Functional Medium-Term Results After Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Prospective Cohort Study

Gottschalk, Oliver; Altenberger, Sebastian; Baumbach, Sebastian Felix; Kriegelstein, S.; Dreyer, Florian; Mehlhorn, Alexander T.; Hörterer, Hubert; Töpfer, Andreas; Röser, Anke; Walther, Markus

doi:10.1053/j.jfas.2017.05.002

Cited by 54 publications

(37 citation statements)

References 50 publications

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“…The FAOS sports score was reported by 2 studies, 35,54 1 study reported on the Foot and Ankle Disability Index (FADI) sports subscale, 8 and 1 study reported on the German Foot Function Index (FFI-D) sports subscale. 25 Because of low reporting, these scores were not further analyzed.…”

Section: Resultsmentioning

confidence: 99%

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

Steman

Dahmen

Lambers

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: Osteochondral defects (OCDs) of the talus are found subsequent to ankle sprains and ankle fractures. With many surgical treatment strategies available, there is no clear evidence on return-to-sport (RTS) times and rates. Purpose: To summarize RTS times and rates for talar OCDs treated by different surgical techniques. Study Design: Systematic review; Level of evidence, 4. Methods: The literature from January 1996 to November 2018 was screened, and identified studies were divided into 7 different surgical treatment groups. The RTS rate, with and without associated levels of activity, and the mean time to RTS were calculated per study. When methodologically possible, a simplified pooling method was used to combine studies within 1 treatment group. Study bias was assessed using the MINORS (Methodological Index for Non-Randomized Studies) scoring system. Results: A total of 61 studies including 2347 talar OCDs were included. The methodological quality of the studies was poor. There were 10 retrospective case series (RCSs) that investigated bone marrow stimulation in 339 patients, with a pooled mean rate of RTS at any level of 88% (95% CI, 84%-91%); 2 RCSs investigating internal fixation in 47 patients found a pooled RTS rate of 97% (95% CI, 85%-99%), 5 RCSs in which autograft transplantation was performed in 194 patients found a pooled RTS rate of 90% (95% CI, 86%-94%), and 3 prospective case series on autologous chondrocyte implantation in 39 patients found a pooled RTS rate of 87% (95% CI, 73%-94%). The rate of return to preinjury level of sports was 79% (95% CI, 70%-85%) for 120 patients after bone marrow stimulation, 72% (95% CI, 60%-83%) for 67 patients after autograft transplantation, and 69% (95% CI, 54%-81%) for 39 patients after autologous chondrocyte implantation. The mean time to RTS ranged from 13 to 26 weeks, although no pooling was possible for this outcome measure. Conclusion: Different surgical treatment options for talar OCDs allow for adequate RTS times and rates. RTS rates decreased when considering patients’ return to preinjury levels versus return at any level.

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Section: Resultsmentioning

confidence: 99%

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

Steman

Dahmen

Lambers

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…In accordance with our results, most studies about AMIC-treated OLTs could not show any significant influence of these demographical factors. 11,24,47 D’Ambrosi et al 11 performed arthroscopic AMIC in 31 OLTs and did not find any age-related differences. However, the preoperative and final functional results were inferior in the subgroup aged >33 years, which may indicate that the preoperative ankle status is a negatively influencing factor.…”

Section: Discussionmentioning

confidence: 96%

“…Since OLTs are often already symptomatic among young and athletic patients, there is a need for long-term clinical results after AMIC repair. Gottschalk et al 24 reported clinical improvement from 1- to 5-year follow-up, yet no studies examined the clinical outcomes beyond 5 years. In the present study, subgroup analysis revealed a slightly lower mean AOFAS score for patients with follow-up >5 years versus 2 to 5 years (92.5 vs 93.5 points).…”

