Background: Conventional autologous chondrocyte transplantation in the ankle often requires tibial or fibular osteotomies with potential morbidity for the patient. Advances in biotechnology and surgical techniques have resulted in the development of matrix-associated chondrocyte implantation (MACI). As the chondrocyte-loaded scaffold can be applied arthroscopically, this procedure is especially useful for the treatment of osteochondral defects in the ankle.
Hypothesis: Arthroscopic MACI is a safe procedure in the ankle with good clinical and magnetic resonance imaging results.
Study Design: Case series; Level of evidence, 4.
Methods: The authors reviewed all patients (n = 18) who had arthroscopic MACI for osteochondral lesions of the ankle (n = 19) between February 2006 and May 2008 clinically and with magnetic resonance imaging. The pain and disability module of the Foot Function Index (FFI), the American Orthopaedic Foot & Ankle Society (AOFAS) clinical rating system, the Core Scale of the Foot and Ankle Module of the American Academy of Orthopaedic Surgeons (AAOS) Lower Limb Outcomes Assessment Instruments, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score were used. The clinical results up to 3 years after MACI (mean follow-up, 24.5 months) were compared with preoperative data for 14 cases and the magnetic resonance imaging data for all 19.
Results: A significant improvement (50.3% ± 13.2%) in all clinical scores was noted (FFI pain before MACI: 5.5 ± 2.0, after MACI: 2.8 ± 2.2; FFI disability before MACI: 5.0 ± 2.3, after MACI: 2.6 ± 2.2; AOFAS before MACI: 58.6 ± 16.1, after MACI: 80.4 ± 14.1; AAOS standardized mean before MACI: 59.9 ± 16.0, after MACI: 83.5 ± 13.2; AAOS normative score before MACI: 23.0 ± 13.0, after MACI: 42.2 ± 10.7). According to the AOFAS Hindfoot score, 64% were rated as excellent and good, whereas 36% were rated fair and poor. The results correlated with the age of the patient and the duration of symptoms, but not with the size of the lesion. Sixteen patients (89%) reported regular sports activities before the onset of symptoms; 13 of them (81%) returned to sports after the MACI, 56% (n = 9) to the same level. The mean MOCART score was 62.4 ± 15.8 points. In general, there was no relation between MOCART score and clinical outcome, although the filling of the defect showed some correlation with the AAOS score.
Conclusion: Arthroscopic MACI is a safe procedure for the treatment of osteochondral lesions in the ankle with overall good clinical and magnetic resonance imaging results.
Background:
In operative treatment of Berndt and Harty stage 1 and stage 2 osteochondral lesions of the talus, the goal is revascularization. The use of computer-assisted guided retrograde drilling of osteochondral lesions has been described as a new technique with promising results.
Purpose:
This study reports the follow-up assessment of patients treated with Iso-C-3D-navigated retrograde drilling. Its aim was to establish whether the greater precision of computer-assisted drilling results in satisfactory clinical outcomes.
Study Design:
Case series; Level of evidence, 4.
Methods:
Patients who underwent navigated Iso-C-3D-based retrograde drilling between June 1, 2003, and July 31, 2005, were included in the follow-up study. Clinical outcomes were measured using (1) the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society and (2) the Visual Analogue Scale–Foot and Ankle. Radiological outcomes were assessed via radiographs and magnetic resonance imaging. Surgeon satisfaction was assessed using a simple 0 to 10 rating scheme for feasibility, accuracy, and clinical benefit.
Results:
Average follow-up time was 25 months (range, 20–34). Twenty patients satisfied the inclusion criteria: 12 men and 8 women; mean age, 35 years (range, 19–58). One patient was excluded because he required a cartilage restoration procedure. All scores improved at the time of follow-up—Ankle-Hindfoot Scale, from 76 to 90 (P < .001); Visual Analogue Scale–Foot and Ankle, from 79 to 92 (P < .001). The average ratings of the operating surgeons (n = 3) were as follows: feasibility 9.0 (range, 7.3–10.0); accuracy, 8.5 (range, 5.8–10.0); and clinical benefit, 8.5 (5.7–10.0). At follow-up, magnetic resonance imaging revealed an improvement of the Hepple score in 80% of patients.
Conclusion:
Arthroscopic treatment of osteochondral lesions of the talus is well established. A retrograde approach does not breach the overlying intact talar cartilage. The results of this follow-up study of 3-dimensional computer navigated drilling are promising.
Background: Autologous chondrocyte implantation (ACI) in the ankle was considered up to now an extremely technically demanding surgery with considerable morbidity for the patients.
Hypothesis: Hyalograft C scaffold allows arthroscopic ACI, thanks to a specifically designed instrumentation.
Study Design: Case series; Level of evidence, 4.
Methods: Forty-six patients with a mean age of 31.4 years (range, 20–47) underwent operation from 2001 to 2004. They had posttraumatic talar dome lesions, type II or IIA. In the first step of surgery, an ankle arthroscopy was performed, with cartilage harvest from the detached osteochondral fragment or from the margins of the lesion. Chondrocytes were cultured on a Hyalograft C scaffold. In the second step of surgery, the Hyalograft C patch was arthroscopically implanted into the lesion, with a specifically designed instrumentation. Lesions >5 mm deep were first filled with autologous cancellous bone. Patients were evaluated clinically with the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at 12 and 36 months after surgery. At a mean time interval of 18 months, the first 3 patients underwent a second-look arthroscopy with cartilage harvest from the implant and histological examination.
Results: The mean preoperative AOFAS score was 57.2 ± 14.3. At the 12-month follow-up, the mean AOFAS score was 86.8 ± 13.4 (P < .0005), while at 36 months after surgery, the mean score was 89.5 ± 13.4 (P < .0005). Clinical results were significantly related to the age of patients and to previous operations for cartilage repair. The results of the histological examinations revealed hyaline-like cartilage regeneration.
Conclusions: The Hyalograft C scaffold and the specifically designed instrumentation allowed arthroscopic implantation of chondrocytes, with excellent clinical and histological results.
