2017 ISAKOS Biennial Congress ePoster #125

 

Dry Arthroscopy with a Retraction System for Matrix-Aided Cartilage Repair of Osteochondral Lesions of the Talus

Boguslaw Dariusz Sadlik, Prof. assistant, Wroclaw POLAND
Martin Wiewiorski, MD, Basel SWITZERLAND
Alexej Barg, MD, Liestal SWITZERLAND
Adrian B. Blasiak, MD, Bielsko-Biala POLAND
Mariusz A. Puszkarz, MD, Żory POLAND
Victor Valderrabano, MD, PhD, Basel SWITZERLAND

Biological Reconstruction Department / Orthopaedic Department, Bielsko-Biala, POLAND

The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Geistlich Pharma AG, ChondroGide

Summary

Treatment of osteochondral lesions of the talus (OCLT) is performed usually through mini-arthrotomy. All-arthrocopic technique developed by our team incuding dry arthroscopy, AMIC, and use of two new tools - retraction plates, holding rod is a feasible procedure for matrix-aided arthroscopic treatment of osteochondral lesions of the talus.

Abstract

Objectives: Arthroscopical treatment of osteochondral lesions of the talus (OCLT) is challenging. Therefore, most repair techniques are performed through a mini-open approach, frequently requiring an additional malleolar osteotomy. We developed an all-arthroscopical technique allowing for minimally invasive retraction of the ankle joint capsule that creates a suitable dry setup for collagen-matrix implantation.

Methods

A retraction plate with a suture at each end is pulled into the joint and placed at the anterior ankle joint capsule. Both ends of the retracting suture run from the inside of the joint to the outside and can be attached to a holding rod. Pulling the retracting sutures lifts the capsule of the talus, allowing adequate access to the cartilage lesion. Following debridement, arthroscopic fluid is evacuated, to create a dry joint cavity. The bony defect is reconstructed with autologous spongiosa and a collagen matrix (Chondro-Gide; Geistlich Pharma AG, Wolhusen, Switzerland) is inserted (AMIC-technique).

Results

8 patients were treated for osteochondral lesions of the talus using AMIC with dry ankle arthroscopy. The OCLT was localized on the medial and lateral side in 4 ankles each. The average surgical time was 65 ± 13.9 min (range 53–80 min). There were no intraoperative or perioperative complications. All patients were followed clinically 1 year postoperatively. The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 63.1 ± 19.6 points (range 17–79 points), and the postoperative AOFAS hindfoot score was 86.0 ± 12.0 points (range 61–100 points) (p<.01). The mean postoperative Lysholm score was 82.8 ± 14.2 (range 62–100 points). All patients were able to return to sport activities by 6 months postoperatively.

Conclusions

Dry arthroscopy using the presented retraction system is a feasible procedure for matrix-aided arthroscopic treatment of osteochondral lesions of the talus.