Biological reconstruction of large osteochondral lesions of the talar dome with a modified “sandwich” technique—Midterm results

Background Autologous Matrix-Induced Chondrogenesis (AMIC) is addressed to osteochondral defects of the talus. However, evidence concerning the midterm efficacy and safety of AMIC are limited. This study assessed reliability and feasibility of AMIC at 60 months follow-up. We hypothesize that AMIC leads to good clinical outcome at midterm follow-up. Methods Surgeries were approached with an arthrotomy via malleolar osteotomy. A resorbable porcine I/III collagen membrane (Chondro-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) was used. Patients were followed at 24 and 60 months. The primary outcome of interest was to analyse the Foot Function Index (FFI), and the subscale hindfoot of the American Orthopaedic Foot and Ankle Score (AOFAS). Complications such as failure, revision surgeries, graft delamination, and hypertrophy were also recorded. The secondary outcome of interest was to investigate the association between the clinical outcome and patient characteristics at admission. Results Data from 19 patients were included. The mean age at admission was 47.3 ± 13.2 years, and the mean BMI 24.1 ± 4.9 kg/m2. 53% (10 of 19 patients) were female. At a mean of 66.2 ± 11.6 months, the FFI decreased at 24-months follow-up of 22.5% (P = 0.003) and of further 1.3% (P = 0.8) at 60-months follow-up. AOFAS increased at 24-months follow-up of 17.2% (P = 0.003) and of further 3.4 (P = 0.2) at 60-months follow-up. There were two symptomatic recurrences within the follow-up in two patients. There was evidence of a strong positive association between FFI and AOFAS at baseline and the same scores last follow-up (P = 0.001 and P = 0.0002, respectively). Conclusion AMIC enhanced with cancellous bone graft demonstrated efficacy and feasibility for osteochondral defects of the talus at five years follow-up. The greatest improvement was evidenced within the first two years. These results suggest that clinical outcome is influenced by the preoperative status of the ankle. High quality studies involving a larger sample size are required to detect seldom complications and identify prognostic factors leading to better clinical outcome. Level of evidence II, prospective cohort study.

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“…Several surgical strategies have been addressed to manage chondral defects of the talus [28,29]. Isolated bone marrow stimulation (e.g.…”

Section: Discussionmentioning

confidence: 99%

AMIC for traumatic focal osteochondral defect of the talar shoulder: a 5 years follow-up prospective cohort study

Götze

Nieder

Felder

et al. 2021

BMC Musculoskelet Disord

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“…The most often reported operative technique was BMS alone with 11 papers including 576 patients (13,14,15,16,17,18,19,20,21,22,23). More than half of the patients (996/total 1695 patients) received BMS alone, BMS with an additional therapy (18,19,23,24,25,26,27) or AMIC (28,29,30,31,32) . BMS alone and BMS with an additional therapy were used in smaller lesions (0.88 cm 2 and 0.86 cm 2 , respectively) than the other therapies (1.86 cm 2 , P < 0.001).…”

Section: Operative Techniquesmentioning

confidence: 99%

Evidence for operative treatment of talar osteochondral lesions: a systematic review

et al. 2022

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Purpose Operative treatment of talar osteochondral lesions is challenging with various treatment options. The aims were (i) to compare patient populations between the different treatment options in terms of demographic data and lesion size and (ii) to correlate the outcome with demographic parameters and preoperative scores. Methods A systemic review was conducted according to the PRISMA guidelines. The electronic databases Pubmed (MEDLINE) and Embase were screened for reports with the following inclusion criteria: minimum 2-year follow-up after operative treatment of a talar osteochondral lesion in at least ten adult patients and published between 2000 and 2020. Results Forty-five papers were included. Small lesions were treated using BMS, while large lesions with ACI. There was no difference in age between the treatment groups. There was a correlation between preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score and change in AOFAS score (R = −0.849, P < 0.001) as well as AOFAS score at follow-up (R = 0.421, P = 0.008). Preoperative size of the cartilage lesion correlates with preoperative AOFAS scores (R= −0.634, P = 0.001) and with change in AOFAS score (R = 0.656, P < 0.001) but not with AOFAS score at follow-up. Due to the heterogeneity of the studies, a comparison of the outcome between the different operative techniques was not possible. Conclusion Patient groups with bigger lesions and inferior preoperative scores did improve the most after surgery. Level of evidence IV.

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“…In AMIC sandwich technique, surgeons tried to use the membrane or gel only to cover on bony chips, such collagen I/III bilayer matrix membrane (Chondro-Gide®; Geistlich Pharma AG, Switzerland), collagen type I gel CaReS®-1S (Arthro Kinetics, Austria) [ 23 , 24 ]. In some cases, the membrane is infiltrated with bone marrow aspirate concentrate (BMAC) to promote cartilage regeneration [ 25 , 26 ].…”

Section: Current Clinical Therapies For Ocdsmentioning

confidence: 99%

Osteochondral tissue engineering: Perspectives for clinical application and preclinical development

Lee

Tan

et al. 2021

Journal of Orthopaedic Translation

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The treatment of osteochondral defects (OCD) remains challenging. Among currently available surgical treatments for OCDs, scaffold-based treatments are promising to regenerate the osteochondral unit. However, there is still no consensus regarding the clinical effectiveness of these scaffold-based therapies for OCDs. Previous reviews have described the gradient physiological characteristics of osteochondral tissue and gradient scaffold design for OCD, tissue engineering strategies, biomaterials, and fabrication technologies. However, the discussion on bridging the gap between the clinical need and preclinical research is still limited, on which we focus in the present review, providing an insight into what is currently lacking in tissue engineering methods that failed to yield satisfactory outcomes, and what is needed to further improve these techniques. Currently available surgical treatments for OCDs are firstly summarized, followed by a comprehensive review on experimental animal studies in recent 5 years on osteochondral tissue engineering. The review will then conclude with what is currently lacking in these animal studies and the recommendations that would help enlighten the community in developing more clinically relevant implants. The translational potential of this article This review is attempting to summarize the lessons from clinical and preclinical failures, providing an insight into what is currently lacking in TE methods that failed to yield satisfactory outcomes, and what is needed to further improve these implants.

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Biological reconstruction of large osteochondral lesions of the talar dome with a modified “sandwich” technique—Midterm results

Cited by 18 publications

References 27 publications

AMIC for traumatic focal osteochondral defect of the talar shoulder: a 5 years follow-up prospective cohort study

AMIC for traumatic focal osteochondral defect of the talar shoulder: a 5 years follow-up prospective cohort study

Evidence for operative treatment of talar osteochondral lesions: a systematic review

Osteochondral tissue engineering: Perspectives for clinical application and preclinical development

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