Early to medium term outcomes of osteochondral lesions of the talus treated by autologous matrix induced chondrogenesis (AMIC)

Ayyaswamy, Brijesh; Salim, Mohammad Shahril; Sidaginamale, R; Elsayed, Mohammed; Karpe, Prasad; Limaye, Rajiv

doi:10.1016/j.fas.2020.04.008

Cited by 15 publications

(6 citation statements)

References 20 publications

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“…Since then, various studies indicating the benefits of AMIC as a single-stage procedure with reduced donor-site morbidity have been published, especially in the treatment of patients with large (15 mm 2 ) OLT. 1 , 2 , 46 However, there is still no consensus in the literature about which surgical procedure is superior to another in the treatment of these defects. 7 , 17 Furthermore, the original AMIC technique had its own disadvantages of being an open procedure, with most cases requiring an arthrotomy to have good exposure and successful restoration of the lesion.…”

Section: Discussionmentioning

confidence: 99%

Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus With Autologous Cancellous Bone Grafts

Görgün

Gamlı

Duran

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Single-step all-arthroscopic techniques have gained popularity recently in the treatment of osteochondral lesions of the talus (OLT). Concomitant subchondral bone defects led surgeons to add autologous bone grafting to the surgical procedures. Collagen scaffolds have been used widely for stabilization of the reconstruction and regeneration of the articular surface. Purpose: To compare single-step all-arthroscopic treatment of OLT consisting of debridement, microfracture, autologous bone grafting, and application of fibrin sealant in 2 patient groups: with versus without collagen scaffold. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 94 patients who underwent single-step all-arthroscopic treatment for OLT. Autologous bone grafting was applied to 48 patients (BG group), while autologous bone grafting plus collagen scaffold was applied to 46 patients (BG+S group). A fibrin sealant was applied to both groups. Clinical outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) score and the visual analog scale (VAS) for pain. Radiological outcomes were evaluated with the magnetic resonance observation of cartilage repair tissue score. The mean follow-up time was 69.3 ± 20.7 months. Results: Patients in both groups showed statistically significant improvement in pre- to postoperative AOFAS and VAS scores ( P < .001 for all), with no difference between groups in AOFAS and VAS score improvement. Complete healing with or without hypertrophy was achieved in 42 patients in the BG group (87.5%) and 38 patients in the BG+S group (82.6%). Conclusion: The treatment of bone lesions in OLT may be the ultimate goal to obtain successful outcomes, in which case using a collagen scaffold besides grafting may not affect clinical and radiological outcomes.

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Section: Discussionmentioning

confidence: 99%

Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus With Autologous Cancellous Bone Grafts

Görgün

Gamlı

Duran

et al. 2023

Orthopaedic Journal of Sports Medicine

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Section: Discussionmentioning

confidence: 99%

“…Although non-osseous grafting of the peroneus longus tendon was used in a limited number of patients in the literature, [19] AMIC is still the most commonly used treatment method, after osteochondral autologous transfer surgery (OATS). [10,11,20] In our study, we present the experiences of two different surgeons who are experienced in the treatment of arthroscopy lesions and OLTs in tertiary care centers with >200 arthroscopic AMIC procedures using many types of scaffolds. The patients with inaccessible scaffold (Group 1) and those who underwent the same procedure combined with the scaffold (Group 2) were compared both functionally and radiologically.…”

Section: Discussionmentioning

confidence: 99%

Mid-term results of autologous matrix-induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study

Fevzi Kekeç,

Yıldırım

2023

Jt Dis Relat Surg

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Objectives This study aims to investigate the effectiveness of arthroscopic autologous matrix-induced chondrogenesis (AMIC) procedure with or without polyglycolic acid-hyaluronic acid (PGA-HA)-based cell-free scaffold (CFS) in Bristol Stage 4 and Stage 5 osteochondral lesion of the talus (OLT) ranging between 1.5 and 3 cm 2 . Patients and methods Between March 2018 and March 2021, a total of 47 patients with OLTs (29 males, 18 females; mean age: 22.8±2.3 years; range, 18 to 65 years) were retrospectively analyzed. The patients were divided into two groups based on the procedures applied. Patients in the first group (Group 1, n=23) underwent the AMIC procedure alone (curettage, microfracture, and grafting), while patients in the second group (Group 2, n=24) underwent AMIC procedure with PGA-HA-based CFS. The localization of the lesions was evaluated. All OLTs were diagnosed with preoperative radiography and magnetic resonance imaging (MRI). During the preoperative period, lesion stages were evaluated based on the Bristol staging system, and the postoperative results were evaluated based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. Results The mean follow-up was 36.2±5.6 months. In the early period, the three-month functional scores were comparable between the groups. While a significant increase was observed in the American Orthopaedic Foot and Ankle Society (AOFAS) scores from the mean preoperative of 62.71±4.44 points to the postoperative of 86.00±6.58 points in Group 1, a significant increase in the AOFAS score was observed from 65.28±7.91 points to 95.42±4.41 points in Group 2 at 12-month follow-up (p=0.016, p=0.011, respectively). The functional scores tended to progress after 12 months. Radiologically, a complete defect filling was observed in a mean of 10.5±2.7 months. No graft hypertrophy was recorded in any patients. The AOFAS and MOCART scores in Group 2 were found to be statistically significantly higher than that in Group 1 (p=0.034 for AOFAS 1/AOFAS 2 and p=0.006 for MOCART 1/MOCART 2). Overall, there was a positive, but weak, significant correlation between the final AOFAS scores and MOCART scores (r=0.347, p<0.001). Conclusion Arthroscopic AMIC procedure in deep OLTs between 1.5 cm 2 and 3 cm 2 can yield a statistically significant improvement both clinically and radiologically; however, the use of a PGA-HA-based CFS in addition to this procedure can improve the clinical and radiological recovery.

