Repair of Bone Defect of the Talus with Calcaneus Autograft and Autologous Matrix-Induced Chondrogenesis: A Case Report

Abstract

Background. The question of choosing a treatment strategy for full-thickness osteochondral defects of the tarsal bone remains relevant. When choosing a treatment strategy, two key points should be considered: restoring the architecture of the tarsal bone and achieving long-term restoration of cartilage-like coverage in the area of the osteochondral defect.
 Case report. A 34-year-old physically active patient sustained an ankle injury in 2011 and was treated conservatively. In 2020, he complained of pain and reduced activity. Initial assessment scores were: VAS (Visual Analog Scale) — 6 points, AOFAS-AHS (American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score) — 49 points, FAAM (Foot and Ankle Ability Measure) — 55 points. An MRI revealed an osteochondral defect in the medial part of the tarsal bone dome, measuring 16.4×9.4 mm and with a depth of 20.8 mm. The patient underwent the replacement of the bone defect with an autograft taken from the heel bone, using autologus matrix induced chondrogenesis (AMIC) procedure. After 6 months, a follow-up examination was performed, including ankle arthroscopy and removal of metal fixators. Arthroscopic findings showed that the chondroplasty area was almost identical to intact joint cartilage. One year after chondroplasty, the patient returned to his previous level of physical activity. Assessment scores were: VAS — 1 point, AOFAS-AHS — 94 points, FAAM — 83 points.
 Conclusion. The proposed method allows for the restoration of the architecture of the tarsal bone along with the cartilage surface. The use of a bone autograft helps to fill the tarsal bone defect, and covering the autograft with a collagen membrane contributes to the formation of hyaline-like cartilage tissue in the defect area.