Osteochondral Autologous Transplantation versus Autologous Matrix-induced Chondrogenesis for talus osteochondral lesions; a retrospective comparison

Year 2024, , 240 - 247, 01.07.2024

Ömer Faruk Eğerci , Aliekber Yapar , Tolga Kirtiş , Fırat Doğruöz , Faruk Aykanat , Özkan Köse

https://doi.org/10.18663/tjcl.1475987

Abstract

Aim: This retrospective analysis aimed to evaluate the comparative efficacy of osteochondral autologous transplantation (OAT) versus autologous matrix-induced chondrogenesis (AMIC) in the management of osteochondral lesions of the talus (OLT).
Materials and Methods: In this retrospective cohort study, 55 individuals (24 males, 31 females) with an average age of 40.7 ± 12.6 years (range 18-66 years) were included. The study assessed 59 ankles in total due to 4 patients undergoing bilateral procedures at separate intervals. Of these, 22 were treated using AMIC and 37 received OAT. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scale preoperatively and at the latest follow-up. The Lysholm Knee Score was utilized for evaluating knee function in patients subjected to OAT. Serial radiographic examinations of the ankle were conducted to assess osteotomy union, reduction loss, graft subsidence, and progression of osteoarthritis (OA) using the Kellgren-Lawrence grading system for post-treatment OA evaluation.
Results: Comparative analysis revealed no statistically significant differences between AMIC and OAT in terms of improvement in AOFAS scores (p=0.467), progression of OA (p=0.141), or complication rates (p=0.373).
Conclusion: Both AMIC and OAT present as effective therapeutic options for OLT, with comparable success rates and outcomes.

Keywords

Autologous osteochondral transplantation, Mosaicplasty, autologous matrix-induced chondrogenesis, talus osteochondral lesion, medial malleolar osteotomy

Ethical Statement

The authors declare that they have no conflict of interest.

Talus osteokondral lezyonlarında Osteokondral Otolog Transplantasyona karşı Otolog Matriks kaynaklı Kondrogenez; retrospektif karşılaştırma

Abstract

Amaç: Bu retrospektif analizin amacı, talus osteokondral lezyonlarının (OLT) tedavisinde osteokondral otolog transplantasyon (OAT) ile otolog matriks kaynaklı kondrogenez (AMIC) tedavilerinin etkinliklerini karşılaştırmalı olarak değerlendirmektir
Materyal ve Yöntem: Bu retrospektif kohort çalışmasında, ortalama yaşları 40,7 ± 12,6 olan (yaş aralığı 18-66) toplam 55 hasta (24 erkek, 31 kadın) incelenmiştir. Çalışma, dört hastada farklı zamanlarda gerçekleştirilen çift taraflı prosedürler nedeniyle toplam 59 ayak bileğini kapsamaktadır. Hastaların 22'si AMIC, 37'si ise OAT ile tedavi edilmiştir. Fonksiyonel sonuçlar, operasyon öncesi ve son takipte Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS) skalası kullanılarak değerlendirilmiştir. OAT uygulanan hastalarda diz fonksiyonunun değerlendirilmesi için Lysholm Diz Skoru kullanılmıştır. Seri radyografik incelemelerle osteotomi hattının kaynama durumu, redüksiyon kaybı, greft çökmesi ve osteoartritin (OA) tedavi sonrası ilerlemesi değerlendirilmiş, OA'nın evrelendirmesinde Kellgren-Lawrence derecelendirme sistemi kullanılmıştır.
Sonuçlar: Karşılaştırmalı analiz, AMIC ve OAT arasında AOFAS skorlarındaki iyileşme (p=0.467), OA'nın ilerlemesi (p=0.141) veya komplikasyon oranları (p=0.373) açısından istatistiksel olarak anlamlı bir fark olmadığını ortaya koymuştur.
Sonuç: AMIC ve OAT, OLT'nin tedavisinde benzer başarı oranları ve sonuçlar ile etkili tedavi seçenekleri olarak karşımıza çıkmaktadır.

Keywords

Otolog osteokondral transplantasyon, Mozaikplasti, otolog matriks kaynaklı kondrogenez, talus osteokondral lezyonu, medial malleol osteotomisi

