All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Treatment of Osteochondral Lesions of the Talus

Abstract

Several surgical techniques have been described for the treatment of talar chondral lesions. Among them, microfracture is well established. Autologous matrix-induced chondrogenesis (AMIC), using microfracture and biomaterials, has shown promising results for the treatment of knee osteochondral lesions and has been proposed for the ankle as an open technique. We describe an all-arthroscopic AMIC technique. The benefits of an all-arthroscopic procedure include smaller incisions with less soft-tissue dissection, better visualization of the joint, and a quicker recovery compared with open surgery. The use of matrix to support cartilage regeneration promotes good-quality cartilage tissue with satisfactory long-term outcomes. Our all-arthroscopic AMIC technique uses a type Ietype III porcine collagen matrix (Chondro-Gide; Geistlich Pharma, Wolhusen, Switzerland) and is characterized by 2 different arthroscopic surgical phases. First, adequate exposure is achieved through use of a Hintermann spreader (Integra LifeSciences, Plainsboro, NJ) with sufficient joint distraction and wet lesion preparation. The second surgical step is performed dry, involving matrix placement and fixation. The all-arthroscopic AMIC technique for the treatment of osteochondral lesions of the talus allows a very precise reconstruction in the case of cartilage defects and avoids the need for a more invasive operation associated with higher morbidity and a longer surgical time.

Recent Advances in Egypt for Treatment of Talar Osteochondral Lesions

“…48 Similarly, the AMIC-plus technique has also been described in which the AMIC collagen membrane is saturated with platelet-rich plasma (PRP) in an attempt to increase growth factor content of the scaffold. 49 Due to its most recent evolution, results of AMIC in talar OCLs are limited to a handful of technical surgical notes 50,51 and small case series. The most important of which reported significant improvement in functional outcomes and MOCART scores, which demonstrated a good quality repair tissue similar to the MRI ultrastructure of the surrounding cartilage at an average of 2 year follow-up.…”

All-arthroscopic AMIC® (AT-AMIC) in the treatment of osteochondral talar lesions

“…Além disso, as membranas de colágeno demonstraram ser um bom biomaterial para restaurar o osso subcondral, que é um passo crítico para a regeneração de uma cartilagem hialina saudável (7) . Inicialmente, esse procedimento foi realizado apenas com uma abordagem aberta, mas recentemente foi descrita a técnica AMIC® totalmente artroscópica (AT-AMIC®) (8) . Essa abordagem tem as vantagens das incisões menores, menor dissecação de partes moles, melhor visualização articular e melhor recuperação do paciente.…”

The Use of All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Management of Humeral and Glenoid Chondral Defects in the Shoulder

“…However, as other authors have noted, the all-arthroscopic AMIC technique can be associated with some complications (collagen allergy, matrix detachment or mobilization, hyper-proliferative healing reaction, and the complications of shoulder arthroscopy). 12,17 In our limited experience with the described technique, magnetic resonance imaging control scans have allowed us to confirm the stability of the implanted membranes (2-and 7-month magnetic resonance imaging scans). It is possible to apply the AMIC technique all-arthroscopically in the glenohumeral joint, allowing an easy approach to the articular surface for application of matrixes on the humeral and glenoid surfaces.…”

“…There are reports on the treatment of cartilage lesions using AMIC techniques arthroscopically, [9][10][11][12][13] but not in the shoulder. It must be taken into account that the shoulder differs from the hip, knee, and ankle in some ways regarding the AMIC procedure: The glenohumeral joint is a noneweight-bearing joint; it also has thinner cartilage and is not so constrained.…”

“…[8][9][10][11][12] Performing the AMIC technique with an allarthroscopic technique decreases the risk of infection, risk of wound morbidity, and operative time. In this report an all-arthroscopic technique to perform AMIC on both the humeral and glenoid sides of the glenohumeral joint is presented.…”