Matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st metatarsophalangeal joint is safe and effective-2-year-follow-up in 20 patients

Comparison of Total Joint Replacement With Arthrodesis of the First Metatarsophalangeal Joint

BACKGROUND

The aim of this study was to compare outcome (clinical, patient-reported outcome measures, radiologic, joint motion and pedographic) of total joint replacement with Roto-Glide (RG) and arthrodesis (A) for severe osteoarthritis of the first metatarsophalangeal joint (MTP1).

METHODS

All consecutive patients with arthrodesis and RG from January 23, 2011, until September 18, 2019, at the authors' institution were considered for inclusion in the study. Preoperatively and at follow-up (FU), radiographs, and/or weightbearing computed tomographic imaging were obtained. Standard dynamic pedography was performed. Visual analog scale foot and ankle (VASFA), European Foot and Ankle Society (EFAS) score, MTP1 range of motion for dorsiflexion/plantarflexion (DF/PF) were registered and compared preoperatively and at FU.

RESULTS

Seventy RG and 72 arthrodesis patients were included. Preoperative VASFA and EFAS scores did not differ between the RG and arthrodesis groups (average scores: VASFA, 50.6 and 45.6; EFAS score, 10.7 and 10.6, respectively; each P > .05). Wound healing delays without further operative measures were registered in 4 patients (6%) for RG and 5 (7%) for arthrodesis (P = .67), and 5 revisions in 5 patients (7%) for RG and 12 in 8 (11%) for arthrodesis (P = .05). The longest available FU was higher in RG than in arthrodesis (47 vs 37 months on average, P < .001). Pedography showed higher first metatarsal head or sesamoids and lower great toe force percentage from force of entire foot in RG than in arthrodesis (P = .05) resulting in physiological pattern in RG only. VASFA and EFAS scores at FU was higher in RG than in arthrodesis (average scores: VASFA, 72.6 and 63.6; EFAS score, 16.1 and 14.1, respectively; each P < .05). DF/PF measurement was only possible in RG (average value: DF/PF, 36.1/14.0).

CONCLUSION

We found marginally lower revision rates and higher patient-reported outcome measures, joint motion (DF/PF), and more physiologic force distribution at slightly longer FU for the RG group than the arthrodesis group. Longer follow-up and broader clinical reporting are needed to identify the potential deficits of RG.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.

Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint - 5-year follow-up

BACKGROUND

The aim of the study was to assess the 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral defects at the first metatarsophalangeal joint (MTP1).

MATERIAL AND METHODS

In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at MTP1 that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included. Size and location of the chondral lesions, the Visual-Analogue-Scale Foot and Ankle (VAS FA) and the EFAS Score before treatment and at 5FU were analysed and compared with previous 2-year-follow-up (2FU). Peripheral Blood Concentrate (PBC) was used to impregnate a collagen I/III matrix (Chondro-Gide, Wolhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue.

RESULTS

One hundred and ninety-eight patients with 238 chondral defects were included. In 21 % of patients no deformities in the forefoot were registered. The average degree of osteoarthritis was 2.2. The chondral defect size was 1.0 cm² on average. The most common location was metatarsal dorsal (33 %), and in most patients one defect was registered (74 %). Corrective osteotomy of the first metatarsal was performed in 79 %. 176 (89 %)/164 (83 %) patients completed 2FU/5FU. VAS FA/EFAS Score were preoperatively 46.8/11.9 and improved to 74.1/17.1 at 2FU and 75.0/17.3 at 5FU on average. No parameter significantly differed between 2FU and 5FU.

CONCLUSIONS

AMIC+PBC as treatment for chondral defects at MTP1 as part of joint preserving surgery led to improved and high validated outcome scores at 2FU and 5FU. The results between 2FU and 5FU did not differ.

Prognostic factors for the management of chondral defects of the knee and ankle joint: a systematic review

Purpose

Different surgical techniques to manage cartilage defects are available, including microfracture (MFx), autologous chondrocyte implantation (ACI), osteoarticular auto- or allograft transplantation (OAT), autologous matrix-induced chondrogenesis (AMIC). This study investigated the patient-related prognostic factors on the clinical outcomes of surgically treated knee and ankle cartilage defects.

