All-arthroscopic AMIC®(AT-AMIC®) technique with autologous bone graft for talar osteochondral defects: clinical and radiological results.
OBJECTIVE
Autologous Matrix-Induced Chondrogenesis (AMIC®) is known to provide satisfactory clinical results for the treatment of knee, hip, and ankle cartilage lesions. The purpose of this study was to evaluate clinical and radiological outcomes of patients treated with a new all-arthroscopic AMIC®(AT-AMIC®) technique with autologous bone graft for talar osteochondral defects at a follow-up of 24 months.


METHODS
Twenty patients underwent the AT-AMIC®procedure and autologous bone graft for type III and IV talar osteochondral lesions. Patients were evaluated pre-operatively and at 6, 12, and 24 months post-operatively using the American Orthopedic Foot and Ankle Society (AOFAS) score, the visual analog scale, and the SF-12 (Short Form-12). Radiological assessment included computed tomography (CT), magnetic resonance imaging (MRI), and magnetic resonance observation of cartilage repair tissue (MOCART).


RESULTS
All scores significantly improved (p < 0.05) with respect to pre-operative values after 6 months. Further improvements were detected at 24 months (AOFAS, from 57.1 ± 14.9 before surgery to 86.6 ± 10.9 after 24 months; VAS, from 8.1 ± 1.4 to 2.5 ± 2.2; SF-12, from 29.9 ± 4.1 to 48.5 ± 6.9 and from 43.8 ± 2.9 to 53.1 ± 3.9, respectively, for Physical and Mental component score). Lesion area significantly reduced from 111.1 ± 43.2 mm2pre-operatively to 76.9 ± 38.1 mm2(p < 0.05) at final follow-up as assessed by CT, and from 154.1 ± 93.6 to 94.3 ± 61.3 mm2(p < 0.05) as assessed by MRI. The mean MOCART score was 42.8 ± 23.5 points and 50.9 ± 24.9 points, respectively, at 12 and 24 months after surgery (p < 0.05).


CONCLUSIONS
AT-AMIC®with autologous bone grafting has proven to be a safe and effective minimal invasive technique, able to rapidly and significantly improve pain, function, and radiological healing of osteochondral talar lesions, with progressive further improvements up to 24 months. Orthopedic surgeons specialized in foot and ankle surgery should adopt the AT-AMIC®technique for the treatment of osteochondral talar lesions, which proved to be effective and minimally invasive, avoiding malleolar osteotomy with a low risk of complications.


METHODS
IV.
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy. fusuelli@gmail.com.
Federico Giuseppe
http://orcid.org/0000-0003-2795-6603
FG
Usuelli
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.|Università degli Studi di Milano, Milan, Italy.
Riccardo
R
D'Ambrosi
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.|Università degli Studi di Milano, Milan, Italy.
Camilla
C
Maccario
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Michele
M
Boga
Laboratorio di Biotecnologie Applicate all'Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
Laura
L
de Girolamo
D000328:Adult; D000843:Ankle Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D006801:Humans; D057072:Intra-Articular Fractures / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D013628:Talus / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014182:Transplantation, Autologous
Ankle arthroscopy; Autologous bone graft; Autologous matrix-induced chondrogenesis; Cartilage healing; MOCART; Osteochondral talar lesions