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Kolar M, Veber M, Girandon L, Drobnič M. Biomaterials augmented with filtered bone marrow aspirate for the treatment of talar osteochondral lesions. A comparison of clinical and cellular parameters. J Orthop Surg (Hong Kong) 2024; 32:10225536231219970. [PMID: 38214308 DOI: 10.1177/10225536231219970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Biomaterials augmented with Bone Marrow Aspirate Concentrate (BMAC) are becoming increasingly utilized in the cartilage treatment. However, the potential role of cellular parameters in the intraoperatively applied BMAC have yet to be elucidated. PURPOSE (A) To evaluate clinical outcomes and safety of a combined single-step approach with scaffolds (fibrin glues, collagen gels, collagen-hydroxyapatite membrane) and filtered Bone Marrow Aspirate (fBMA) for the treatment of osteochondral lesions of the talus (OLTs). (B) To identify significant factors for postoperative improvements, considering cellular parameters as potential predictors. METHODS All the patients operated on due to OLTs by the combination above were selected from the hospital registry database (35 pts, years 16-55, and minimally 1 year follow-up). Treatment outcomes were followed clinically with Patient-reported outcome measures (PROMs), and by pursuing serious adverse events (SAE) and graft failures (GF). Cellular parameters of the injected fBMA were determined. Pre- and postoperative PROMs values were compared to evaluate postoperative improvements. Multivariable regression models were applied to identify potential factors (demographics, medical history, joint and lesion characteristics, scaffold type, surgical and cellular parameters) that predict the treatment outcomes. RESULTS At the mean follow-up of 32.2 (12.5) months, all Foot and Ankle Outcome Score (FAOS) and European Quality of Life in Five Dimensions Three-Level (EQ-5D-3 L) values improved significantly. 4 (11%) SAE (3 arthrofibrosis, one hardware removal), and 3 (9%) GF occurred. Female gender and concomitant procedures were the main negative predictors for postoperative outcomes. The number of fibroblast colony forming units (CFU-F) or their proportion among total nucleated cells (CFU-F/TNC) were positively correlated with the improvements of some PROMs. CONCLUSIONS Scaffolds augmented with fBMA proved as an adequate and safe approach for OLTs treatment. Cellular parameters seem to influence the treatment outcomes, thus further attention should be given to the intraoperatively applied products. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Matic Kolar
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | | | - Matej Drobnič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Richter M, Zech S, Meissner S, Naef I. Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach - 5-year follow-up. Foot Ankle Surg 2022; 28:1321-1326. [PMID: 35803836 DOI: 10.1016/j.fas.2022.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to assess 5-year-follow-up (5FU) after Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle as part of a complex surgical approach. METHODS In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral lesion at the ankle 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 twenty-nine patients with 136 chondral lesions were included in the study. The chondral lesions were located as follows (n (%)), medial talar shoulder only, 62 (46); lateral talar shoulder only, 42 (31); medial and lateral talar shoulder, 7 (10); tibia, 18 (13). The average for lesion size was 1.8 cm2, for VAS FA 45.7 and for EFAS Score 9.8. 2FU/5FU was completed in 105 (81 %)/104(81 %) patients with 112/111 previous chondral lesions. VAS FA improved to 79.8/84.2 and EFAS Score to 20.3/21.5 (2FU/5FU). No parameter significantly differed 2FU and 5FU. CONCLUSIONS AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores at 2FU/5FU. 2FU and 5FU did not differ.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Stefan Meissner
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | - Issam Naef
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
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Richter M, Zech S, Meissner SA, Naef I. Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint - 5-year follow-up. Foot Ankle Surg 2022; 28:1366-1371. [PMID: 35850950 DOI: 10.1016/j.fas.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany.
