PMC5974671_01
Mortise projections of the right ankle. After persisting ankle pain, on 3-month follow- up, the radiographs were interpreted as normal with no signs of osteonecrosis (a). On 4-week post-procedure clinical follow-up, the ankle was painless, but due to restricted weight-bearing, the mineral density ofthe ankle had decreased as seen on radiographs (b). On the last follow-up (15 months after the procedure), the ankle was symptomless and radiographs were interpreted as normal (c).
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F1
The radiographs were normal (Fig. 1a), but the MRI revealed ARC O Stage I osteonecrosis of the talus with increased signal on T2- weighted fat-saturated images and decreased signal on T1- weighted images; an additional minor crescent sign was also present (Fig. 2a and b). Radiographs were normal except for the low mineral density of the bones in general (Fig. 1b).
Magnetic resonance imaging (MRI) studies of the right ankle. On the initial MRI, the fluid-sensitive sagittal T2-weighted fat-saturated (a) image shows significant bone marrow edema (hyperintense signal) in the talus. The T1-weighted sagittal image (b) shows corresponding bone marrow edema as hypointense signal in the talus. On both sequences, a minor crescent sign can be distinguished on the talar dome (arrows in a, b). The 3-month follow-up, MRI shows complete resolution of the osteonecrotic appearance in the talus on fluid-sensitive proton density fat- saturated (c) and T1-weighted sagittal images (d). Some patchy osteoporosis can be distinguished (arrows in c). On the 15-month follow-up MRI, the talus appears normal on proton density fat- saturated (e) and on T1-weighted images (f).
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F2
The MRI revealed virtually complete resolution of the talar osteonecrotic changes (Fig. 2c and d). On the subsequent 15-month follow-up, the patient presented no symptoms and the MRI scan (Fig. 2e and f) as well as the radiographs (Fig. 1c) were normal.
The procedure using fluoroscopic guidance, core decompression ofthe talar dome was performed using a guidance spike (arrowhead) and a 2.7 mm drill (arrow) (a). In addition to standard procedure, autologic mesenchymal stem cells combined with platelet-rich plasma were injected into the osteonecrotic region in the talus (b).
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F3
Next, the PRP-BMA concoction was injected into the osteonecrotic region under fluoroscopic control using a 3 mm aspiration needle (Fig. 3).