Research Article: Three-Dimensional Matrix-Induced Autologous Chondrocytes Implantation for Osteochondral Lesions of the Talus: Midterm Results

Date Published: April 17, 2012

Publisher: Hindawi Publishing Corporation

Author(s): B. Magnan, E. Samaila, M. Bondi, E. Vecchini, G. M. Micheloni, P. Bartolozzi.


Introduction. We evaluate the midterm results of thirty patients who underwent autologous chondrocytes implantation for talus osteochondral lesions treatment. Materials and Methods. From 2002 to 2009, 30 ankles with a mean lesion size of 2,36 cm2 were treated. We evaluated patients using American Orthopaedic Foot and Ankle Surgery and Coughlin score, Van Dijk scale, recovering time, and Musculoskeletal Outcomes Data Evaluation and Management System. Results. The mean AOFAS score varied from 36.9 to 83.9 at follow-up. Average of Van Dijk scale was 141.1. Coughlin score was excellent/good in 24 patients. MOCART score varied from 6.3 to 3.8. Discussion. This matrix is easy to handle conformable to the lesion and apply by arthroscopy. No correlation between MRI imaging and clinical results is found. Conclusions. Our results, compared with those reported in literature with other surgical procedures, show no superiority evidence for our technique compared to the others regarding the size of the lesions.

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Ankle sprain is the most common trauma in sports, and an osteochondral lesion occurs, in up to 50% of an acute ankle trauma [1, 2]. Every day 1 out of 10000 people undergoes to an ankle injury, and in sports practice, this incidence becomes 5,23 out of 10000 [3–5]. The incidence of these lesions is more frequent in male (70%), with an average age ranging between 20 and 30 years, and is bilateral in 10% of cases [6]. The symptoms are impaired function, limited range of motion, stiffness, ankle pain even after a mild traumatic event, or chronic ankle pain [7, 8].

This study was approved by the institutional review board.

The average follow-up was 45 months (range, 18–96 months).

In literature many authors reported different treatments of the osteochondral lesion [31, 32], but a true comparison between studies is difficult considering the different rating scales used, as indicated by Zengerink et al. in a meta-analysis [33], in which so many scores as AOFAS Ankle-Hindfoot scale, Hannover score, patient satisfaction score, criteria proposed by Berndt and Harty, visual analog scale, Martin score, Alexander and Lichtman, Ogilvie Harris score, MODEMS (Musculoskeletal Outcomes Data Evaluation and Management System), Karlsson scoring scale, Tegner score, evaluation proposed by Loomer, Mazur score, Freiburg ankle score, SANE (Single Assessment Numeric Evaluation), according to Thompson and Loomer, and McCullough score are used for clinical assessment.

Three-dimensional matrices can be considered for single Outerbridge lesions type 3 or 4, sized more than 1,5 cm², patients aged less than 50 years without degenerative changes. Contraindications are overweight patients, “kissing lesions”, patients aged more than 50 years, diabetic or HCV patients, and rheumatologic pathology.