Surgical Treatment of Osteochondral Lesions of the Talus by Open-Field Autologuous Chondrocyte Implantation

Giannini, Sandro; Battaglia, Milva; Buda, Roberto; Cavallo, Marco; Ruffilli, Alberto; Vannini, Francesca

doi:10.1177/0363546509349928

Cited by 122 publications

(100 citation statements)

References 39 publications

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“…The results of our study are consistent with these findings reflecting a high and stable postoperative outcome in the AOFAS score and patient-derived evaluation. In contrast to other shorter-termed studies, we could not detect age, size, previous intervention or duration of symptoms as influencing factors for the clinical outcome [11,17,19,23]. ACI is a proven sophisticated cell-based technique for cartilage repair.…”

Section: Discussioncontrasting

confidence: 81%

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Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation—results at five years

Anders

Goetz

Schubert

et al. 2012

International Orthopaedics (SICOT)

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Purpose Treatment of focal full-thickness chondral or osteochondral defects of the talus remains a challenge. The aim of this study was to evaluate the postoperative success and the long-term efficacy of matrix associated autologous chondrocyte implantation in these defects. Methods Matrix associated autologous chondrocyte implantation (MACI) was applied in 22 consecutive patients (mean age 23.9 years) with full-thickness chondral or osteochondral lesions of the talus. The average defect-size was 1.94 cm² (range 1-6). In case of osteochondritis dissecans (n013) an autologous bone graft was performed simultaneously. Follow-ups were routinely scheduled up to 63.5 (±7.4) months, consisting of clinical evaluation and magnetic resonance imaging. Results The AOFAS score improved significantly from 70.1 to 87.9/92.6/93.5/95.0/95.5 and 95.3 points at three, six, 12, 24, 36 and 63.5 months, respectively. On a visual analogue scale, pain intensity decreased from 5.7 (±2.6) to 0.9 (±0.8) while subjective function increased from 5.3 (±2.3) to 8.9 (±0.9) at final follow-up (each p<0.001). The Tegner score rose significantly from 2.4 (±1.2) to 4.7 (±0.6). The MOCART score improved from 62.6 (±19.4) at three months to 83.8 (±9.4) at final follow-up. No significant differences were found between lesions caused by osteochondritis dissecans or trauma and between first-or second-line treatments. For all scores, the most benefit was seen within the first 12 months with stable results afterwards. No major complications were noted. Conclusions Matrix associated autologous chondrocyte implantation is capable of significant and stable long-term improvement of pain and functional impairment caused by focal full-thickness chondral and osteochondral talus lesions.

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Section: Discussioncontrasting

confidence: 81%

“…In the longest follow-up found in literature, Giannini et al [17] accounted a series of ten patients (defect size 3.1 cm²) with a follow-up of ten years. The AOFAS score was 37.9 points at baseline, 89.4 points at 12 months, 93.9 at 36 months and 92.7 points at final follow-up.…”

Section: Discussionmentioning

confidence: 99%

Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation—results at five years

Anders

Goetz

Schubert

et al. 2012

International Orthopaedics (SICOT)

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“…[16][17][18] However, Nam et al 18 did not recommend autologous chondrocyte implantation as an initial treatment option because the investigations on talar lesions were preliminary. Giza et al 17 suggested that matrix-induced autologous chondrocyte implantation into articular defects of the talus is a reasonable revision treatment for osteochondral defects of the talus in patients who do not respond to an initial bone marrow stimulation technique.…”

Section: Discussionmentioning

confidence: 99%

The “Cup-Shaped” Technique for Uncontained Osteochondral Lesion of the Talus

Yoshimura

Hagio

Naito

2013

Arthroscopy Techniques

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The arthroscopic bone marrow stimulation technique is defined as the first-line procedure for an osteochondral lesion of the talus. The containment of the lesion has been reported as 1 of the prognostic factors for clinical outcomes of arthroscopic bone marrow stimulation. It was surmised that lesions without a stable rim lose the protective border, thereby making stable formation of fibrocartilage less likely. The purpose of the cup-shaped technique is to improve the stability of blood clots after arthroscopic bone marrow stimulation in an uncontained lesion. The geometry of the lesion changes from "uncontained" to "contained like," which improves the stability of the blood clots.

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“…ACI is a cell-based, two-stage procedure. In the first procedure, healthy articular cartilage is harvested and the chondrocytes isolated by filtration are cultured for approximately 2 to 3 weeks [34]. In the second step, viable cultured chondrocytes are implanted into the defect site and covered by a periosteal flap harvested from the distal end of the tibia, facilitating a hyaline-like repair tissue.…”

Section: Autologous Chondrocyte Implantationmentioning

confidence: 99%

“…Additionally, it was found that the mean Tegner activity score improved from 1.6 to 4.3. Giannini et al [34] reported clinical and MRI outcomes at a 10-year follow-up following ACI for OLT. The authors evaluated 10 OLT patients with a mean lesion size of 3.1 cm 2 treated with ACI at a mean follow-up of 119 months.…”

Section: Autologous Chondrocyte Implantationmentioning

confidence: 99%

Osteochondral lesions of the talus in the athlete: up to date review

Shimozono

Yasui

Ross

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of review Osteochondral lesions of the talus (OLT) are common injuries in athletes. The purpose of this study is to comprehensively review the clinical results and return to sport capacity in athletes following treatment for OLT. Recent findings Reparative procedures, such as bone marrow stimulation, and replacement procedures, such as autologous osteochondral transplantation, provide good clinical outcomes in short-and mid-term follow-up in the athlete. Recently, biological augmentation and scaffold-based therapies have been shown to improve clinical and radiological outcomes in OLT in both the general population and athletes. Summary Most studies are of a low level of evidence. Studies analyzing the return to sport capability in athletes are further lacking. High-level evidence and well-designed clinical trials are required to establish the most effective treatment protocol.

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Surgical Treatment of Osteochondral Lesions of the Talus by Open-Field Autologuous Chondrocyte Implantation

Cited by 122 publications

References 39 publications

Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation—results at five years

Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation—results at five years

The “Cup-Shaped” Technique for Uncontained Osteochondral Lesion of the Talus

Osteochondral lesions of the talus in the athlete: up to date review

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