SLR - July 2019 - Bryan M. Duffin
Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2 to 8 Year Follow-up Study
Reference: Lizzy Weigelt, MD, Rebecca Hartmann, MD, Christian Pfirrmann, MD, Norman Espinosa, MD, Steph-an Wirth, MD. Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2 to 8 Year Follow-up Study. The American Journal of Sports Medicine, Volume: 47 issue: 7, page(s): 1679-1686
Scientific Literature Review
Reviewed By: Bryan M. Duffin, DPM
Residency Program: Hunt Regional Medical Center – Greenville, TX
Podiatric Relevance: Osteochondral lesions of the talus are a common injury seen by foot and ankle surgeons and can be treated in several different fashions. Some options for the treatment of cartilage defects include chondral resurfacing with microfracture, autologous chondrocyte transplantation (ACT), autologous matrix-induced chon-drocyte transplantation (AMIC), and osteochondral autologous transplantation (OATS). Which procedure is used in each case is surgeon preference and is guided by size and location of the lesion.
Methods: In this case series, thirty-three patients with osteochondral lesions of the medial talar dome were retrospectively evaluated after open AMIC repair. AMIC is a one-step procedure that involves micro fracture of the derided cartilage lesion to introduce mesenchymal stem cells to the area followed by application of a commercially available collagen I or III covering. The covering is typically fixated with fibrin glue. The lesions ranged in size from .4 - 2.3 cm with a mean of .9 cm. All lesions were approached through a medial malleolar osteotomy. Data analysis included the visual analog scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society score (AO-FAS)for ankle function, the Tegner score for sports activity, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system for repair cartilage and subchondral bone evaluation. Mean follow up was 4.7 years and ranged from 2.3-8.0 years.
Results: Significant improvement was seen is VAS (6.4 down to 1.4), AOFAS (mean 93.0), Tenger score (3.5 to 5.2) with 79 percent returning to their previous sports levels. MOCART score averaged 60.6 with 88 percent of cases having complete filling of the defect. Fifty-two percent of the patients had hypertrophy of the cartilage layer and all but one had persistent subchondral sclerosis. Fifty-eight of patients underwent revisional surgery mainly for painful hardware but none required revisional surgery for failed AMIC.
Conclusions: Overall great patient outcomes were seen with AMIC in this study. The MOCART score did not correlate with the patients outcomes.