Human Amniotic Allograft in Use on Talar Dome Lesions: A Prospective Report of 37 Patients

Abstract

One of the most challenging joint conditions facing ankle surgeons today is the treatment of Osteochondritis Dissecans (OCD) of the talar dome. The use of human amniotic allograft (HAA) in various surgical procedures, has been proven to facilitate bone growth and both soft tissue and cartilage healing. The authors of this paper propose the addition of HAA to the surgical repair of talar dome lesions to improve postoperative results, specifically pain reduction. For the study, 37 patients were identified having an OCD lesion of the talus measuring no larger than 2 cm 2 . All patients were treated surgically with an arthroscopic micro-fracture repair along with the addition of HHA. Modified ACFAS ankle scores were taken pre-operatively and at 3 months, 12 months, and at 24 months postoperatively. Visual analog scores were also taken preoperative and 24 months postoperatively. The size of the talar lesions documented with pre-operative MRI's was compared with intra-operative measurements for each patient. Additional surgical repairs, comorbidities and any complications were also recorded and evaluated. All patients were treated with micro-fracture with HAA. Postoperative ACFAS scores for 3 months, 12 months and 24 months were significantly improved (p < 0.0001) compared with average preoperative scores. Additionally, VAS scores were also significantly improved when comparing the average pre-operative (4.9) and post-operative (1.1) pain scores (p < 0.0001). The size of the lesions documented by pre-operative MRI correlated to intra-operative measurements. There were no identified complications. The addition of HAA to arthroscopic micro-fracture repair of talar dome lesions measuring less than 2 cm 2 has shown to significantly improve both post-operative VAS scores, when compared to preoperative scores. This improvement in ACFAS and VAS scores speaks to the potential use of HAA in the treatment of OCD.

Improved ex vivo expansion of mesenchymal stem cells on solubilized acellular fetal membranes

“…The fetal membranes envelops the fetus and amniotic fluid during pregnancies and, along with other birth‐associated tissues, are discarded postpartum. Fetal membranes possess several advantages over other tissue types: (1) they are one of the few human tissue sources that are readily available, inexpensive to harvest, and available in large quantities (~15 million m 2 /year, globally); (2) the membranes and other birth‐associated tissues harbor various MSC populations; (3) they contain tissue from both fetal and maternal origin; (4) the safety and effectiveness of fetal membranes have been demonstrated clinically for other purposes and commercially available product such as AmnioGraft® are currently use, and (5) biological advantages including low immunogenicity and anti‐microbial properties via endogenous production of antimicrobial molecules during pregnancy …”

Initial Experience with Tricortical Iliac Crest Bone Graft and Human Amniotic Allograft in Evans Calcaneal Osteotomy

“…There have been no publications on complications having to do with amniotic stem cells. Given that these cells are a precursor line, it is felt that these amniotic stem cells would avoid the antigenicity and also have the benefit of being pluripotential and developing into local environment induced cell types to help facilitate allograft fusions [18]. The authors have taken this approach to the Evans calcaneal graft.…”

“…The authors undertook this study to evaluate the usefulness of HAA as related by healing. The surgeons have been using HAA applied to human tri-cortical allograft in difficult high-risk fusion sites and fractures in attempt to facilitate faster bony ingrowth, theoretically to facilitate better healing and decrease the healing time of patients [18]. by discussion and consensus.…”

The Use of Human Amniotic Allograft on Osteochondritis Dissecans of the Talar Dome: A Comparison with and without Allografts in Arthroscopically Treated Ankles

“…The authors have used amniotic allograft for other surgery applications and have so far encountered no adverse effects [24] [25]. They have applied it to calcaneal osteotomies with iliac crest grafts, trans-chondral fracture defects of the talus (TCF), tendon ruptures, high-risk fusions and high-risk wounds [24]- [26].…”