evolution of ankle osteochondral lesion surgery
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Istituto Ortopedico Rizzoli
University of Bologna
head: Prof. Sandro Giannini
Evolution of ankle osteochondral
lesion surgery
S. Giannini, R. Buda, M. Cavallo, A. Ruffilli, F. Vannini
Evolution of ankle osteochondral
lesion surgery
Prof. Sandro Giannini
My disclosure is in the
Final AOFAS Mobile App.
I have no potential conflicts with
this presentation.
Autologous Chondrocyte Implantation (ACI)
• Open technique (I generation)
• Arthroscopic technique (II generation)
Bone Marrow Derived Cells Transplantation
(III generation)
OSTEOCHONDRAL LESIONS
Chronic type II-IIIA lesions of Giannini
classification (2005):
Indication for a regenerative procedure:
ANKLE HIND FOOT SCORE (100 POINTS)
(MEAN AOFAS SCORE, 10 PATIENTS)
PRE-OP : 41,2 ± 14.5 PTS
12 MONTHS : 79.4, ±12.6 (p<0,0005)
36 MONTHS : 85.3 ±11.0 (p<0,0005)
10 YEARS : 88.3 ±17.0 (p<0,0005)
OPEN FIELD ACI
MALE 40 yrs ACI open 8 yrs FU
AOFAS score 87
Excellent cartilage
regeneration hyaline-like
(45 msc) focus with no
signal both between 20
and 50 msc and between
50 and 80
Once the signal was
extend, it appeared as
a bony focus
biopsy site?
OPEN FIELD ACI:
CASE REPORT
ANKLE HIND FOOT SCORE (100 POINTS)
(MEAN AOFAS SCORE, 46 PATIENTS)
PRE-OP : 41,2 ± 14.5 POINTS
12 MONTHS : 79.4, ±12.6 (p<0,0005)
36 MONTHS : 85.3 ±11.0 (p<0,0005)
7 YEARS : 88.3 ±17.0 (p<0,0005)
ARTHROSCOPIC ACI
Chondrocytes expansion seed
onto the biomaterial
ARTHROSCOPIC ACI: CASE REPORT
Male 32 years : MRI T2 mapping at 5 yrs FU
High T2 area suggestive for hyaline cartilage in the
regenerated site
1) Platelet gel production
2) Bone marrow harvesting and concentration
3) Biomaterial preparation
4) Arthroscopic implantation
“ONE-STEP” TECHNIQUE
• 202 patients
• Mean age 28.3 yrs (min 15 yrs, max 46)
• Aofas pre-op: 64.4 (min 35- max 79)
• Mean f-u 29.8 months
(Min 6 months, max 57 months)
• All the patients received a completely arthroscopic treatment
• 3 biopses at 1 year of follow up with patients’ consent
CASE SERIES: ANKLE
AOFAS score: progressive significant
improvement over time.
Safranin-O staining of the biopsy specimen shows
a chondral tissue.
Proteoglicans are highly express (red) while
collagen component (green) is less represented
The presence of underlying bone is evident in
specimens
Hyaline regenerate in 80% of
regenerated area correlate
with higher clinical score (89
± 16 points) at 48 months FU
(p=0.06)
The presence of fibrocartilage
regenerate (T2 map<35 ms)
had a negative influence on the
clinical score at 48 months
(p=0.06)
MRI T2 MAPPING
CONCLUSIONS
The arthroscopic BMDC transplantation demonstrated to be able
to obtain good results under clinical, MRI and histological
aspects in osteochondral lesions of the ankle
Main advantages of this procedure are:
Less morbidity: only one step is required
Less invasivity: use of arthroscopy
Good results
Regeneration of both cartilage and subchondral bone
Lower costs
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