Methods

This study followed the PRISMA statement. In May 2022, the following databases were accessed: PubMed, Google Scholar, Embase, and Scopus. All the studies investigating the outcomes of surgical management for knee and/or talus chondral defects were accessed. Only studies performing mesenchymal stem cells transplantation, OAT, MFx, ACI, and AMIC were considered. A multiple linear model regression analysis through the Pearson Product–Moment Correlation Coefficient was used.

Results

Data from 184 articles (8905 procedures) were retrieved. Female sex showed a positive moderate association with visual analogue scale at last follow-up (P = 0.02). Patient age had a negative association with the American Orthopaedic Foot and Ankle Score (P = 0.04) and Lysholm Knee Scoring Scale (P = 0.03). BMI was strongly associated with graft hypertrophy (P = 0.01). Greater values of VAS at baseline negatively correlate with lower values of Tegner Activity Scale at last follow-up (P < 0.0001).

Conclusion

The clinical outcomes were mostly related to the patients’ performance status prior surgery. A greater BMI was associated with greater rate of hypertrophy. Female sex and older age evidenced fair influence, while symptom duration prior to the surgical intervention and cartilage defect size evidenced no association with the surgical outcome. Lesion size and symptom duration did not evidence any association with the surgical outcome.

Outcomes of bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) for treatment of osteochondral lesions of the talus

BACKGROUND

To analyze the outcomes of Bone marrow aspirate concentrate and Matrix-Induced Chondrogenesis (BMIC) in Osteochondral Lesions of the Talus (OLTs).

METHODS

Patients with OLTs treated with BMIC from June 2013 to July 2020 were included. Visual Analogue Scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Score (FAOS) before treatment and at last follow-up were subjected to analysis.

RESULTS

Forty-five patients were included and mean follow-up was 39.1 months (range, 13-97 months). Mean lesion size and depth were 180.7 ± 110.4 mm² and 9.6 ± 3.7 mm, respectively. BMIC was performed without malleolar osteotomy in 36 patients (80%) and bone graft was performed in 42 (93.3%). VAS, FFI, and FAOS improved significantly. No complication occurred and no revision was required.

CONCLUSIONS

The BMIC procedure is feasible and should be considered a viable treatment option for OLTs associated with large subchondral bone defects.

[Description of a technique that uses Lapidus arthrodesis plus osteochondral autotransplantation in the treatment of severe hallux rigidus]

OBJECTIVE

The objective of this technique is the treatment a severe hallux rigidus deformity by reorientation of an elevated first metatarsal using arthrodesis of the first tarsometatarsal joint and performing a one-step transplantation of an osteochondral graft, which is harvested from the first cuneiform, to the head of the first metatarsal bone.

INDICATIONS

Severe arthritis of the first metatarsophalangeal joint (MTP) stage 3 and 4 in the Vanore classification.

CONTRAINDICATIONS

General contraindications for a foot surgery; ankylosis of MTP joint; severe arthritis of the sesamoid joint; osteonecrosis; short first metatarsal; previous infection in the metatarsophalangeal joint; large cysts at the head of the first metatarsal.

SURGICAL TECHNIQUE

The first step is the preparation of the metatarsophalangeal and the first tarsometatarsal joint. After mobilizing the first metatarsal in a medioplantar direction, a cartilage-bone cylinder is removed from the articular surface of the medial cuneiform using special osteochondral autograft transfer system (OATS) instruments (Small Joint OATS, Arthrex medical instruments GmbH, Munich, Germany). This is followed by the arthrodesis of the first tarsometatarsal joint with reorientation of the position of the first metatarsal bone. Then the removed osteochondral cylinder is implanted into the articular surface of the first metatarsal head. After that the capsule is closed and the skin sutured.

POSTOPERATIVE MANAGEMENT

Postoperative management is guided mainly by the requirements of the first tarsometatarsal arthrodesis. When a plantar plate is used pain orientated full weightbearing is allowed in a postoperative shoe with a stiffened sole for 6-8 weeks. Physiotherapy is prescribed to exercise the first metatarsophalangeal joint.

RESULTS

In the study, 5 patients were treated with the method described in the years 2011-2012 and were followed up for a period of 2 years. All of these patients were subjectively satisfied with the outcome of the operation. There were no relevant surgery-associated complications.

Autologous matrix-induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint

OBJECTIVE

Chondral restoration in chondral defects of the 1st metatarsophalangeal joint (MTP1) using autologous matrix-induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC).

INDICATIONS

Chondral defects MTP1.