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
| | | | - Issam Naef
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany
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Kim BS, Na Y, Jang DS. Outcomes of bone marrow aspirate concentrate and matrix-induced chondrogenesis (BMIC) for treatment of osteochondral lesions of the talus. Foot Ankle Surg 2022; 28:944-949. [PMID: 35063361 DOI: 10.1016/j.fas.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/12/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Bom Soo Kim
- Department of Orthopaedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea.
| | - Yeop Na
- Department of Orthopaedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
| | - Dong-Su Jang
- Department of Orthopaedic Surgery, Inha University College of Medicine, Incheon, Republic of Korea
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Danilkowicz R, Murawski C, Pellegrini M, Walther M, Valderrabano V, Angthong C, Adams S. Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Foot and Ankle: An Orthoregeneration Network Foundation Review. Arthroscopy 2022; 38:2350-2358. [PMID: 35605840 DOI: 10.1016/j.arthro.2022.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 02/02/2023]
Abstract
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the foot and ankle (including acute traumatic injuries and fractures, tumor, infection, osteochondral lesions, arthritis, and tendinopathy) and procedures, including osteotomy or fusion. Promising and established treatment modalities include 1) bone-based therapies (such as cancellous or cortical autograft from the iliac crest, proximal tibia, and/or calcaneus, fresh-frozen or freeze-dried cortical or cancellous allograft, including demineralized bone matrix putty or powder combined with growth factors, and synthetic bone graft substitutes, such as calcium sulfate, calcium phosphate, tricalcium phosphate, bioactive glasses (often in combination with bone marrow aspirate), and polymers; proteins such as bone morphogenic proteins; and platelet-derived growth factors; 2) cartilage-based therapies such as debridement, bone marrow stimulation (such as microfracture or drilling), scaffold-based techniques (such as autologous chondrocyte implantation [ACI] and matrix-induced ACI, autologous matrix-induced chondrogenesis, matrix-associated stem cell transplantation, particulated juvenile cartilage allograft transplantation, and minced local cartilage cells mixed with fibrin and platelet rich plasma [PRP]); and 3) blood, cell-based, and injectable therapies such as PRP, platelet-poor plasma biomatrix loaded with mesenchymal stromal cells, concentrated bone marrow aspirate, hyaluronic acid, and stem or stromal cell therapy, including mesenchymal stem cell allografts, and adipose tissue-derived stem cells, and micronized adipose tissue injections. LEVEL OF EVIDENCE: Level V, expert opinion.
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Affiliation(s)
- Richard Danilkowicz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Christopher Murawski
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Manuel Pellegrini
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Markus Walther
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Victor Valderrabano
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Chayanin Angthong
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Samuel Adams
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, U.S.A.
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Štalc J, Cicchinelli LD, Miller S, Richter M. Fiber-reinforced fixation implant for proximal interphalangeal joint arthrodesis shows implant bio-integration at 1-year follow-up. Foot Ankle Surg 2022; 28:418-423. [PMID: 34247921 DOI: 10.1016/j.fas.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND A new bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) was developed for proximal interphalangeal joint (PIPJ) correction-arthrodesis. The main purpose of this clinical study was to assess implant bio-integration at 1-year follow-up. METHODS Twenty-four patients, previously treated for a Hammertoe deformity using the bio-integrative, fiber-reinforced implant, were enrolled in this follow-up study. One-year follow-up included clinical examination, patient reported outcomes, radiographs, Magnetic Resonance Imaging (MRI) and bio-integration scoring. RESULTS Proximal interphalangeal joint (PIPJ) radiographic fusion rate was 92% (n = 22). MRI was analyzed for 24 (100%) patients. In 100% of patients (n = 24), the border between implant and surrounding tissue was scored as partially visible. There were no cyst formation or fluid accumulation findings. Mild bone edema was detected in 29% (n = 7) and is attributed to the chronic distribution of forces due to chronic abnormal gait and pasture. None of the edema findings were considered as adverse implant-related finding. The mean bio-integration score was 7.71 ± 0.46. CONCLUSIONS This study demonstrates safe bio-integration of the newly developed fiber-reinforced implant at 1-year follow-up without negative side effects.
