Clinical and imaging outcome of osteochondral lesions of the talus treated using autologous matrix-induced chondrogenesis technique with a biomimetic scaffold

Abstract

BackgroundThe purpose of our study was to assess the clinical and imaging outcome of autologous matrix-induced chondrogenesis (AMIC) technique consisting of microfractures followed by the filling of osteochondral lesions of the talus (OLTs) with a cell-free biphasic collagen-hydroxyapatite osteochondral scaffold (MaioRegen).MethodsSixteen patients (eight males, age: 42.6 ± 18.4, range 14–74) with OLT repaired using AMIC technique, with implantation of MaioRegen, were clinically evaluated through the American Orthopedic Foot and Ankle Society Score (AOFAS) and a 10-point Visual Analogue Scale (VAS) pain score after a mean follow-up of 30 ± 16.9 months. The MRI examinations were performed 12 and 24 months after surgery. A paired t-test was applied to compare pre- and post-operative clinical findings (VAS and AOFAS) and Magnetic resonance observation of cartilage repair tissue (MOCART) score changes in the follow-up. To assess the correlation between variation of AOFAS and MOCART scores, the Pearson’s correlation coefficient was calculated.ResultsNo complications after surgery were encountered. From pre-operative to post-operative values, there was a significant (P < 0.001) reduction of mean VAS pain score (6.3 ± 0.9,range: 4–8 and 2.9 ± 1.8,range: 0–6, respectively) and increase of AOFAS score (60.2 ± 7.8,range: 50–74 and 77.4 ± 16.2,range: 50–100, respectively). Among 16 patients, six (37%) were not satisfied at the end of follow-up, six (37%) were moderately satisfied and four (25%) were highly satisfied. The treatment was considered failed in five out of 16 patients (31%). Among them, four (25%) required re-interventions with implantation of ankle prostheses, whereas one patient was treated with a further AMIC technique combined with autologous bone graft and platelet-rich plasma. The mean MOCART score was 41.9 ± 14.6 (25–70) 12 months after surgery and 51.9 ± 11.6 (30–70) after 24 months, with a statistically significant increase (P = 0.012). However, no correlation was seen between AOFAS and MOCART changes (r = 0.215, p = 0.609).ConclusionThe high rates of treatment failure encountered in our study using MaioRegen need to be confirmed by larger studies and should induce the scientific community questioning the reliability of this biomimetic scaffold for the treatment of OLTs.

Assesment of the Degree of Traumatic Lesions of Syndesmosis in the Functions of the Ankle Joint

“…The results were obtained using the American Ortopaedic Foot and Ankle Society score (AOFAS). 10,11 The study consisted of 58 (57.87%) male respondents and 44 (43.13%) female respondents. In G1, there were 32 male and 16 female respondents, while in G2 there were 28 male and 26 female respondents.…”

“…The research methods used the analysis of the database of the Clinic for Orthopedics and Traumatology UCC Sarajevo: electronic and paper forms, history of diseases, discharge summary, questionnaire and patients' check-up as predicted by the AOFAS score. 10,11 Nonparametric χ2-test and, where necessary, the Fisher's exact test were used to test the differences in categorical dependent variables.…”

Mesenchymal Stem Cells: Potential Role in the Treatment of Osteochondral Lesions of the Ankle

“…However, at this short follow‐up period, no difference was found in the clinical outcome between the two groups. Despite their promise, the clinical findings of BST‐CarGel and other scaffolds such as collagen I/III matrices and Maioregen® are unreliable. Therefore, more biomaterials will need to be licensed and clinically examined before the evidence‐base is sufficient to support their mainstream adoption.…”

“…After the operation, a coagulate forms within the biomaterial leading to chondrogenesis. Two biomaterials used in recent publications are a solid, acellular collagen I/III matrix of porcine origin and MaioRegen®, a solid collagen I and magnesium‐hydroxyapatite matrix . The matrices are bilaminar and trilaminar, respectively, consisting of a compact upper construct that contains the blood coagulate within the defect and a porous lower side composed of loose collagen fibers to support chondrogenesis and osteogenesis.…”

“…A clear advantage of autologous matrix‐induced chondrogenesis is its one‐step and “off‐the‐shelf” nature. Nevertheless, the short‐term clinical results for treating OCLA have been poor, with short‐term follow‐up showing inconsistent tissue regeneration, hypertrophic cartilage, and high treatment failure rates . As early results are not encouraging, it remains too early to confirm if this method of integrating biomaterials with BMSCs will become truly validated.…”