gms | German Medical Science

Objective: Surgical treatment of osteochondral lesions (OCL) of the talus remains a challenging task and frequently concerns young sportive patients. Several surgical techniques are available, e.g. autologous chondrocyte implantation (ACI), osteochondral autograft transfer system (OATS), matrix-induced autologous chondrocyte implantation (MACI). Good clinical results are reported; however, certain disadvantages remain (sacrificing healthy cartilage of another joint for grafts, the need for two-stage procedure, high costs). We present the clinical-radiological results of a novel one-step surgical technique for treatment of OCL of the talus. The autologous matrix-induced chondrogenesis (AMIC) – aided procedure combines debridement, spongiosa-plasty from the iliac crest and covering with a collagen I/III membrane.

Material/Methods: Twenty-five patients (8 female, 17 male; mean age 35 years [range 17–55 years]) were prospectively assessed in our outpatient clinic for OCL of the talus. Clinical examination included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale and Visual Analogue Scale (VAS). Radiological imaging consisted of conventional radiographs and magnetic resonance imaging (MRI). For the evaluation of MRI scans the magnetic resonance observation of cartilage repair tissue (MOCART)-Score was used. Surgical procedure consisted of debridement of the OCL, spongiosa-plasty from the iliac crest and coverage with a commercially available I/III collagen membrane (Chondrogide, Geistlich, Switzerland). Clinical and radiological follow-up was performed after a minimum of 12 months postoperatively.

Results: Both function and pain could be improved largely and remained stable over a mean of 23.1 months postoperatively. The mean preoperative AOFAS hindfoot scale increased significantly from 60.2 points (SD ±15.9) pre-operatively to 89.6 points (SD 11.9) at final follow-up (p<0.01). Pain measured with VAS improved significantly (p<0.01) from 5.0 (SD 1.7) to 1.5 (SD 2.1). At follow-up conventional radiographs showed osseous integration of the graft in all cases. MRI showed intact cartilage covering of the lesions in all cases with a mean MOCART-Score of 62.0 points (SD 17.1).

Conclusion: Excellent clinical and radiological results were demonstrated after a mean follow-up of 23.1 months. The results are comparable or superior with the results of ACI, OATS and MACI. More, the AMIC-aided technique is a readily available, economically efficient, and a successful one step surgical procedure. Therefore it can be recommended as treatment option of osteochondral lesions of the talus.