Bone Marrow Aspirate Concentrate as a Reliable Adjunct in Tibiotalocalcanal Fusion: A Radiographic Modified RUST Score Analysis

Background Tibiotalar and subtalar arthritis requiring tibiotalocalcaneal (TTC) fusion can be technically challenging and is dependent on reliable fusion for a good clinical outcome. Initial data regarding bone marrow aspirate concentrate (BMAC) has shown promise in use as an aide in both fracture and fusion healing. The purpose of this study is to determine the outcomes in TTC fusion when utilizing BMAC as an adjunct. Methods Twenty consecutive patients who underwent TTC fusion with BMAC adjunct between March 2013 and November 2017 were retrospectively screened for inclusion. Patients were included regardless of comorbidities or risk factors for non-union, and only excluded if they did not have a minimum of 12 months of clinical and/or radiographic chart data. Follow-up was obtained at regular intervals of 6 weeks, 3 months, 6 months and 1 year. Modified RUST scores were applied to grade bony union in a blinded fashion by two orthopedic trauma fellowship-trained surgeons and agreement was assessed via intraclass correlation coefficient (ICC). Results Twenty patients were screened and 12 met inclusion criteria for analysis. Majority were male (66.6%) at a mean age of 55.4 years and they were all treated via TTC fusion for a diagnosis of tibiotalar and subtalar arthritis. There were no postoperative complications and no reoperations in this cohort; no donor site morbidity was associated with BMAC. By the 3-month follow-up timepoint, all but one patient received a minimum modified RUST score of 10 indicating bony union (ICC 0.91); by the 6-month time point (ICC 0.94), all 12 patients were deemed united. Conclusion BMAC as an adjunct in the setting of TTC fusion is a safe treatment option that can promote reliable, consistent bony fusion with minimal complications.