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ankle osteoarthritis; FADI; mesenchymal stromal cells; platelet-rich plasma; ultrasound-guided injections
Background: Orthobiologics such as mesenchymal stromal cells and platelet-rich plasma are intensely being investigated as treatment options for osteoarthritis. The purpose of this retrospective case series is to evaluate the safety, adverse events, long-term outcomes, and efficacy of bone marrow concentrate (BMC) combined with platelet-rich plasma (PRP) to treat moderate to advanced Kellgren-Lawrence (KL3-4) post-traumatic ankle osteoarthritis.
Methods: Study population at final follow-up included 19 patients with 22 treated ankles with post-traumatic ankle osteoarthritis with a mean duration of symptoms of 56 months before treatment with ultrasound-guided intra-articular injection of BMC and PRP. Patients were followed prospectively from the time of treatment for a mean of 2.6 years at final follow-up. Pre and post Foot and Ankle Disability (FADI) scores were tabulated to assess outcomes, and 7 patients also completed the FADI sports module. Total nucleated cell counts were obtained on all treated patients and Mishra Type 3A PRP was utilized.
Results: A total of 19 of 22 ankles treated showed improvement in their FADI scores. Thirteen of the 19 who had improved FADI scores patients reached MCID (P = .17). Three of the six patients who did not reach MCID eventually underwent ankle arthrodesis. The average patient age was 56 years old. There was no correlation between the history of previous surgery, KL grade, sex, or age in terms of outcomes. Seven patients completed the sports module of the FADI, and none reached MCID. Patients with a shorter duration of symptoms had higher post-FADI scores reaching MCID (P < .001). The three patients who underwent arthrodesis had the longest duration of symptoms of 84, 84, and 120 months. No adverse effects were reported in the study group. Total nucleated cell count (TNCC) did not correlate with outcomes in this group, and there was no correlation of TNCC based on age and sex.
Conclusion: BMC combined with PRP is a safe treatment option for patients with moderate to advanced ankle arthritis and can provide functional pain relief for a sustained period and delay or possibly obviate the need for future ankle arthrodesis. A shorter duration of symptoms may lead to improved outcomes.