Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus

Viehöfer, Arnd; Casari, Fabio A.; Waibel, Felix W A; Beeler, Silvan; Imhoff, Florian B.; Wirth, Stephan; Ackermann, Jakob

doi:10.1177/1947603520959405

Cited by 4 publications

(4 citation statements)

References 35 publications

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“… 15 , 20 , 33 This finding supports the growing evidence of the negative effect of smoking after cartilage repair. 15 , 20 , 33 , 38 …”

Section: Discussionmentioning

confidence: 99%

“…15,20,33 This finding supports the growing evidence of the negative effect of smoking after cartilage repair. 15,20,33,38 The following limitations have to be acknowledged. First, this is a retrospective study with its associated biases, including infrequently documented patient-reported outcome measurements, which did not allow for a comprehensive clinical outcome analysis.…”

Section: Discussionmentioning

confidence: 99%

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Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC)

Waltenspül

Meisterhans

Ackermann

et al. 2023

Foot & Ankle Orthopaedics

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Background: Autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLT) results in favorable clinical outcomes, yet high reoperation rates. The aim of this study was to report and analyze typical complications and their risk factors after AMIC for OLT. Methods: A total of 127 consecutive patients with 130 AMIC procedures for OLT were retrospectively assessed. All AMIC procedures were performed in an open fashion with 106 (81.5%) cases requiring a malleolar osteotomy (OT) to access the OLT. Seventy-one patients (54.6%) underwent subsequent surgery. These cases were evaluated at a mean follow-up of 3.1 years (±2.5) for complications reviewing postoperative imaging and intraoperative findings during revision surgery. Six patients (8.5%) were lost to follow-up. Regression model analysis was conducted to identify factors that were associated with AMIC-related complications. Results: Among the 65 (50%) patients who required revision surgery, 18 patients (28%) demonstrated AMIC-related complications with deep fissuring (83%) and thinning (17%) of the AMIC graft. Conversely, 47 patients (72%) underwent subsequent surgery due to AMIC-unrelated reasons including isolated removal of symptomatic hardware (n = 17) and surgery addressing concomitant pathologies with (n = 25) and without hardware removal (n = 5). Previous prior cartilage repair surgery was significantly associated with AMIC graft-associated complications in patients undergoing revision surgery ( P = .0023). Among age, body mass index, defect size, smoking, and bone grafting, smoking was the only factor showing statistical significance with an odds ratio of 3.7 (95% CI 1.24, 10.9; P = .019) to undergo revision surgery due to graft-related complications, when adjusted for previous cartilage repair surgery. Conclusion: The majority of revision surgeries after AMIC for OLT are unrelated to the performed AMIC graft but frequently address symptomatic hardware and concomitant pathologies. Both smoking and previous cartilage repair surgery seem to significantly increase the risk of undergoing revision surgery due to AMIC-related complications. Level of evidence: Level IV, case series.

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“… 15 , 20 , 33 This finding supports the growing evidence of the negative effect of smoking after cartilage repair. 15 , 20 , 33 , 38 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC)

Waltenspül

Meisterhans

Ackermann

et al. 2023

Foot & Ankle Orthopaedics

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“…Similar to a previous report of AMIC for osteochondral lesions of the talus, especially high preinjury sporting level activity patients tend to not return to their previous level. 60 The following limitations have to be acknowledged. First, preoperative KOOS were unavailable and only 67.7% of preoperative Kujala scores were available as the study was retrospective in its design.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to a previous report of AMIC for osteochondral lesions of the talus, especially high preinjury sporting level activity patients tend to not return to their previous level. 60 …”