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Affiliation(s)
- Jurij Štalc
- Valdoltra Orthopedic Hospital, Ankaran, Slovenia.
| | | | - Stuart Miller
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Martinus Richter
- Department for Foot and Ankle Surgery, Rummelsberg and Nuremberg, Germany
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Gottschalk O, Baumbach SF, Altenberger S, Körner D, Aurich M, Plaass C, Ettinger S, Guenther D, Becher C, Hörterer H, Walther M. Influence of the Medial Malleolus Osteotomy on the Clinical Outcome of M-BMS + I/III Collagen Scaffold in Medial Talar Osteochondral Lesion (German Cartilage Register/Knorpelregister DGOU). Cartilage 2021; 13:1373S-1379S. [PMID: 33030049 PMCID: PMC8808948 DOI: 10.1177/1947603520961169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Osteochondral lesions of the talus are common injuries, with one of the leading treatment options being the M-BMS (matrix-augmented bone marrow stimulation) + I/III collagen scaffold. Osteotomy of the medial malleolus is not unusual but presents the risk of malunion or irritation by hardware. The aim of the study was to analyze data from the German Cartilage Society (Knorpelregister DGOU) to evaluate the influence of medial malleolar osteotomy on clinical results of M-BMS + I/III collagen scaffold. DESIGN The ankle module of the Cartilage Register includes a total of 718 patients, while 45 patients met the inclusion criteria. Patients were treated with an M-BMS + I/III collagen scaffold of the medial talus, 30 without and 15 with an osteotomy of the medial malleolus. The follow-up evaluations included FAAM (Foot and Ankle Ability Measure), FAOS (Foot and Ankle Outcome Score), and VAS (visual analogue scale). RESULTS Forty-five patients (22 male, 23 female) aged between 18 and 69 years (mean: 34 years) were included in this study. Between preoperative and 12 months postoperative, we noted a significant improvement in FAAM-ADL (Activity of Daily Living) (P = 0.004) as well as FAOS-Pain (P = 0.001), FAOS-Stiffness (P = 0.047), FAOS-ADL (P = 0.002), FAOS-Sport (P = 0.001), and FAOS Quality of Life (P = 0.009). There was no significant difference between patients who underwent an osteotomy or not. CONCLUSION The results show a significant improvement in patients' outcome scores following a M-BMS + I/III collagen scaffold. No statistical difference was noted among those undergoing medial malleolar osteotomy.
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Affiliation(s)
- Oliver Gottschalk
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany,Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany,Oliver Gottschalk, Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Harlachinger Straße 51, Munich, 81547, Germany
| | - Sebastian Felix Baumbach
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany,Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | | | - Daniel Körner
- Department of Traumatology and Reconstructive Surgery, BG Trauma Centre Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Matthias Aurich
- Center for Orthopedics and Trauma Surgery, Klinikum Mittleres Erzgebirge, Zschopau, Germany
| | - Christian Plaass
- Department for Foot and Ankle Surgery, Diakovere Annastift, Orthopedic Clinic of the Hannover Medical School, Hannover, Germany
| | - Sarah Ettinger
- Department for Foot and Ankle Surgery, Diakovere Annastift, Orthopedic Clinic of the Hannover Medical School, Hannover, Germany
| | - Daniel Guenther
- Department of Orthopedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Witten, Germany
| | - Christoph Becher
- Center for Knee, Hip, and Foot Surgery, ATOS Clinic, Heidelberg, Germany
| | - Hubert Hörterer
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany,Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Markus Walther
- Center for Foot and Ankle Surgery, Schön Klinik München Harlaching, Munich, Germany
