Artikel
MR imaging after cartilage reconstruction with autologous matrix induced chondrogenesis (AMIC)
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Autoren
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Markus Walther
- Schön Klinik München Harlaching, Zentrum für Fuß- und Sprunggelenkchirurgie, München, Germany
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Oliver Gottschalk
- Schön Klinik München Harlaching, Zentrum für Fuß und Sprunggelenkchirurgie, München, Germany
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Sebastian Baumbach
- Klinkum der Universität München, Klinik für Allgemeine, Unfall- und Wiederherstellungschirurgie, München, Germany
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Anke Röser
- Orthopädische Klinik München-Harlaching, Zentrum für Fuß- und Sprunggelenkchirurgie, München, Germany
| Veröffentlicht: | 23. Oktober 2017 |
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Gliederung
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Objectives: MRI after cartilage reconstruction of the talus often leads to controversies interpreting the findings. This prospective cohort study was performed to correlate MRI findings to clinical outcome in patients having a 3-5 year FU after autologous matrix induced chondrogenesis (AMIC).
Methods: 36 consecutive patients with cartilage defects (Grad III and IV ICRS, size>1.5cm²) were treated with an autologous, matrix induced chondrogenesis (AMIC). The follow up included clinical examination, the Foot Function Index (FFI), the AOFAS score as well as the Visual Analogue Scale (VAS). MRI was analyzed using the MOCART score.
The figure [Fig. 1] shows the MR images preoperative (left) and 12 months after surgical therapy (right) with grafting of the cyst with autologous bone from the calcaneus and coverage of the surface with a collagen membrane.
Results and Conclusion: FFI improved in the category pain from 55.0±19.6 to 26.2±15.1, in the category function from 60.1±13.7 to 23.7±21.4. The AOFAS Score increased from 50.8±17.9 to 82.4±14.1. The VAS improved from 7.7±2.4 to 3.1±2.5. The MOCART Score averaged 54.1±17.2. During the first year after surgery, bone edema was visible in all patients, 80% had irregularities of the subchondral bone plate without any correlation to clinical symptoms. After 18 months, the bone edema decreased. 21 patients had moderate effusion. Partial detachment of the collagen membrane (2 patients), new cyst formation and synovitis had a significant correlation with clinical symptoms (Spearman Rho 0,73).
In all patients, independent of symptoms, the area of the reconstructed cartilage was still visible at the last follow up. Minor irregularities in the signal of the subchondral bone was not related to symptoms. A partial detachment of the collagen membrane, cysts and synovitis in MRI showed a high correlation with pain.
