Unorganized fibrocartilage and osseous proliferation after bone marrow stimulation for an osteochondral lesion of the talus

Abstract

Introduction: Bone marrow stimulation (BMS) is the most commonly used treatment for an osteochondral lesion of the talus (OLT). BMS can fail, however, and may require revision surgery. Objectives: To describe the clinical-, radiological-, and histological presentation of an unusual fibrocartilaginous fragment after failed BMS. Methods: The present case-report includes a description of the patient (treatment) history, clinical presentation, and radiological-, intraoperative-, and histological findings. Results: A 33-year-old female was referred to our tertiary academic center. The patient presented with persistent pain in the left ankle three and a half years after a BMS procedure at another institution. On preoperative imaging a large, cystic, osteochondral lesions of the lateral talus (OLT) and an ossified fragment in the tibiofibular joint was observed. Through shared-decision making, the patient elected to undergo the Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) procedure to address her complaints originating from the OLT. Intraoperatively, a fibrocartilaginous outgrowth, emanating from the lesion site, was found and excised. Histological examination revealed a predominantly fibrocartilaginous cell structure with focal reactive and degenerative changes. Additionally, osseus proliferation within the fibrocartilage outgrowth was observed. Conclusions: The present study outlines a specific case in which BMS failed and was addressed with revision surgery. This case highlights the complex and potentially unorganized remodeling of fibrocartilaginous tissue, which drives the hypothesis that cartilage regeneration following a BMS procedure is unorganized and may sometimes be inadequate in specific cases.

Keywords

• Ankle
• Fibrocartilage
• Olt
• Osteochondral lesion
• Secondary lesion
• Talus