References

• Flick AB, Gould N. Osteochondritis dissecans of the talus (transchondral fractures of the talus): review of the literature and new surgical approach for medial dome lesions. Foot Ankle. 1985 Jan-Feb;5(4):165-85.
• Giannini S, Buda R, Grigolo B, Vannini F. Autologous chondrocyte transplantation in osteochondral lesions of the ankle joint. Foot Ankle Int. 2001 Jun;22(6):513-7.
• Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin. 2003 Jun;8(2):233-42, viii-ix.
• Abu-Shakra M, Buskila D, Shoenfeld Y. Osteonecrosis in patients with SLE. Clin Rev Allergy Immunol. 2003 Aug;25(1):13-24.
• Shearer C, Loomer R, Clement D. Nonoperatively managed stage 5 osteochondral talar lesions. Foot Ankle Int. 2002 Jul;23(7):651-4.
• Tol JL, Struijs PA, Bossuyt PM, Verhagen RA, van Dijk CN. Treatment strategies in osteochondral defects of the talar dome: a systematic review. Foot Ankle Int. 2000 Feb;21(2):119-26.
• Wang CC, Yang KC, Chen IH. Current treatment concepts for osteochondral lesions of the talus. Tzu Chi Med J. 2020 Oct 5;33(3):243-249.
• Bruns J, Habermann C, Werner M. Osteochondral Lesions of the Talus: A Review on Talus Osteochondral Injuries, Including Osteochondritis Dissecans. Cartilage. 2021 Dec;13(1_suppl):1380S-1401S.
• Jantzen C, Ebskov LB, Johansen JK. AMIC Procedure for Treatment of Osteochondral Lesions of Talus-A Systematic Review of the Current Literature. J Foot Ankle Surg. 2022 Jul-Aug;61(4):888-895.
• Hannon CP, Bayer S, Murawski CD, Canata GL, Clanton TO, Haverkamp D, et al.; International Consensus Group on Cartilage Repair of the Ankle. Debridement, Curettage, and Bone Marrow Stimulation: Proceedings of the International Consensus Meeting on Cartilage Repair of the Ankle. Foot Ankle Int. 2018 Jul;39(1_suppl):16S-22S.
• Valderrabano V, Miska M, Leumann A, Wiewiorski M. Reconstruction of osteochondral lesions of the talus with autologous spongiosa grafts and autologous matrix-induced chondrogenesis. Am J Sports Med. 2013 Mar;41(3):519-27.
• Kellgren JH, Lawrence JS. Radiological Assessment of Osteo-Arthrosis. Ann Rheum Dis 1957; 16: 494–502.
• Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int. 1999 Dec;20(12):789-93.
• Gao L, Orth P, Cucchiarini M, Madry H. Autologous Matrix-Induced Chondrogenesis: A Systematic Review of the Clinical Evidence. Am J Sports Med. 2019 Jan;47(1):222-231.
• Toale J, Shimozono Y, Mulvin C, Dahmen J, Kerkhoffs GMMJ, Kennedy JG. Midterm Outcomes of Bone Marrow Stimulation for Primary Osteochondral Lesions of the Talus: A Systematic Review. Orthop J Sports Med. 2019 Oct 30;7(10):2325967119879127.
• Migliorini F, Eschweiler J, Maffulli N, Schenker H, Driessen A, Rath B, et al. Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures for Chondral Defects of the Talar Shoulder: A Five-Year Follow-Up Prospective Cohort Study. Life (Basel). 2021 Mar 16;11(3):244.
• Becher C, Malahias MA, Ali MM, Maffulli N, Thermann H. Arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus. Knee Surg Sports Traumatol Arthrosc. 2019 Sep;27(9):2731-2736.
• Weigelt L, Hartmann R, Pfirrmann C, Espinosa N, Wirth SH. Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study. Am J Sports Med. 2019 Jun;47(7):1679-1686.
• Baums MH, Schultz W, Kostuj T, Klinger HM. Cartilage repair techniques of the talus: An update. World J Orthop. 2014 Jul 18;5(3):171-9.
• Shimozono Y, Hurley ET, Myerson CL, Kennedy JG. Good clinical and functional outcomes at mid-term following autologous osteochondral transplantation for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3055-3062.
• Kennedy JG, Murawski CD. The Treatment of Osteochondral Lesions of the Talus with Autologous Osteochondral Transplantation and Bone Marrow Aspirate Concentrate: Surgical Technique. Cartilage. 2011 Oct;2(4):327-36.
• Scranton PE Jr, Frey CC, Feder KS. Outcome of osteochondral autograft transplantation for type-V cystic osteochondral lesions of the talus. J Bone Joint Surg Br. 2006 May;88(5):614-9.
• Baltzer AW, Arnold JP. Bone-cartilage transplantation from the ipsilateral knee for chondral lesions of the talus. Arthroscopy. 2005 Feb;21(2):159-66.
• Hangody L, Dobos J, Baló E, Pánics G, Hangody LR, Berkes I. Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med. 2010 Jun;38(6):1125-33.
• Valderrabano V, Leumann A, Rasch H, Egelhof T, Hintermann B, Pagenstert G. Knee-to-ankle mosaicplasty for the treatment of osteochondral lesions of the ankle joint. Am J Sports Med. 2009 Nov;37 Suppl 1:105S-111S.
• Reddy S, Pedowitz DI, Parekh SG, Sennett BJ, Okereke E. The morbidity associated with osteochondral harvest from asymptomatic knees for the treatment of osteochondral lesions of the talus. Am J Sports Med. 2007 Jan;35(1):80-5.
• LaPrade RF, Botker JC. Donor-site morbidity after osteochondral autograft transfer procedures. Arthroscopy. 2004 Sep;20(7):e69-73.
• Woelfle JV, Reichel H, Nelitz M. Indications and limitations of osteochondral autologous transplantation in osteochondritis dissecans of the talus. Knee Surg Sports Traumatol Arthrosc. 2013 Aug;21(8):1925-30.
• Shimozono Y, Seow D, Yasui Y, Fields K, Kennedy JG. Knee-to-Talus Donor-Site Morbidity Following Autologous Osteochondral Transplantation: A Meta-Analysis with Best-case and Worst-case Analysis. Clin Orthop Relat Res. 2019 Aug;477(8):1915-1931.
• Hangody L, Füles P. Autologous osteochondral mosaicplasty for the treatment of full-thickness defects of weight-bearing joints: ten years of experimental and clinical experience. J Bone Joint Surg Am. 2003;85-A Suppl 2:25-32.