title: Combining Microfractures, Autologous Bone Graft, and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions.
abstract: BACKGROUND
  The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT).
  
  
  METHODS
  Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed.
  
  
  RESULTS
  Mean lesion size measured during surgery was 1.1 cm3± 0.5 cm3. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures ( P < .001). All clinical scores significantly improved ( P < .05) from T0to T3. Lesion area significantly reduced from 119.1 ± 29.1 mm2preoperatively to 77.9 ± 15.8 mm2( P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm2to 85.3 ± 14.5 mm2( P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) ( P = .011).
  
  
  CONCLUSIONS
  The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.|2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: D'Ambrosi
authors.affiliation: 1 Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.|2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Maccario
authors.affiliation: 3 Università Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Ursino
authors.affiliation: 4 Seconda Università di Napoli, Dipartimento di Radiologia, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Serra
authors.affiliation: 2 IRCCS Istituto Ortopedico Galeazzi, U.O. C.A.S.C.O., Piede e Caviglia, Milan, Italy.
authors.forename: Federico Giuseppe
authors.initials: FG
authors.lastname: Usuelli
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D001182:Arthroscopy / Q000295:instrumentation*; D016025:Bone Transplantation / Q000379:methods*; D020219:Chondrogenesis / Q000502:physiology*; D015775:Fractures, Stress / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D011788:Quality of Life; D012189:Retrospective Studies; D013628:Talus / Q000601:surgery*; D014182:Transplantation, Autologous / Q000379:methods*; D064232:Visual Analog Scale
keywords: BMI; autologous bone graft; autologous matrix-induced chondrogenesis; juvenile osteochondral talar lesions; microfractures; quality of life