Summary
The purpose of this study is to introduce the clinical and imaging results according to our technical AMIC (Chondrogide, Geistlich Pharma, Switzerland) experience for the treatment of osteochondral defects of the talus with 36 months follow-up
Abstract
Objectives: Osteochondral lesion (OCL) of the talus is a quite common problem in sportsmen. In literature to solve these ankle diseases are described several operative techniques with a good outcomes on follow-up examinations. However, limitations such as sacrificing healthy cartilage (osteochondral autograft transfer system [OATS], mosaicplasty), multiple-stage operative procedures (autologous chondrocyte implantation [ACI]), high costs (ACI, allograft), and limited availability (allograft) reflect potential drawbacks of these currently used techniques. Autologous matrix-induced chondrogenesis (AMIC) technique applied to the ankle has become an estabilished procedure, but there are few reports in letterature showing results with a long-term follow-up. This technique involves the use of collagenous scaffolds: sterile and safe platforms implanted with one-step surgery and able to induce the proliferation and organization of chondrocytes: autologus matrix- induced chondrogenesis(AMIC).
Materials And Methods
Between January 2010 and March 2016, 15 patients underwent autologous matrix induced chondrogenesis reconstruction of osteochondral lesions of the talus. All patients were followed for a minimum of 30 months after surgery. The mean follow-up time was 38,3 months (range, 36-71 months). The lesions measured an average of 2.13 cm2 (range 1.4 to 3.2 cm2). Ligaments repair was performed in 5 of 15 cases. In 10 cases it had been necessary osteotomy of the medial malleolus to reach the lesion in the posterior-medial corner of the talus. Patient-reported outcome measures were taken preoperatively, at 6, 12 and 36 months after surgery using the American Orthopaedic Foot and Ankle Score (AOFAS); Visual Analogue Scale (VAS) and Tegner Activity Level Scale. Each patient underwent also magnetic resonance imaging (MRI) evaluations. The magnetic resonance observation of cartilage repair tissue findings were evalueted postoperatively after 6,12 and 36 months.
Results
The AOFAS score improved significantly from a mean of 52,40 points preoperatively (range, 29,00-75,00 points) to 93,13 points (range, 83,00-98,00 points) postoperatively after 36 months (p<0,05); associated with a decrease directly proportional of the VAS score. The preoperative pain score improved from a mean score of 7 (range, 5-8), to 1.66 (range 0-4) postoperatively after 6 months (p<0,05). The Tegner score allowed us to quantify the postoperative recovery considering the functional needs of each patient. Radiologically, the MRI follow-up showed a progressive improvement of the signal of the cartilage surface affected by the injury and a decrease directly proportional of the bone edema. Complete filling of the defect at the level of the surrounding cartilage was found in 46,6% cases, and a complete filling with a hypertrophic cartilage layer was found in 33,3% of the patients. Normal signal intensity of the repair tissue compared with the adjacent native cartilage was seen in 26,6% cases.
Conclusion
and discussion: The AMIC techinque is safe technique like a surgical solution for the treatment of OLTs in the ankle with overall good clinical and MRI results at 36 months of follow-up, specially in sportsmen.