SLR - July 2021 - John R. Constantino

Matrix-Associated Autologous Chondrocyte Implantation with Autologous Bone Grafting of Osteochondral Lesions of the Talus in Adolescents: Patient-Reported Outcomes with a Median Follow-Up of 6 Years

Reference: Komer D, Gonser CE, Dobele S, Konrads C, Springer F, Keller G. Matrix-Associated Autologous Chondrocyte Implantation with Autologous Bone Grafting of Osteochondral Lesions of the Talus in Adolescents: Patient-Reported Outcomes with a Median Follow-Up of 6 Years. Journal of Orthopaedic Surgery and Research. 2021 April. 16:243

Level of Evidence: Level IV (Retrospective Case Series) 

Scientific Literature Review

Reviewed By: John R. Constantino, DPM
Residency Program: Mount Auburn Hospital - Cambridge, MA

Podiatric Relevance: Osteochondral lesions of the Talus (OLT) remain a difficult pathology to treat for podiatric surgeons. OLTs are uncommon in the pediatric and adolescent population and there is little evidence of operative treatment for severe OLTs in adolescents. The use of matrix associated autologous chondrocyte implantation (MACI) has been described in recent literature as a safe and reliable approach for OLTs. However, this study aims to investigate patient reported outcomes after combined MACI with autologous bone grafting (ABG) in adolescents.

Methods: Twelve patients (13 ankles) that underwent MACI/ABG for a solitary OLT were retrospectively analyzed. All patients included were under the age of 20. Information collected included demographic data, BMI, etiology of OLT. MACI/ABG was performed as a two-stage procedure. Cartilage was harvested from an area outside the weightbearing zone of the talus. After cultivation, MACI scaffold was implanted as a second procedure. Bone cylinders were harvested from the iliac crest and placed into the bony talar defect. German version of the FAOS and FAAM were utilized to evaluate outcome measures. Preoperative and postoperative ankle radiographs were evaluated according to the Van Dijk ankle osteoarthritis scale. Shapiro-Wilk W test was applied to screen the data for normality of distribution. Mean, standard deviation, median and range for non-normally distributed data were reported. 

Results: Mean follow up for patients was 80 months. The mean BMI was 23.5 and mean lesion size and depth were 1.3 square centimeters and 5 millimeters respectively. No perioperative complications were noted. A total of nine patients replied to the FAOS and FAAM evaluation. The mean FAOS score was 78 ± 13. Preoperative radiographs demonstrated 62 percent of cases with stage 1 OA according to the Van Dijk ankle OA scale. Postoperatively, 69 percent had stage 1 OA. The FAAM activities of daily living score was 81 ± 20 and sports subscale was 65 ± 29. According to the FAAM function score, two cases assessed normal function, three as nearly normal and three as abnormal. 

Conclusions: The authors conclude that patient-reported outcome following MACI/ABG for OLTs in adolescents were heterogenous and inconclusive. Long term-limitations following this procedure affect sports/ recreational activities. Injuries leading to OLT area associated with osteoarthritis which can be assessed preoperatively. No significant progression of OA was noted following MACI/ABG. Limitations of this study include its retrospective design, the limited sample size, as well as the number of patients that did not respond to the PROM survey. Given the heterogeneity of the PROM results, multiple operations, as well as the potential of higher financial costs, the results do not seem to be superior compared to other established methods in the adolescent population. 

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