The role of bone marrow edema on osteochondral lesions of the talus

• After autologous matrix induced chondrogenesis of the talus bone marrow edema disappear in more than 70% of the patients. • Arthroscopic talus autologous matrix induced chondrogenesis can be considered a safe and reliable procedure. • Lesion size in patients with bone marrow edema is significantly higher respect patients without bone marrow edema. • No clinical differences exist after surgical procedure between patients with and without bone marrow edema. To assess the functional and radiological outcomes after arthroscopic talus autologous matrix-induced chondrogenesis (AT-AMIC ® ) in 2 groups: patients with and without bone marrow edema (BME). Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC ® repair for symptomatic osteochondral talar lesion. Clinical and radiological parameters were evaluated with VAS score for pain, AOFAS and SF-12 at T 0 (preoperatively), T 1 (6 months), T 2 (12 months), T 3 (24 months) and MRI and CT-scan at T 0 , T 1 , T 2 and T 3 . No patients were lost to the final follow-up. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points (p < 0.001). In GNE, AOFAS improved significantly at each follow-up (p < 0.05); while CT and MRI showed a significant reduction in lesion size between T 1 and T 2 and T 2 and T 3 (p < 0.05). In GE, AOFAS improved significantly between T 0 and T 1 and T 2 and T 3 (p < 0.05); lesion size, measured with CT, decreased between T 1 and T 2 (p < 0.05), while with MRI the lesion showed a reduction at each follow-up (p < 0.05). Lesion size was significantly higher both in MRI and CT in GE compared to GNE (p < 0.05). In GNE no patients presented edema at T 3, while in GE only 23.08% of the patients presented edema at T 3. The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC ® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.