CONTRAINDICATIONS

Acute infection.

SURGICAL TECHNIQUE

Thigh tourniquet. Medial approach. Tenolysis of all tendons, arthrolysis, synovectomy. Bursectomy in case of bursitis. Resection osteophytes, optional cheilectomy. Debridement of chondral defects until surrounding cartilage stable. Microfracturing with 1.6 mm K‑wire. 15 cc peripheral venous blood harvested with double lumina syringe. Centrifugation (10 min, 1500 RPM). Aspiration of supernatant including the entire fluid layer directly above the erythrocyte layer (peripheral blood concentrate [PBC]). Chondro-Gide matrix was cut to size and impregnated in PBC 3 min (impregnation). Fixation of the matrix into the chondral defect with fibrin glue (AMIC+PBC). Joint motion to ensure stable fixation. Insertion drainage and wound infiltration catheter. Layer wise closure.

POSTOPERATIVE MANAGEMENT

Full weightbearing in a dressing shoe. Joint motion exercise starting at the day of surgery.

RESULTS

The aim of the study was to compare matrix-associated stem cell transplantation (MAST) with AMIC+PBC. Patients who were treated with MAST from October 1, 2011 to July 15, 2016 (n = 623) or with AMIC+PBC from July 17, 2016 to March 19, 2018 (n = 230) were included. In all, 480 (89%)/176 (89%) patients (MAST/AMIC+PBC) completed 2‑year follow-up. The average degree of osteoarthritis was 2.1/2.2. The chondral defect size was 0.9/1.0 cm² on average. Visual Analogue Scale Foot and Ankle (VAS FA) and European Foot and Ankle Society score (EFAS score) improved to 72.4/74.1//16.8/17.1 (MAST//AMIC+PBC) at follow-up, respectively. No parameter significantly differed between the MAST and AMIC+PBC cohorts.

Matrix-induced autologous chondrocyte implantation versus autologous matrix-induced chondrogenesis for chondral defects of the talus: a systematic review

INTRODUCTION

Chondral defects of the talus are common and their treatment is challenging.

SOURCE OF DATA

Recent published literatures.

AREAS OF AGREEMENT

Membrane-induced Autologous Chondrocyte Implantation (mACI) and Autologous Matrix-Induced Chondrogenesis (AMIC) have been proposed as management for chondral defects of the talus.

AREAS OF CONTROVERSY

It is debated whether AMIC provides greater outcomes compared to mACI for chondral regeneration. Several clinical studies showed controversial results, and the best treatment has not yet been clarified.

GROWING POINTS

To investigate whether AMIC provide superior outcomes than mACI at midterm follow-up.

AREAS TIMELY FOR DEVELOPING RESEARCH

AMIC exhibits similar clinical results to mACI. However, AMIC involves one single surgical procedure, no articular cartilage harvest and hence no morbidity from it, no need for chondrocyte expansion in a separate laboratory setting. For these reasons, AMIC may be preferred to mACI.

Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis

BACKGROUND

The aim of this study is to systematically review the literature on clinical outcomes of patients who have undergone autologous matrix-induced chondrogenesis (AMIC) for treatment of osteochondral lesions of the talus (OCL) and compare the studies' outcomes.

METHODS

Pubmed and Embase were searched in January 2020 for articles concerning OCL surgery. Studies were included if they had a minimum 1-year follow-up and the primary measures were functional outcomes. The meta-analysis compared the Visual Analogic Score (VAS), the American Orthopedic Foot and Ankle Score (AOFAS), and the Foot Function Index (FFI) between baseline and follow-up of 1-2years, and 3-5years. A random effects model was used to evaluate outcome changes.

RESULTS

The search returned 15 studies, with a total of 492 patients. The VAS improved 4.45 and 4.6 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). AOFAS improved 31.59 and 32.47 points from baseline to the 1-2year and 3-5yearfollow-up, respectively (p<0.001). The FFI showed a significant improvement of 30.93 points from baseline to year 3-5 (p<0.001). A total of 6 patients with revision surgeries have been reported within the follow up period. It was not possible to correlate clinical features like lesion size, surgical approach, and bone marrow stimulation technique to the reported outcome.

CONCLUSION

Surgical treatment of OCL via the AMIC procedure provided significant improvement in the functional outcome and pain scores when compared to the pre-operative values. Improvements were observed up to 5years post-operatively.