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International Orthopaedics

, Volume 42, Issue 12, pp 2949–2956 | Cite as

Stem cell therapy in early post-traumatic talus osteonecrosis

  • Philippe Hernigou
  • Arnaud Dubory
  • Charles Henri Flouzat Lachaniette
  • Issam Khaled
  • Nathalie Chevallier
  • Helene Rouard
Original Paper

Abstract

Purpose

Avascular necrosis of the talus is one of the most notable complications associated with talar neck fractures with frequent evolution of the osteonecrosis into a difficult arthrodesis. We tested whether the injection of bone marrow mesenchymal stem cells (MSCs) could improve the repair process of the osteonecrosis.

Material and methods

Forty-five early (without collapse) post-traumatic talus osteonecroses (group 1; study group) were treated between 1995 and 2012 with percutaneous injection of progenitor cells (autologous bone marrow concentrate from the iliac crest). The number of MSCs transplanted in each ankle of group 1 was 124 × 103 cells (range 101 × 103 to 164 × 103 cells). The evolution of these osteonecroses treated with autologous bone marrow implantation was compared with the evolution of a control group of 34 talar osteonecroses without collapse and treated with only core decompression (group 2; control group) between 1985 and 1995. The outcome was determined by progression in radiographic stages to collapse, by the need of arthrodesis, and by the time to successfully achieve fusion for patients who needed arthrodesis.

Results

For the 45 ankles with autologous concentrate bone marrow grafting, collapse frequency was lower (27%, 12 among 45 versus 71%, 24 among 34; odds ratio 0.1515, 95% CI 0.0563–0.4079; P = 0.0002) and follow-up showed longer duration of survival before collapse or arthrodesis, compared to 34 ankles of the control patients with core decompression alone. Furthermore, the time to successfully achieve fusion after arthrodesis was significantly shorter in patients treated with bone marrow progenitors as compared with the other ankles, which had core decompression alone.

Conclusion

In our study the early conservative surgical treatment with autologous bone marrow grafting improved the natural course of the disease as compared with core decompression alone.

Keywords

Talus osteonecrosis Talus fracture Talus stem cell therapy Talus core decompression 

Notes

Acknowledgments

We thank Richard Suzuki and Meghana Malur of Celling Biosciences for the review of the final manuscript and their help in translation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Philippe Hernigou
    • 1
  • Arnaud Dubory
    • 1
  • Charles Henri Flouzat Lachaniette
    • 1
  • Issam Khaled
    • 1
  • Nathalie Chevallier
    • 1
  • Helene Rouard
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity Paris East (UPEC), Hôpital Henri MondorCreteilFrance

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