow of your bones. Typically, the iliac crest(the ridge of bone above your hip joint) is the preference in foot and ankle surgery. In arthroscopic ankle surgery, a needle is placed into the iliac crest just before the ankle surgery while the patient is asleep. About 60 cc of blood is obtained from the iliac crest bone marrow. It is then spun down, or centrifuged, to concentrate about 6cc of special cells called stem cells. These stem cells are then injected into the osteochondral lesion of the talus after arthroscopic debridement and drilling. The stem cells have been shown to have the ability to differentiate into cartilage or bone cells and help in restoring the cartilage of the ankle. 

If you have questions about OCD talus or about any other foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon with Ortho-Care Wayne in Passiac County New Jersey and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC.

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