Stephanie Geyer1, Jens Mattes2, Wolf Petersen3, Andreas B Imhoff4, Andrea E Achtnich1. 1. Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany. 2. Department for Trauma Surgery, Klinikum Wels-Grieskirchen, Grieskirchner Straße 42, 4600, Wels, Austria. 3. Department for Orthopaedic and Trauma Surgery, Martin-Luther-Krankenhaus, Caspar-Theyß-Straße 27-31, 14193, Berlin, Germany. 4. Department for Orthopaedic Sports Medicine, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany. imhoff@tum.de.
Abstract
OBJECTIVE: All arthroscopic one-step treatment of osteochondral defects of the talus with matrix-assisted bone marrow stimulation with a cell-free hyaluronic acid 3D matrix. INDICATIONS: Symptomatic osteochondral defects of the talus (1-2 cm2, ICRS III-IV). CONTRAINDICATIONS: Large non-shouldered osteochondral defects (2 cm2) of the talus, arthritis, kissing lesions of the distal tibia, metabolic arthropathies, non-reconstructable defects, hindfoot malalignment, chronic inflammatory systemic disorders. SURGICAL TECHNIQUE: Arthroscopic examination of the ankle joint and visualization of the osteochondral defect of the talus to confirm the indication via standard portals. First, debridement of the osteochondral defect with arthroscopic curette or shaver, removal of loose fragments, resection of the sclerotic bone via shaver and measurement of the defect size. Second, multiple perforation of the subchondral plate to recruit mesenchymal stem cells from the underlying bone marrow by an microfracturing awl to stimulate the differentiation of fibrocartilaginous repair tissue in the defect zone. Then, the cell-free hyaluronic acid 3D matrix is placed into the defect via arthroscopic forceps and modulated by a probe to avoid detachment of the matrix by ankle joint movement. POSTOPERATIVE MANAGEMENT: Postoperative management includes movement restrictions for pro- and supination but free passive dorsal extension and plantar flexion. No weight-bearing is allowed for 6 weeks. RESULTS: Twenty-three patients (male: 11/women: 12) with a mean age of 33 years (range: 18-56) and a minimum follow-up of 24 months were included in this retrospective two-center study. The mean values for Foot and Ankle Outcome Score (FAOS) were 79 (range 33-93), for Tegner score 3 (range: 1-5) and the Visual analog scale (VAS) pain 1 (range: 0-3) and VAS function 2 (range: 0-5). At follow-up, MRI was available in 17 of 23 patients. MRI results showed a mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score of 81 (range: 65-90). Complications were not observed during the follow-up period.
OBJECTIVE: All arthroscopic one-step treatment of osteochondral defects of the talus with matrix-assisted bone marrow stimulation with a cell-free hyaluronic acid 3D matrix. INDICATIONS: Symptomatic osteochondral defects of the talus (1-2 cm2, ICRS III-IV). CONTRAINDICATIONS: Large non-shouldered osteochondral defects (2 cm2) of the talus, arthritis, kissing lesions of the distal tibia, metabolic arthropathies, non-reconstructable defects, hindfoot malalignment, chronic inflammatory systemic disorders. SURGICAL TECHNIQUE: Arthroscopic examination of the ankle joint and visualization of the osteochondral defect of the talus to confirm the indication via standard portals. First, debridement of the osteochondral defect with arthroscopic curette or shaver, removal of loose fragments, resection of the sclerotic bone via shaver and measurement of the defect size. Second, multiple perforation of the subchondral plate to recruit mesenchymal stem cells from the underlying bone marrow by an microfracturing awl to stimulate the differentiation of fibrocartilaginous repair tissue in the defect zone. Then, the cell-free hyaluronic acid 3D matrix is placed into the defect via arthroscopic forceps and modulated by a probe to avoid detachment of the matrix by ankle joint movement. POSTOPERATIVE MANAGEMENT: Postoperative management includes movement restrictions for pro- and supination but free passive dorsal extension and plantar flexion. No weight-bearing is allowed for 6 weeks. RESULTS: Twenty-three patients (male: 11/women: 12) with a mean age of 33 years (range: 18-56) and a minimum follow-up of 24 months were included in this retrospective two-center study. The mean values for Foot and Ankle Outcome Score (FAOS) were 79 (range 33-93), for Tegner score 3 (range: 1-5) and the Visual analog scale (VAS) pain 1 (range: 0-3) and VAS function 2 (range: 0-5). At follow-up, MRI was available in 17 of 23 patients. MRI results showed a mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score of 81 (range: 65-90). Complications were not observed during the follow-up period.
Authors: Charles P Hannon; Christopher D Murawski; Ashraf M Fansa; Niall A Smyth; Huong Do; John G Kennedy Journal: Am J Sports Med Date: 2012-09-11 Impact factor: 6.202