One step treatment of talus osteochondral lesions with microfracture and cell free hyaluronic acid based scaffold combination

Yontar, Necip Selçuk; Aslan, Lercan; Can, Ata; Öğüt, Tahir

doi:10.1016/j.aott.2019.04.002

Cited by 24 publications

(16 citation statements)

References 34 publications

(41 reference statements)

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“…These features commit AMIC of special interest of both patients and surgeons. Several studies showed promising results of AMIC for talar chondral defects, with high patient satisfaction and quick return to sport [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. We identified only three long term studies investigating efficacy and feasibility of AMIC [12,15,21].…”

Section: Discussionmentioning

confidence: 99%

“…A cell-free resorbable membrane is then trimmed and ensured over the defect, to create a blood clot rich in stem cells [9]. Several studies which focused on AMIC for chondral defects of the talus demonstrated high rate of patient satisfaction [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. However, evidence concerning the midterm efficacy and safety of AMIC are limited.…”

Section: Introductionmentioning

confidence: 99%

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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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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…In our study, we observed a histologically significant difference at Week 4 in the control group, while the histological and macroscopic scoring was significantly higher in the experimental group at Week 8. Yontar et al [35] applied MF-HA-based scaffold combination in the treatment of talus osteochondral defect and concluded that it was a safe and effective technique with good clinical results for lesions deeper than 7 mm. In our study, adipose-derived SVF increased the efficacy of MF-HA-based scaffold combination used in osteochondral treatment, particularly in the late period, and we were able to show this effect macroscopically and histologically.…”

Section: Discussionmentioning

confidence: 99%

Effects of adipose tissue-derived stromal vascular fraction on osteochondral defects treated by hyaluronic acid-based scaffold: An experimental study

et al. 2021

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Objectives: This study aims to evaluate the effect of adipose-derived stromal vascular fraction (SVF) on osteochondral defects treated by hyaluronic acid (HA)-based scaffold in a rabbit model. Materials and methods: Eighteen white New Zealand rabbits were randomly grouped into the experimental group (n=9) and control group (n=9). In all groups, osteochondral defects were induced on the weight-bearing surfaces of the right femoral medial condyles, and a HA-based scaffold was applied to the defect area with microfractures (MFs). In this study, 1 mL of adipose-derived SVF was injected into the knee joints of the rabbits in the experimental group. For histological and macroscopic evaluation, four rabbits were randomly selected from each group at Week 4, and the remaining rabbits were sacrificed at the end of Week 8. Macroscopic assessments of all samples were performed based on the Brittberg scoring system, and microscopic evaluations were performed based on the O’Driscoll scores. Results: Samples were taken at Weeks 4 and 8. At Week 4, the O’Driscoll scores were significantly higher in the control group than the experimental group (p=0.038), while there was no significant difference in the Brittberg scores between the two groups (p=0.108). At Week 8, the O’Driscoll score and Brittberg scores were statistically higher in the experimental group than in the control group (p=0.008 and p=0.007, respectively). According to the microscopic evaluation, at the end of Week 8, the cartilage thickness was greater in the experimental group, and nearly all of the defect area was filled with hyaline cartilage. Conclusion: Application of adipose-derived SVF with MF-HA-based scaffold was better than MF-HA-based scaffold treatment in improving osteochondral regeneration. Therefore, it can be used in combination with microfracture and scaffold to accelerate cartilage regeneration, particularly in the treatment of secondary osteoarthritis.

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“…Besides weak evidence of ankle osteoarthritis, there are studies that show good results with HA injection for primary OLT has proven to have the quite favorable results. 8,30…”

Section: Discussionmentioning

confidence: 99%

“…Besides weak evidence of ankle osteoarthritis, there are studies that show good results with HA injection for primary OLT has proven to have the quite favorable results. 8,30 To our knowledge, no previous study has investigated HA treatments for recurrent or unresolved ankle pain after arthroscopic bone marrow stimulation. Only a few studies on the use of HA in OLT have been published.…”

Section: Discussionmentioning

confidence: 99%

Intra-articular Injections of Hyaluronic Acid on Osteochondral Lesions of the Talus After Failed Arthroscopic Bone Marrow Stimulation

et al. 2020

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Background: The purpose of the study was to compare clinical and functional outcomes before and after hyaluronic acid (HA) injections in patients with osteochondral lesions of the talus who experienced a failure of their primary treatment with arthroscopic microfracture surgery. Methods: A total of 40 patients were included in the final study. These patients had received microfracture surgery but continued to experience postoperative pain over an average of 13.0 months (range, 0-81 months) and were available for investigation with a mean follow-up for 29.1 months (SD 14.7; range 2.6-79.6 months). All patients received intra-articular injections of HA once per week for 3 weeks. We assessed clinical and functional outcomes before and after injection using the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Short Form Health Survey (SF-36), the visual analog scale (VAS) for pain, and the Alexander subjective scale. Results: The AOFAS score significantly increased from 50.7 ± 13.8 to 79.9 ± 13.8 and the FAOS scores for symptom, pain, daily living, and sports were significantly higher postinjection compared to preinjection (all P < .001). Similarly, the mean VAS for pain was significantly decreased after 6 weeks following injection and continued to decrease over the follow-up period; the mean VAS was significantly lower postinjection compared to preinjection at 12 months ( P < .001). Conclusion: Intra-articular HA injections on average significantly improved clinical and functional scores after failed primary operative treatment. HA injections may provide an alternative to secondary operative treatment and provide better clinical outcomes than other conservative treatments. Level of Evidence: Level II, prospective observational cohort study.

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One step treatment of talus osteochondral lesions with microfracture and cell free hyaluronic acid based scaffold combination

Cited by 24 publications

References 34 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

Effects of adipose tissue-derived stromal vascular fraction on osteochondral defects treated by hyaluronic acid-based scaffold: An experimental study

Intra-articular Injections of Hyaluronic Acid on Osteochondral Lesions of the Talus After Failed Arthroscopic Bone Marrow Stimulation

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