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Rikken QGH, Dahmen J, Altink JN, Buck TMF, Stufkens SAS, Kerkhoffs GMMJ. Surgical Treatment of Osteochondral Lesions of the Tibial Plafond: A Systematic Review and Meta-Analysis. JBJS Rev 2021; 9:01874474-202107000-00001. [PMID: 34223828 DOI: 10.2106/jbjs.rvw.20.00190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The literature on osteochondral lesions of the tibial plafond (OLTPs) is sparse. The aim of this study was therefore to provide an overview of clinical and radiological outcomes following treatment of OLTPs. METHODS We performed a systematic search of the MEDLINE, Embase, and Cochrane library databases. The review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and included all original articles on treatment outcomes for OLTPs. The methodological quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Baseline patient and lesion characteristics were pooled and weighted according to the number of lesions per study. The primary outcome was any clinical or patient-reported outcome measure pooled by treatment method when separable data were available. Secondary outcomes were complications, reoperation rates, radiological outcomes, and sport outcomes. RESULTS The search yielded 2,079 articles, of which 10 studies (1 prospective case series, 1 retrospective comparative study, and 8 retrospective case series) with a total of 175 patients were included. The overall methodological quality of the studies was low. All patients were treated surgically; 96% of the lesions were primary cases (i.e., first-time surgery) and 58% were solitary tibial lesions (i.e., no opposing talar lesion). Arthroscopic bone marrow stimulation was the most frequently used treatment strategy (51%), followed by cartilage transplantation (17%), chondrogenesis-inducing techniques (11%), osteochondral transplantation (3%), retrograde drilling (3%), and mixed (i.e., inseparable) treatments (15%). The clinical outcomes of the different surgical therapies were considered to be moderate to good. The pooled postoperative AOFAS (American Orthopaedic Foot & Ankle Society) score for bone marrow stimulation and osteochondral transplantation was 54.8 (95% confidence interval [CI], 49.5 to 85.0) (n = 14) and 85.3 (95% CI, 56 to 100) (n = 3), respectively. Overall, complications and reoperations were rarely reported. The pooled complication and reoperation rates could only be calculated for bone marrow stimulation and were 5% and 7%, respectively. CONCLUSIONS Surgical interventions for OLTPs appear to yield moderate to good clinical outcomes. Bone marrow stimulation resulted in a moderate AOFAS score. Complications and reintervention rates were found to be low. The current evidence in the literature is limited because of the underreporting of clinical, radiological, and sport data and the heterogenous outcome scores reported. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Q G H Rikken
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - J Dahmen
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - J N Altink
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - T M F Buck
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - S A S Stufkens
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - G M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.,Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, the Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, the Netherlands
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Walther M, Valderrabano V, Wiewiorski M, Usuelli FG, Richter M, Baumfeld TS, Kubosch J, Gottschalk O, Wittmann U. Is there clinical evidence to support autologous matrix-induced chondrogenesis (AMIC) for chondral defects in the talus? A systematic review and meta-analysis. Foot Ankle Surg 2021; 27:236-245. [PMID: 32811744 DOI: 10.1016/j.fas.2020.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/10/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Markus Walther
- Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547 München, Germany.
| | - Victor Valderrabano
- Swiss Ortho Center Schmerzklinik Basel, Swiss Medical Network, Hirschgässlein 15, 4010 Basel, Switzerland.
| | - Martin Wiewiorski
- Kantonspital Winterthur, Zeughausstrasse 73, 8400 Winterthur, Switzerland.
| | - Federico Giuseppe Usuelli
- Istituto Ortopedico Galeazzi, USPeC - Unità Specialistica Piede e Caviglia, Foot and Ankle Department, Italy.
| | - Martinus Richter
- Klinik for Foot and Ankle Surgery, Rummelsberg 71, 90592 Schwarzenbruck, Germany.
| | - Tiago Soares Baumfeld
- Hospital Felicio Rocho, Department of Orthopaedics, Av. do Contorno, 9530 Belo Horizonte, MG, Brazil.
| | - Johanna Kubosch
- Department of Orthopedics and Trauma Surgery, Medical Center, Albert-Ludwigs-University of Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany.
| | - Oliver Gottschalk
- Department of General, Trauma and Reconstructive Surgery, University Hospital, LMU, Munich, Germany; Schön Klinik München Harlaching - FIFA Medical Centre, Harlachinger Straße 51, 81547 München, Germany.
| | - Udo Wittmann
- Consult AG, Tramstrasse 10, 8050 Zürich, Switzerland.
