2015 ISAKOS Biennial Congress ePoster #122

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

Boguslaw Dariusz Sadlik, Prof. assistant, Wroclaw POLAND
Victor Valderrabano, MD, PhD, Basel SWITZERLAND
Alexej Barg, MD, Liestal SWITZERLAND
Martin Wiewiorski, MD, Basel SWITZERLAND
Orthopaedic Department, St Lukes Clinic, 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, Chondroguide

Summary: We present a novel technique for arthroscopic osteochondral repair of OCLT.

Abstract:

Introduction

Matrix-aided cartilage repair is commonly used for treatment of osteochondral lesions of the talus. However, implantation of a natural or synthetic matrix during conventional arthroscopy under continuous irrigation may be a challenging, time consuming, and occasionally frustrating procedure. To overcome the issues of arthroscopic matrix implantation, we modified the arthroscopic approach for matrix-aided cartilage repair of ankle osteochondral lesions. We describe the use of a minimal-invasive retraction system to assist dry ankle arthroscopy, and facilitate matrix insertion.

Methods

The retraction system consists of threads, a retraction plate (Retraction plate, ATMED, Katowice, Poland), and a holder rod (Artromast, ATMED, Katowice, Poland) attached to the surgery table. A thread is attached to each side of the retraction plate. The plate is pulled into the joint cavity through a standard arthroscopic portal and placed at the anterior capsule of the ankle joint. Tension applied to the threads lifted the capsule and distracts the joint cavity. The threads are attached to a holder rod, or are held manually to retain tension. The plates are available in different sizes according to joint size.
Following installation of the retraction system, an arthroscopical AMIC-procedure using a collagen type I/III matrix (Chondro-Gide, Geistlich Pharma AG, Wolhusen, Switzerland) can be performed using standard arthroscopical portals.

Results

From January 2013 to January 2014, there were 8 patients treated for osteochondral lesions of the talus using AMIC with dry ankle arthroscopy. There were 3 male and 5 female patients with a mean age of 28.2 ± 8.9 years (range, 17-42 years). The OCLT was localized on the medial and lateral side in 4 and 4 ankles, respectively. The mean surface and volume of OCLT were 101 ± 14.1 mm2 (range, 84-120 mm2) and 503 ± 70.7 mm3 (range, 420-600 mm3), respectively.
The average surgical time was 65 ± 13.9 minutes (range, 53-80 minutes). There were no intraoperative or perioperative complications. Wound-healing occurred within two weeks after the surgery, without adverse events, in all 8 ankles. All patients were followed clinically one 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 < 0.01).

Conclusion

Dry arthroscopy utilizing the presented retraction system is a feasible and safe procedure for matrix-aided arthroscopic treatment of osteochondral lesions of the talus. The retraction system lifts the capsule to allow adequate access to talar osteochondral lesions. The joint cavity is prevented from collapsing after fluid evacuation which facilitates insertion of a matrix onto the defect site. Further clinical studies are needed to address the learning curve and functional outcome of this new surgical technique.