Surgical Treatment of Osteochondral Lesions of the Talus in Young Active Patients

Regenerative treatment in osteochondral lesions of the talus: autologous chondrocyte implantation versus one-step bone marrow derived cells transplantation

“…The goal of the finest surgical procedure should be the regeneration, restoring worn tissue with high biomechanical quality hyaline cartilage. To date, only osteochondral grafts and regenerative techniques, like autologous chondrocyte implantation (ACI) and bone marrow-derived cell transplantation (BMDCT), have proven effective at this purpose [4][5][6][7][8][9][10][11][12][13]. Nevertheless, osteochondral autograft is a technically demanding procedure with many drawbacks, and other techniques may be preferable [4].…”

“…Nevertheless, osteochondral autograft is a technically demanding procedure with many drawbacks, and other techniques may be preferable [4]. ACI, firstly proposed for knee lesions, is a consolidated and valuable technique for OLT, even at long-term follow-up [4][5][6][7][8]. The chondrocytes are harvested from a non-bearing area of the knee joint, a peri-lesional area or a loose body, then are cultured, expanded and seeded on a scaffold [5].…”

“…The Bone step^BMDCT technique is based on the mesenchymal stem cells coming from the aspiration of bone marrow [8,14]. These cells are capable of differentiation in many lineages, like bone and cartilage, under the stimulation of paracrine factors from the micro-environment [13,15,16].…”

“…These cells are capable of differentiation in many lineages, like bone and cartilage, under the stimulation of paracrine factors from the micro-environment [13,15,16]. After the aspiration of the stem cells and their Bniche^from the iliac crest, the whole bone marrow aspirate is concentrated directly in operating room and then loaded on a scaffold and implanted [5,8,13]. The procedure can be easily performed arthroscopically, in a single surgical procedure [5,8].…”

“…After the aspiration of the stem cells and their Bniche^from the iliac crest, the whole bone marrow aspirate is concentrated directly in operating room and then loaded on a scaffold and implanted [5,8,13]. The procedure can be easily performed arthroscopically, in a single surgical procedure [5,8].…”