SLR - July 2018 - Derek A. McLister
Reference: D’Ambrosi R, Villafane JH, Indino C, Liuni FM, Berjano P, Usuelli FG. “Return to Sport After Arthroscopic Autologous Matrix-Induced Chondrogenesis for Patients with Osteochondral Lesion of the Talus”. Clin J Sport Med. 2017 Dec 26:1–6.
Scientific Literature Review
Reviewed By: Derek A. McLister, DPM
Residency Program: Sanford Health Podiatric and Surgery Residency, Fargo, ND
Podiatric Relevance: Osteochondral lesions of the talar dome are increasingly diagnosed and are a difficult pathology to treat. As cartilage is avascular, it has a poor propensity to heal. Subsequent slow and relentless progression toward increasing size and severity can occur and can eventually lead to osteoarthritis or degenerative arthrosis. Chondral injury may occur in up to 50 percent of acute ankle sprains and in up to 73 percent of ankle fractures. As these injuries have increased in being diagnosed due to our advanced imaging techniques, so has our ability to treat these injuries. Surgical options include marrow stimulation with drilling or microfractures, osteochondral autograft or mosaicplasty, allograft transplantation, autologous chondrocyte implantation (ACI) and matrix-induced ACI. The principle of the AMIC technique is to combine the advantages of microfractures with a matrix that enhances the chondrogenic differentiation of mesenchymal stem cells. The matrix, is composed of collagen type I and III, stabilizes the clot and avoids the leakage of mesenchymal stem cells. Because of these properties, the technique can be used in all types of injuries, without distinction of size and regardless of age and body mass index.
Methods: This study was a retrospective observational cross-sectional study with 26 consecutive patients who underwent surgical treatment of OLTs type III and IV. The treatment was with AT-AMIC, an all-arthroscopic technique using a two-phase technique, a preparation phase and an implantation phase. Outcomes were measured by the American Orthopaedic Foot and Ankle Score (AOFAS) ankle-hindfoot scale. The twelve-item Short Form Health Survey (SF-12) with its Physical Component Score (PCS). Halasi panel, which consists in a single-page, easy-to-survey system with 53 sports, three working activities and four general activities in categories from zero to 10. UCLA activity index is a scale from one to 10 with phrases (“no physical activity” to “regular participation in impact sports”), which the patient chooses to best describe his or her most appropriate activity level. Every patient underwent preoperative magnetic resonance imaging (MRI) examination to evaluate lesion size as well.
Results: 80.8 percent of the patient group returned to the same preinjury sport. The physical activity and ankle functionality (AOFAS, Halasi and UCLA) score results showed a significant improvement in all parameters. There were no complications recorded during the follow-up with no matrix mobilization reported, and the results were with no other additional surgical procedures performed.
Conclusions: The results of the study showed that AT-AMIC procedure allows a return to amateur sport and physical activities in patients with symptomatic OLTs. The study was limited by the absence of comparison group of conservatively treated or a microfracture group. The study could have been clearer on the number of patients out of the 26 that answered each survey, as well as a possible postoperative MRI. Overall, this study shows AMIC is a treatment option for OLTs, which allows a possible return to preinjury activity.