gms | German Medical Science

Objectives: Microfracture is an established method in the treatment of articular cartilage defects of the talus. The value of an additional acellular matrix is still under debate. Aim of this study was to compare the results of arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis using a collagen I/III matrix (AMIC) in the treatment of articular cartilage defects of the talus with common clinical scores.

Methods: Patients from our database with a minimum follow-up of 5 years after arthroscopic treatment for an articular cartilage defect of the talus with either microfracture alone or an additional acellular matrix were matched according to the variables age, sex and BMI. All arthroscopic treatments were performed by one surgeon who changed his approach after availability of the acellular matrix independent of any other influencing factors. The Hannover Scoring System for the ankle (HSS) and a Visual analog scale (VAS) for pain, function and satisfaction were used to evaluate the clinical outcome. Overall median values were taken for statistical analysis using a non-parametric Mann-Whitney U-Test for group comparisons and Wilcocoxon sign rank sum test for differences between the pre- and postoperative values. A p-value <0.05 was considered significant.

Results and conclusion: 32 patients (16 microfracture, 16 AMIC) were included. No significant between-group differences were observed in demographic data and preoperative score values. Both groups showed statistically significant improvement when comparing the pre- and postoperative score values. No statistically significant differences were observed between the median values of the groups with the HSS (microfracture: 82 (71 - 96) points; AMIC 88 (40 - 98) points). Accordingly, no significant differences were observed for the VAS pain (microfracture: 0.95 (0 - 3.8); AMIC: 1.0 (0 - 8.5), VAS function (microfracture: 8.4 (3.5 - 10); AMIC: 9.0 (1.5 - 10) and VAS satisfaction (microfracture: 8.9 (2.8 - 10); AMIC: 9.45 (1.5 - 10).

In conclusion, good clinical results were observed for arthroscopic microfracture with or without an additional acellular collagen I/III matrix in the treatment of articular cartilage defects of the talus. The results were statistically comparable between both groups with a slight tendency towards better score results at the HSS and VAS function and satisfaction with the AMIC approach.