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“…The AOFAS improved significantly from 60 to 89 points after a mean follow‐up of 31 months. In a retrospective study by Ayyaswamy et al [1], 25 patients with a mean OCLT lesion size of 1.75 mm treated with M‐BMS were evaluated using the AOFAS and VAS score. 20 patients had a modified Broström–Gould procedure and one had an internal brace for lateral ligament augmentation.…”

Section: Discussionmentioning

confidence: 99%

Preexisting and treated concomitant ankle instability does not compromise patient-reported outcomes of solitary osteochondral lesions of the talus treated with matrix-induced bone marrow stimulation in the first postoperative year: data from the German Cartilage Registry (KnorpelRegister DGOU)

Ahrend

Aurich²,

Ateschrang

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to compare the subjective ankle function within the irst year following matrixinduced bone marrow stimulation (M-BMS) of patients with a solitary osteochondral lesion of the talus (OCLT) with and without concomitant chronic ankle instability (CAI). Methods Data from the German Cartilage Registry (KnorpelRegister DGOU) for 78 patients with a solitary OCLT and a follow-up of at least 6 months were included. All patients received M-BMS for OCLT treatment. The cohort was subdivided into patients with OCLT without CAI treated with M-BMS alone (n = 40) and patients with OCLT and CAI treated with M-BMS and additional ankle stabilisation (n = 38). The Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), and the Numeric Rating Scale for Pain (NRS) were used to assess patient-reported outcomes (median (minimum-maximum)). Results From preoperatively to 12 months postoperatively, patients with OCLT without CAI treated with M-BMS alone had a signiicant improvement of all subscales in the FAAM [activity of daily living 64.3 (10-100) to 88.1 (39-100); sports 34.4 (0-100) to 65.6 (13-94), functional activities of daily life 50 (0-90) to 80 (30-100), functional sports 30 (0-100) to 70 (5-100)] and FAOS [pain 61.1 (8-94) to 86.1 (50-100), symptoms 60.7 (18-96) to 76.8 (29-100), activities of daily living 72.1 (24-100) to 91.9 (68-100), sport/recreational activities 30.0 (0-70) to 62.5 (0-95), quality of life 31.3 (6-50) to 46.9 (19-100)]. Within the irst year, patients with OCLT and CAI treated with M-BMS and ankle stabilisation also showed signiicant improvement in the FAAM [activity of daily living 68.8 (5-99) to 90.5 (45-100); sports 32.8 (0-87.5) to 64.1 (0-94), functional activities of daily life 62.5 (25-100) to 80 (60-90), functional sports 30 (0-100) to 67.5 (0.95)] and the FAOS [pain 66.7 (28-92) to 87.5 (47-100), symptoms 57.1 (29-96) to 78.6 (50-100), activities of daily living 80.1 (25-100) to 98.5 (59-100), sport/recreational activities 35.0 (0-100) to 70.0 (0-100), quality of life 25.0 (0-75) to 50.0 (19-94)]. The pain level decreased signiicantly in both groups. No signiicant diference was found between both groups regarding the subscales of FAAM, FAOS and the NRS 1 year postoperatively. Conclusion Improvements in subjective ankle function, daily life activities and sports activities were observed within the irst year following M-BMS. Our results suggest that preexisting and treated ankle instability did not compromise subjective outcome in patients treated with M-BMS in the irst postoperative year. Level of evidence Level IV.

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Early to medium term outcomes of osteochondral lesions of the talus treated by autologous matrix induced chondrogenesis (AMIC)

Cited by 15 publications

References 20 publications

Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus With Autologous Cancellous Bone Grafts

Collagen Scaffold Application in Arthroscopic Reconstruction of Osteochondral Lesions of the Talus With Autologous Cancellous Bone Grafts

Mid-term results of autologous matrix-induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study

Preexisting and treated concomitant ankle instability does not compromise patient-reported outcomes of solitary osteochondral lesions of the talus treated with matrix-induced bone marrow stimulation in the first postoperative year: data from the German Cartilage Registry (KnorpelRegister DGOU)

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