Treatment of osteochondral lesions of the talus with autologous collagen-induced chondrogenesis: clinical and magnetic resonance evaluation at one-year follow-up

Abstract

Purpose: the aim of this study is to report the clinical and imaging results recorded by a series of patients in whom osteochondral lesions of the talus (oLts) were repaired using the autologous collagen-induced chondrogenesis (ACiC) technique with a completely arthroscopic approach. Methods: nine patients (mean age 37.4±10 years) affected by oLts (lesion size 2.1±0.9 cm 2 ) were treated with the ACiC technique. the patients were evaluated clinically both preoperatively and at 12 months after surgery using the American orthopaedic Foot and Ankle society Ankle-Hindfoot scale (AoFAs) and a visual analog scale (VAs). For morphological evaluation, the magnetic resonance observation of cartilage repair tissue (MoCARt) score was used. Results: the AoFAs score improved from 51.4±11.6 preoperatively to 71.8±20.6 postoperatively, while the VAs value decreased from 6.9±1.8 to 3.2±1.9. the mean MoCARt score was 51.7±16.6 at 12 months of follow-up; these scores did not directly correlate with the clinical results. Conclusion: use of the ACiC technique for arthroscopic repair of oLts allowed satisfactory clinical results to be obtained in most of the patients as soon as one year after surgery, with no major complications or delayed revision surgery. ACiC is a valid and lowinvasive surgical technique for the treatment of chondral and osteochondral defects of the talus. Level of evidence: therapeutic case series, level iV.

No superior treatment for primary osteochondral defects of the talus

“…Five publications describing the results of 68 ankles treated by CIT were identified [ 28 , 60 , 120 , 121 , 130 ]. One study was a prospective case series, one was a retrospective comparative study, and the other three were retrospective case series, which discouraged pooling.…”

“…The range of the success rate was 56–100% [CI 27–100%] (Fig. 3 ) [ 28 , 60 , 120 , 121 , 130 ]. For the AMIC procedures, the range of success percentages was 73 to 91% [CI 43–98%] (Fig.…”

“…3 ) [ 28 , 60 , 121 ]. Volpi et al [ 130 ] and Usuelli et al [ 120 ] described the results of ACIC, and the means of the success rate ranged from 56 to 100% [CI 27–100%] (Fig. 3 ).…”

Geles y membranas

“…La mayor resistencia mecánica y estabilidad que los geles o membranas imprimen al coágulo, así como un mejor aislamiento del medio intraarticular que evite migración celular o de factores inflamatorios no deseados al interior de la lesión o hueso subcondral, podría interferir con el proceso reparativo y en algunos trabajos se ha relacionado este hecho con la principal causa de dolor en las LOA, dado que el cartílago en sí mismo es un tejido anervado (25) . Sin embargo, la ventaja de los geles respecto a las membranas puede ser su facilidad técnica para implantarlos por vía artroscópica (24,26) .…”

“…Pueden añadirse coadyuvantes biológicos como PRP. Usuelli et al (26) publican una serie de 9 pacientes con LOA pequeñas (2,1 ± 0,9 cm 2 ) intervenidos mediante esta técnica que denominan ACIC (autologous collagen-induced chondrogenesis) con un año de seguimiento. Destacan los buenos resultados clínicos en cuanto a función y dolor, la seguridad del implante, la sencillez de la técnica (un tiempo y artroscópica) y el bajo coste en comparación con otros tratamientos.…”