SLR - July 2018 - Derek A. McLister
Return to Sport After Arthroscopic
Autologous Matrix-Induced Chondrogenesis for Patients with
Osteochrondral Lesion of the Talus
D’Ambrosi R, Villafane JH, Indino C, Liuni
FM, Berjano P, Usuelli FG. “Return to Sport After Arthroscopic Autologous
Matrix-Induced Chondrogenesis for Patients with Osteochondral Lesion of the
Talus”. Clin J Sport Med.
2017 Dec 26:1–6.
Scientific Literature Review
Reviewed By: Derek A. McLister, DPM
Residency Program: Sanford Health
Podiatric and Surgery Residency, Fargo, ND
Podiatric Relevance: Osteochondral lesions of the talar dome are
increasingly diagnosed and are a difficult pathology to treat. As
cartilage is avascular, it has a poor propensity to heal. Subsequent slow and
relentless progression toward increasing size and severity can occur and
can eventually lead to osteoarthritis or degenerative arthrosis. Chondral injury
may occur in up to 50 percent of acute ankle sprains and in up to 73 percent of ankle
fractures. As these injuries have increased in being diagnosed due to our
advanced imaging techniques, so has our ability to treat these injuries. Surgical
options include marrow stimulation with drilling or microfractures,
osteochondral autograft or mosaicplasty, allograft transplantation, autologous
chondrocyte implantation (ACI) and matrix-induced ACI. The principle of
the AMIC technique is to combine the advantages of microfractures with a
matrix that enhances the chondrogenic differentiation of mesenchymal stem
cells. The matrix, is composed of collagen type I and III, stabilizes the clot
and avoids the leakage of mesenchymal stem cells. Because of these properties,
the technique can be used in all types of injuries, without distinction of size
and regardless of age and body mass index.
study was a retrospective observational cross-sectional study with 26
consecutive patients who underwent surgical treatment of OLTs type III and IV. The
treatment was with AT-AMIC, an all-arthroscopic technique using a two-phase
technique, a preparation phase and an implantation phase. Outcomes were measured
by the American Orthopaedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale. The
twelve-item Short Form Health Survey (SF-12) with its
Physical Component Score
(PCS). Halasi panel, which consists in a single-page, easy-to-survey
with 53 sports, three working activities and four general activities in categories
from zero to 10.
UCLA activity index is a scale from one to 10 with phrases (“no
physical activity” to “regular participation in impact sports”), which the
patient chooses to best describe his or her most appropriate activity level.
patient underwent preoperative magnetic resonance
imaging (MRI) examination to
evaluate lesion size as well.
Results: 80.8 percent of the
patient group returned to the same preinjury sport. The physical activity and ankle functionality (AOFAS, Halasi and UCLA) score
results showed a significant improvement in all parameters. There were no complications recorded during the
follow-up with no matrix mobilization reported, and the results were with no
other additional surgical procedures performed.
Conclusions: The results of the study showed that
AT-AMIC procedure allows a return to amateur sport and physical activities in patients
with symptomatic OLTs. The study was limited by the absence of comparison group
of conservatively treated or a microfracture group. The study could have been
clearer on the number of patients out of the 26 that answered each survey, as
well as a possible postoperative MRI. Overall, this study shows AMIC is a
treatment option for OLTs, which allows a possible return to preinjury