Section: Discussionmentioning

confidence: 99%

Autologous Matrix-Induced Chondrogenesis (AMIC) for Isolated Retropatellar Cartilage Lesions: Outcome after a Follow-Up of Minimum 2 Years

et al. 2021

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Purpose To evaluate autologous matrix-induced chondrogenesis (AMIC) for isolated focal retropatellar cartilage lesions and the influence of patellofemoral (PF) anatomy on clinical outcomes at a minimum of 2-year follow-up. Methods Twenty-nine consecutive patients (31 knees) who underwent retropatellar AMIC with a mean age of 27.9 ± 11.0 years were evaluated at a follow-up averaging 4.1 ± 1.9 years (range, 2-8 years). Patient factors, lesion morphology, and patient-reported outcome measures, including Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner, Kujula score, and visual analogue scale (VAS) score were collected. PF anatomy was assessed on pre- and postoperative imaging, and subsequently correlated to outcome scores and failure to determine risk factors for poor outcome. Results At final follow-up, the AMIC graft failed in 4 cases (12.9%) at a mean follow-up of 21 ± 14.1 months. Patients with failed grafts had a significantly smaller patellar and Laurins’s PF angle than patients whose graft did not fail ( P = 0.008 and P = 0.004, respectively). Concomitant corrective surgery for patellar instability was performed in 29 knees (93.5%). Grafts that did not fail presented with an average Kujala score of 71.3 ± 16.9, KOOS Pain of 76.2 ± 16.6 and Tegner scores of 4.2 ± 1.8. The patellar angle was significantly associated with the patient’s satisfaction level ( r = 0.615; P < 0.001). Conclusion AMIC for retropatellar cartilage lesions in combination with concomitant corrective surgery for patellar instability results in low failure rate with satisfactory clinical outcome and patient satisfaction of almost 80% at mid-term follow-up. As most failures occurred in patients without concurrent tibial tubercle osteotomy and both a smaller patellar and Laurins’s PF angle were associated with less favorable outcome, this study supports the growing evidence for the need of unloading retropatellar cartilage repair, when indicated. Level of Evidence Case series; level of evidence, 4.

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Effect of Cigarette Smoking on Postoperative Outcomes After Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Cheng,

Su,

et al. 2024

Foot Ankle Int.

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Background: Bone marrow stimulation (BMS) is presently considered first-line surgical treatment for osteochondral lesions of the talus (OLTs); however, some patients still experience pain or dysfunction after surgery, and the reasons for success or failure remain somewhat unclear. This study aimed to investigate the effect of smoking on postoperative outcomes after arthroscopic BMS for OLTs. Methods: Consecutive patients with OLTs who underwent BMS between January 2017 and January 2020 were included. Smokers were defined as patients who actively consumed cigarettes before surgery and postoperatively, whereas nonsmokers were patients who never smoked. Visual analog scale (VAS), American Orthopaedic Foot & Ankle Society ankle hindfoot score (AOFAS), Karlsson-Peterson, and Tegner scores were assessed preoperatively and at follow-up. Additionally, a general linear model (GLM) was performed, followed by the interaction analysis to explore the potential influence of smoking. Results: The study enrolled 104 patients with a mean follow-up of 30.91 ± 7.03 months, including 28 smokers and 76 nonsmokers. There were no significant differences in patient age (35.2 ± 10.0 years vs 37.6 ± 9.7 years, P = .282) or OLT area (63.7 ± 38.7 mm2 vs 52.8 ± 37.0 mm2, P = .782). Both univariate analysis and GLM revealed that smoking was associated with worse postoperative pain levels, Karlsson-Peterson, and AOFAS scores ( P < .05). The interaction analysis showed a significant interaction between smoking and OLT area for postoperative Karlsson-Peterson scores (general ankle function) ( P = .031). Simple main effects analysis revealed that the negative effect of smoking on Tegner score significantly increased among patients >32 years old or with OLT area>50 mm2 ( P < .05). Conclusion: Smoking was associated with worse clinical outcomes following BMS of OLTs. As the size of OLTs increased, the difference in general ankle function between smokers and nonsmokers also increased. Furthermore, smokers who were older than 32 years or had larger OLTs were less likely to resume participation in high-level activities.

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Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus

Cited by 4 publications

References 35 publications

Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC)

Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC)

Autologous Matrix-Induced Chondrogenesis (AMIC) for Isolated Retropatellar Cartilage Lesions: Outcome after a Follow-Up of Minimum 2 Years

Effect of Cigarette Smoking on Postoperative Outcomes After Arthroscopic Bone Marrow Stimulation for Osteochondral Lesions of the Talus

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