The use of fibrin matrix-mixed gel-type autologous chondrocyte implantation in the treatment for osteochondral lesions of the talus

Abstract

PurposeThis study assessed the clinical results and second-look arthroscopy after fibrin matrix-mixed gel-type autologous chondrocyte implantation to treat osteochondral lesions of the talus.MethodsChondrocytes were harvested from the cuboid surface of the calcaneus in 38 patients and cultured, and gel-type autologous chondrocyte implantation was performed with or without medial malleolar osteotomy. Preoperative American orthopedic foot and ankle society ankle-hind foot scores, visual analogue score, Hannover scoring system and subjective satisfaction were investigated, and the comparison of arthroscopic results (36/38, 94.7 %) and MRI investigation of chondral recovery was performed. Direct tenderness and relationship to the active daily life of the donor site was evaluated.ResultsThe preoperative mean ankle–hind foot scores (71 ± 14) and Hannover scoring system (65 ± 10) had increased to 91 ± 12 and 93 ± 14, respectively, at 24-month follow-up (p < 0.0001), and the preoperative visual analogue score of 58 mm had decreased to 21 mm (p < 0.0001). Regarding subjective satisfaction, 34 cases (89.5 %) reported excellent, good or fair. Chondral regeneration was analysed by second-look arthroscopy and MRI. Complications included one non-union and two delayed-unions of the osteotomy sites, and 9 ankles (9/31, 29.0 %) sustained damaged medial malleolar cartilage due to osteotomy. Marked symptoms at the biopsy site did not adversely affect the patient’s active daily life.ConclusionsFibrin matrix-mixed gel-type autologous chondrocyte implantation using the cuboid surface of the calcaneus as a donor can be used for treating osteochondral lesions of the talus.Level of evidenceTherapeutic study, prospective case series, Level IV.

No superior treatment for primary osteochondral defects of the talus

“…The other three publications performed a MACI procedure with a total of 46 ankles, and the success percentages ranged from 80 to 100% [CI 38–100%] as illustrated in Fig. 3 [4, 66, 84]. …”

Scaffolds based therapy for osteochondral lesions of the talus: A systematic review

“…The weighted mean MCMS of the overall population of studies was 49.3 ± 10.0 out of a possible 100 points. There were seven studies (25%) of fair quality [ 8 , 18 , 20 , 21 , 30 , 31 , 38 ] and the remainder (75%) were of poor quality[ 4 - 7 , 16 , 17 , 19 , 22 - 29 , 32 - 37 ] (Table 5 ). Further QOE data is shown in Table 5 .…”

“…Clinical outcomes were evaluated using a number of different scoring systems for scaffolds-based therapy for OLT (Table 7 ). The American Orthopaedic Foot and Ankle Society (AOFAS) score was the most frequently utilized in 25 studies of the included[ 4 - 8 , 16 - 18 , 20 - 34 , 37 , 38 ]. Of the 25 studies that used AOFAS, 22 studies investigated both pre- and post-operative scores[ 4 - 8 , 16 , 18 , 20 - 23 , 25 - 32 , 34 , 37 , 38 ].…”

“…Twelve of 13 MACT groups reported pre and postoperative AOFAS scores and of the 310 patients who underwent MACT[ 5 , 6 , 16 - 18 , 20 - 26 ], the mean AOFAS score improved from 59.1 to 86.7 at a mean follow-up of 47.9 mo. Of the 416 patients from the nine BMDCT groups[ 4 , 8 , 26 - 31 ], the mean AOFAS score improved from 61.1 to 88.2 at a mean of 32.7 mo of follow-up.…”

“…In this systematic review, 12 procedure groups reported sequential clinical outcomes at two or more post-operative time points[ 4 , 5 , 8 , 18 , 20 , 21 , 26 , 28 - 31 ]. Four groups, which were all BMDCT studies, found temporal improvement in AOFAS scores over the first 2-3 years of post-operative follow-up with a mean decrease in AOFAS score of 87.1 reported at a mean 41.8 mo follow-up[ 4 , 28 , 29 , 31 ].…”