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Andjelkov N, Riyadh H, Ivarsson M, Kacarevic-Popovic Z, Krstic J, Wretenberg P. The enhancement of cartilage regeneration by use of a chitosan-based scaffold in a 3D model of microfracture in vitro: a pilot evaluation. J Exp Orthop 2021; 8:12. [PMID: 33599885 PMCID: PMC7892646 DOI: 10.1186/s40634-021-00328-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/18/2021] [Indexed: 01/15/2023] Open
Affiliation(s)
- N Andjelkov
- Department of Orthopedics, Västmanlands Regional Hospital, Västerås, Sweden. .,Centre for Clinical Research, Uppsala University, Västmanlands Regional Hospital, Västerås, Sweden. .,Department of Orthopaedics, School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - H Riyadh
- Department of Orthopedics, Västmanlands Regional Hospital, Västerås, Sweden
| | - M Ivarsson
- Department of Health Sciences, University of Örebro, Örebro, Sweden
| | - Z Kacarevic-Popovic
- Department of Radiation Chemistry and Physics, Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - J Krstic
- Department of Radiation Chemistry and Physics, Vinca Institute of Nuclear Sciences, University of Belgrade, Belgrade, Serbia
| | - P Wretenberg
- Department of Orthopaedics, School of Medical Sciences, Örebro University, Örebro, Sweden
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Richter M, Milstrey A, Zech S, Evers J, Grueter A, Raschke MJ, Ochman S. Comparison of clinically used bilayer collagen membrane and trilayer collagen prototype fixation stability in chondral defects at the talus - An experimental human specimen study. Foot Ankle Surg 2021; 27:35-39. [PMID: 32044174 DOI: 10.1016/j.fas.2020.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/02/2020] [Accepted: 01/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this human specimen experimental study was to compare the fixation stability of clinically used bilayer collagen membrane with fibrin glue with trilayer collagen prototype without fibrin glue in chondral defects at the medial or lateral talar shoulder (both matrices from Geistlich Pharma AG, Wollhusen, Switzerland). METHODS Eleven human specimens were used. The membranes were implanted in standardized chondral defects at the medial and lateral talar shoulder randomized. All tests were performed in load-control 15 kg. Range of motion ROM of each ankle was examined individually before testing. The average ROM was 10° dorsiflexion range 0°-20° and 30° plantarflexion range 20°-45°. 1,000 testing cycles with the defined ROM were performed. Two independent investigators, blinded to membrane and fixation type, visually assessed the membrane fixation integrity for peripheral detachment, area of defect uncovered, membrane constitution and delamination. RESULTS The clinically used bilayer collagen membrane plus fibrin glue showed higher fixation stability than the trilayer prototype (all p < 0.05). No significant differences occurred between medial and lateral talar shoulder location (all p > 0.05). CONCLUSIONS The fixation stability of the trilayer collagen prototype without fibrin glue is lower than of the clinically used bilayer membrane with fibrin glue in chondral defects at the medial and lateral talar shoulder in an experimental human specimen test. Clinical use of trilayer collagen prototype without fibrin glue has to be validated by clinical testing to evaluate if the lower stability of fixation is still sufficient.
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Affiliation(s)
- Martinus Richter
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany(2).
| | - Alexander Milstrey
- Department of Trauma-, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Stefan Zech
- Department for Foot and Ankle Surgery Rummelsberg and Nuremberg, Germany(2)
| | - Julia Evers
- Department of Trauma-, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Angelika Grueter
- Department of Trauma-, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Michael J Raschke
- Department of Trauma-, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Sabine Ochman
- Department of Trauma-, Hand and Reconstructive Surgery, University of Muenster, Muenster, Germany
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12
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Wang CC, Yang KC, Chen IH. Current treatment concepts for osteochondral lesions of the talus. Tzu Chi Med J 2020; 33:243-249. [PMID: 34386361 PMCID: PMC8323653 DOI: 10.4103/tcmj.tcmj_106_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022] Open
Abstract
Osteochondral lesions of the talus (OLT) are a well-known cause of ankle joint pain and can sometimes lead to instability. These lesions are not only confined to articular hyaline cartilage, they can also affect the subchondral bone at the weight-bearing aspect of the talar dome. Nonoperative treatment is the preferred option for small lesions, however surgical intervention is recommended for large lesions or those for which conservative treatment has failed. Microfracture, abrasion arthroplasty and multiple drilling are all classified as bone marrow stimulation procedures; they are used to try to recruit precursor cells for cartilage regeneration and are especially suitable for small OLT lesions. For large lesions, osteochondral autografting and allografting are better options to reconstruct the articular defect, as they have better contours and mechanical strength. When there is limited subchondral bone involvement in large lesions, cell-based therapies such as autogenous chondrocyte implantation, potentially combined with a biomaterial matrix, are a promising option and acceptable functional outcomes have been reported. To provide evidence-based recommendations for clinicians, this article evaluates the currently available treatment strategies for OLT and their evolution over the past few decades.
