Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures for Chondral Defects of the Talar Shoulder: A Five-Year Follow-Up Prospective Cohort Study

Abstract

Introduction: Many procedures are available to manage cartilage defects of the talus, including microfracturing (MFx) and Autologous Matrix Induced Chondrogenesis (AMIC). Whether AMIC or MFx are equivalent for borderline sized defects of the talar shoulder is unclear. Thus, the present study compared the efficacy of primary isolated AMIC versus MFx for borderline sized focal unipolar chondral defects of the talar shoulder at midterm follow-up. Methods: Patients undergoing primary isolated AMIC or MFx for focal unipolar borderline sized chondral defects of the talar shoulder were recruited prospectively. For those patients who underwent AMIC, a type I/III collagen resorbable membrane was used. The outcomes of interest were: Visual Analogic Scale (VAS), Tegner Activity Scale, American Orthopedic Foot and Ankle Score (AOFAS). The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Data concerning complication rate and additional procedures were also collected. Results: The mean follow-up was 43.5 months. The mean age of the 70 patients at operation was 32.0 years, with a mean defect size of 2.7 cm2. The mean length of hospitalization was shorter in the MFx cohort (p = 0.01). No difference was found between the two cohorts in terms of length of prior surgery symptoms and follow-up, mean age and BMI, sex and side, and defect size. At a mean follow-up of 43.5 months, the AOFAS (p = 0.03), VAS (p = 0.003), and Tegner (p = 0.01) scores were greater in the AMIC group. No difference was found in the MOCART score (p = 0.08). The AMIC group evidenced lower rates of reoperation (p = 0.008) and failure (p = 0.003). Conclusion: At midterm follow-up, AMIC provides better results compared to MFx.

Fibrin glue does not assist migration and proliferation of chondrocytes in collagenic membranes: an in vitro study

“…However, suture generates partial-thickness lesions of the articular cartilage which may not heal and enlarge with time, leading to persisting symptoms and premature degeneration [ 7 – 9 ]. To avoid membrane suture, fibrin glue has been introduced, although some studies secured the membrane with suture [ 10 , 11 ], fibrin glue [ 12 – 21 ], or both [ 22 – 25 ]. However, the membrane remains stable in the defects even without formal fixation [ 26 – 30 ].…”

Cell therapies for chondral defects of the talus: a systematic review

“…At two-year follow-up, they evidenced no difference between the two procedures in the rate of revision and failures [ 57 ]. Isolated AMIC for chondral defects of the talus reported promising outcomes [ 79 , 80 ], with results superior to isolated MFx [ 81 ].…”

Autologous Bone Grafting in Trauma and Orthopaedic Surgery: An Evidence-Based Narrative Review

“…The new bone formation is already demonstrable a few weeks postoperatively, and remodelling occurs within two months, with complete graft osteointegration achieved after approximately one year [ 12 , 18 ]. Given its proprieties, cancellous bone graft is employed to enhance fracture healing and arthrodesis, and to fill bone defects [ 19 , 20 , 21 , 22 ]. Cortical bone graft shows moderate osteoconductive, osteoinductive, and osteogenic capabilities, together with adequate mechanical stability [ 7 , 23 , 24 ].…”

“…The distal part of the tibia is an alternative grafting site, particularly convenient in foot and ankle surgery, as it is adjacent to the operative field; it produces relatively little blood loss, and it is an easy source of small volumes of cancellous bone [ 18 ]. Furthermore, the technique of harvesting is simple and is associated with a low rate of infections and fragility fractures [ 20 , 38 , 72 ]. The calcaneus is another grafting site often used in foot and ankle surgery for osteoinductive purposes [ 73 ].…”