title: Treatment of Hemophilic Ankle Arthropathy with One-Step Arthroscopic Bone Marrow-Derived Cells Transplantation.
abstract: OBJECTIVE
  Ankle arthropathy is a frequent and invalidating manifestation of hemophilia. Arthrodesis is the gold standard surgical procedure in end-stage disease, with many drawbacks in young patients. Recent literature has shown increase interest in regenerative procedures in hemophilic arthropathy, which may be desirable to delay or even avoid arthrodesis. The aim of this article is to present five cases of osteochondral lesions in ankle hemophilic arthropathy treated with a regenerative procedure: bone marrow-derived cells transplantation (BMDCT).
  
  
  METHODS
  We report five hemophilic patients (four cases with hemophilia type A; one case with hemophilia type B) who have undergone BMDCT treatment, synovectomy, and arthroscopic debridement, with the use of autologous platelet-rich fibrin, to treat osteochondral lesions in hemophilic ankle arthropathy. The patients, included within this retrospective study, were clinically and radiologically evaluated with serial follow-ups, using the American Orthopaedic Foot and Ankle Society (AOFAS) scores, radiographs, and magnetic resonance imaging (MRI).
  
  
  RESULTS
  The mean preoperative AOFAS score was 35. After a mean follow-up of 2 years, the mean postoperative AOFAS score was 81, which included three patients returning back to sporting activities. The MRI Mocart score demonstrated signs of regeneration of chondral and bony tissue. No progression of joint degeneration was shown radiographically.
  
  
  CONCLUSIONS
  BMDCT is a promising regenerative treatment for osteochondral lesions in mild ankle hemophilic arthropathy, which may be useful to delay or even avoid ankle arthrodesis. Nevertheless, longer follow-ups and a larger case series are required.
authors.affiliation: I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Buda
authors.affiliation: I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cavallo
authors.affiliation: I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Castagnini
authors.affiliation: Service of Immunohematology and Transfusional Medicine, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Cenacchi
authors.affiliation: I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Natali
authors.affiliation: I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Vannini
authors.affiliation: I Clinic of Orthopaedic and Traumatology, Rizzoli Orthopaedic Institute, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
keywords: ankle; hemophilia; one-step; regenerative technique