Section: Discussionmentioning

confidence: 99%

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

et al. 2019

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Background: Autologous matrix-induced chondrogenesis (AMIC) has become an interesting treatment option for osteochondral lesions of the talus (OLTs) with promising clinical short- to midterm results. Purpose: To investigate the clinical and radiological outcome of the AMIC procedure for OLTs, extending the follow-up to 8 years. Study Design: Case series; Level of evidence, 4. Methods: Thirty-three patients (mean age, 35.1 years; body mass index, 26.8) with osteochondral lesions of the medial talar dome were retrospectively evaluated after open AMIC repair at a mean follow-up of 4.7 years (range, 2.3-8.0 years). Patients requiring additional surgical procedures were excluded. All OLTs (mean size, 0.9 cm2; range, 0.4-2.3 cm2) were approached through a medial malleolar osteotomy, and 28 patients received subchondral autologous bone grafting. Data analysis included the visual analog scale for pain, the American Orthopaedic Foot and Ankle Society score for ankle function, the Tegner score for sports activity, and the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system for repair cartilage and subchondral bone evaluation. Results: Mean ± SD visual analog scale score improved significantly from 6.4 ± 1.9 preoperatively to 1.4 ± 2.0 at latest follow-up ( P < .001). The mean American Orthopaedic Foot and Ankle Society score was 93.0 ± 7.5 (range, 75-100). The Tegner score improved significantly from 3.5 ± 1.8 preoperatively to 5.2 ± 1.7 at latest follow-up ( P < .001), and 79% returned to their previous sports levels. The MOCART score averaged 60.6 ± 21.2 (range, 0-100). Complete filling of the defect was seen in 88% of cases, but 52% showed hypertrophy of the cartilage layer. All but 1 patient showed persistent subchondral bone edema. The patient’s age and body mass index, the size of the osteochondral lesion, and the MOCART score did not show significant correlation with the clinical outcome. There were no cases of revision surgery for failed AMIC. Fifty-eight percent underwent reoperation, mainly for symptomatic hardware after malleolar osteotomy. Conclusion: AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. The MOCART score did not correlate with the good clinical results; the interpretation of postoperative imaging remains therefore challenging.

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“…Com um acompanhamento mínimo de dois anos, Walther et al, Valderrabano e outros autores relataram excelentes resultados clínicos e radiológicos usando AMIC®, atingindo altas pontuações AOFAS e MOCART (16,17) . Em um estudo de coorte prospectivo muito recente, Gottschalk et al corroboram esses achados, atingindo alta satisfação clínica em um seguimento de 5 anos, o seguimento mais longo da literatura (18) . Os maiores benefícios da técnica foram observados no primeiro ano; no entanto, a satisfação clínica adicional foi atingida após 5 anos.…”

Section: Discussionunclassified

“…Entre as novas alternativas para tratar essas lesões, a Condrogênese Autóloga Induzida por Matriz (AMIC®) provou fornecer resultados satisfatórios em um seguimento de médio prazo (6) . AMIC® combina microfraturas com a aplicação de Chondro-Gide®, uma matriz de dupla camada de colágeno tipo I/III (Geistlich Surgery, Wolhusen, Suíça), usada para estabilizar e proteger o coágulo sanguíneo que resulta das microfraturas do osso subcondral.…”

Section: Introductionunclassified

All-arthroscopic AMIC® (AT-AMIC) in the treatment of osteochondral talar lesions

Baumfeld

Prado

et al. 2018

Sci J Foot Ankle

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Objective: The objective of this study was to report the postoperative clinical outcomes of patients undergoing the all-arthroscopic AMIC® technique (AT-AMIC®) combined with autologous bone graft placement as necessary. Methods: This was a case series of 17 consecutive patients who underwent AT-AMIC® between January 2016 and April 2017. Nine men and eight women between 15 and 67 years of age were diagnosed with an osteochondral talar lesion (OTL) and underwent surgery only after failure ofconservative treatment of at least 3 months. Patients answered the AOFAS scale before surgery and at the final follow-up session, which ranged from 8 to 20 months. Results: The mean size of the OTLs was 1.16cm2, and “Raikin-4” was the most common site of lesions (71%). Calcaneal osteotomy was the mostcommonly associated procedure (18%). The mean follow-up period was 12.3 months. The mean AOFAS score before surgery was 46.4 points, rising to 89.5 points at the last follow-up, and this difference was statistically significant (p<0.001). No complications were observed in any of the treated patients. Conclusion: AT-AMIC® is a reliable and reproducible treatment method for OTLs and achieves high postoperative clinical scores with very low complication rates. Level of Evidence IV; Therapeutic Studies; Case Series.

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Functional Medium-Term Results After Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Prospective Cohort Study

Cited by 54 publications

References 50 publications

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

Return to Sports After Surgical Treatment of Osteochondral Defects of the Talus: A Systematic Review of 2347 Cases

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study

All-arthroscopic AMIC® (AT-AMIC) in the treatment of osteochondral talar lesions

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