Biologic Adjuvants for the Management of Osteochondral Lesions of the Talus

MaCalus V. Hogan, MD, MBA; Justin J. Hicks, MD; Monique C. Chambers, MD, MSL; John G. Kennedy, MD, FRCS


J Am Acad Orthop Surg. 2019;27(3):e105-e111. 

In This Article

Hyaluronic Acid

Hyaluronic acid (HA) is a glycosaminoglycan located within synovial fluid. In water, HA forms a viscous gel-like substance with nociceptive blocking properties that may play a role in osteoarthritis treatment. In vitro, HA has been found to promote cartilage regeneration through increased chondrocyte proliferation and synthesis of proteoglycans while also preventing cartilage degradation and the production of deleterious proinflammatory cytokines and matrix metalloproteinases.[21] The chondroprotective and regenerative effects of HA have been validated in animal models. Strauss et al[22] demonstrated that HA supplementation through three weekly intra-articular injections enhanced filling of the defects grossly and histologically in rabbits after microfracture surgery. Kaplan et al[23] created 10- × 10-mm partial-thickness articular cartilage lesions in the medial condyle of sheep followed by two HA injections 7 days apart. Lesions were evaluated at 12 weeks demonstrating that early administration of HA is chondroprotective.

Three recent studies comparing OLT treatment using microfracture surgery alone with microfracture surgery supplemented with HA demonstrate improved outcomes in the HA group (Table 2). Comparing a single-dose PRP injection with a multidose HA injection regimen as adjunct to microfracture surgery in OLT, the authors found that both PRP and HA improved outcomes; however, PRP was recommended over HA because a single injection yielded superior outcomes (Table 2). Given the in vitro evidence of chondroprotection and increased cartilage regeneration as well as improved outcomes scores clinically, HA seems to be a viable adjunct to OLT repair. Further studies are needed to make more robust treatment recommendations regarding HA injections alone or even in combination with PRP to supplement cartilage regeneration.