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

Abstract

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 (n = 13) 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.

• Authors: Sven Anders, Juergen Goetz, Thomas Schubert, Joachim Grifka, Jens Schaumburger
• Journal: International orthopaedics (Int Orthop) Vol. 36 Issue 11 Pg. 2279-85 (Nov 2012) ISSN: 1432-5195 [Electronic] Germany
• PMID: 22885840 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Ankle Injuries (pathology, surgery)
• Arthroplasty, Subchondral (methods)
• Cartilage (transplantation)
• Cartilage, Articular (pathology, surgery)
• Cell Transplantation (methods)
• Chondrocytes (transplantation)
• Diagnostic Self Evaluation
• Female
• Health Status Indicators
• Humans
• Male
• Talus (injuries, pathology, surgery)
• Transplantation, Autologous
• Treatment Outcome
• Young Adult