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Affiliation(s)
- Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Kai-Chiang Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ing-Ho Chen
- Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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13
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Comparison Matrix-Associated Stem Cell Transplantation (MAST) with Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle-A clinical matched-patient analysis. Foot Ankle Surg 2020; 26:669-675. [PMID: 31548148 DOI: 10.1016/j.fas.2019.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to compare Matrix-Associated Stem Cell Transplantation (MAST) with Autologous Matrix Induced Chondrogenesis plus Peripheral Blood Concentrate (AMIC+PBC) in chondral lesions at the ankle. METHODS In a matched-patient clinical follow-up study, patients with chondral lesion at the ankle that were treated with MAST from April 1, 2009 to July 15, 2016, and patients that were treated with AMIC+PBC from July 17, 2016 to May 31, 2017 were included and compared. Size and location of the chondral lesions and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Bone Marrow Aspirate Concentrate (BMAC) was used for MAST and Peripheral Blood Concentrate (PBC) for AMIC+PBC to impregnate a collagen I/III matrix (Chondro-Gide, Wollhusen, Switzerland) that was fixed into the chondral lesion with fibrin glue. RESULTS One hundred and twenty-nine patients with 136 chondral lesions were included in both groups. The chondral lesions were located as follows (MAST/AMIC+PBC, n (%)), medial talar shoulder only, 59 (43)/62 (46); lateral talar shoulder only, 44 (32)/42 (31); medial and lateral talar shoulder, 7 (10)/7 (10); tibia, 19 (14)/18 (13). The lesion size was 1.6/1.8cm2 on average and VAS FA was 46.9/45.7 (MAST/AMIC+PBC). For MAST/AMIC+PBC groups, 107 (83%)/105 (81%) with 112/110 previous chondral lesions completed the defined 2-year-follow-up after 24.4/23.8 months on average. VAS FA improved to 82.3/79.8 (MAST/AMIC+PBC). No parameter significantly differed between MAST and AMIC+PBC groups. CONCLUSIONS MAST and AMIC+PBC as part of a complex surgical approach led to improved and high validated outcome scores in 2-year-follow-up. MAST and AMIC+PBC showed similar results.
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Daniels TR, Wilson IR, Fu JM. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2020; 102:856-865. [PMID: 32187125 DOI: 10.2106/jbjs.20.00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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15
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Matrix-associated stem cell transplantation is successful in treating talar osteochondral lesions. Knee Surg Sports Traumatol Arthrosc 2019; 27:2737-2743. [PMID: 30888452 DOI: 10.1007/s00167-019-05452-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 02/27/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to try and treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix-associated stem cell transplantation (MAST) is one such treatment described for larger lesions > 15 mm2 or failed alternative therapies. This cohort study describes a 3 year review of the outcomes of talar lesions treated with MAST. METHODS A review of all patients treated with MAST by a single surgeon was conducted. Pre-operative radiographs, MRIs, and FAOS outcome questionnaire scores were reviewed. Intraoperative classification was undertaken to correlate with imaging. Post-operative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment, and progression to ankle fusion. RESULTS In this study, 38 OCLs in 32 patients were identified. Median patient age was 35 years of which (68.8%) were male. Median length of follow-up was 36.7 months (range 12-64 months). (83%) returned to playing sport. Twenty-three patients underwent MAST in the setting of a failed previous operative attempt, with just nine having MAST as a first option. Nine patients out of 32 had a further procedure. Improvements were seen in all domains of the FAOS (p < 0.05). CONCLUSION MAST has demonstrated encouraging results in lesions which prove challenging to treat, even in a "failed microfracture" cohort. LEVEL OF EVIDENCE IV.
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