High-Density Autologous Chondrocyte Implantation as Treatment for Ankle Osteochondral Defects

Abstract

Purpose Two-year follow-up to assess efficacy and safety of high-density autologous chondrocyte implantation (HD-ACI) in patients with cartilage lesions in the ankle. Design Twenty-four consecutive patients with International Cartilage repair Society (ICRS) grade 3-4 cartilage lesions of the ankle were included. Five million chondrocytes per cm2 of lesion were implanted using a type I/III collagen membrane as a carrier and treatment effectiveness was assessed by evaluating pain with the visual analogue scale (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at baseline, 12-month, and 24-month follow-up, together with dorsal and plantar flexion. Magnetic resonance observation for cartilage repair tissue (MOCART) score was used to evaluate cartilage healing. Histological study was possible in 5 cases. Results Patients’ median age was 31 years (range 18-55 years). Median VAS score was 8 (range 5-10) at baseline, 1.5 (range 0-8) at 12-month follow-up, and 2 (rang e0-5) at 24-month follow-up ( P < 0.001). Median AOFAS score was 39.5 (range 29-48) at baseline, 90 (range 38-100) at 12-month follow-up, and 90 (range 40-100) at 24-month follow-up ( P < 0.001). Complete dorsal flexion significantly increased at 12 months (16/24, 66.7%) and 24 months (17/24, 70.8%) with regard to baseline (13/24, 54.2%) ( P = 0.002). MOCART at 12- and 24-month follow-ups were 73.71 ± 15.99 and 72.33 ± 16.21. Histological study confirmed that neosynthetized tissue was cartilage with hyaline extracellular matrix and numerous viable chondrocytes. Conclusion HD-ACI is a safe and effective technique to treat osteochondral lesions in the talus, providing good clinical and histological results at short- and mid-term follow-ups.

High-Density Autologous Chondrocyte Implantation (HD-ACI) in patients with bilateral knee chondral defects

“…Another secondary finding in our work was that improvement in VAS and IKDC was not cartilage defect location-or size-dependent. We also found the lack of influence of both factors in HD-ACI treatment in patients with unilateral cartilage defects (12,13).…”

“…The technique has been developed from the first publication of ACI, in which cells were implanted in liquid medium under a periosteal flap (9), to the current use of biomaterials such as porcine type I/III collagen membranes in MACI (10) and high-density autologous chondrocyte implantation (HD-ACI) (11). Although this last alternative, as well as the other ACI variants, is a two-step technique implying two surgeries (a first surgery to take a biopsy of healthy cartilage as a cell source and a second one to implant cultured chondrocytes), it has been successfully used to treat knee or talus chondral defects (12,13).…”

The management of talar osteochondral lesions - Current concepts

“… 58 , 59 Chondrocytes are enzymatically extracted from the cartilage and culture-expanded in vitro prior to being re-implanted into the defect some 3–4 weeks later, beneath either a periosteal patch or a commercially available type I/III collagen patch. 60 Alternatively, extracted chondrocytes can be cultured directly on the collagen patch, a procedure known as matrix-assisted ACI, or MACI. Pagliazzi et al.…”

Outcomes from Osteochondral Autograft Transplant or Mosaicplasty in 26 Patients with Type V Osteochondral Lesions of the Talus

“…OLTs may occur when an ankle sprain or fracture causes the talar dome to hit the distal tibia plafond [ 2 ]. Although the incidence rate is relatively low, in most cases, it is necessary to heal the cartilage and osteochondral talus injury because it has a great influence on daily life, particularly in young people and those who wish to actively participate in sports [ 3 ]. Indeed, nondisplaced cartilage lesions were often treated with a nonoperative approach, and symptomatic injuries were surgically treated [ 4 – 6 ].…”