Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte

Implantation

Christopher E. Gross, MD1; Brandon Erickson, MD2; Yale Fillingham, MD2;

Michael Hellman, MD2; Samuel B. Adams, MD3; Selene Parekh, MD3

1Department of Orthopaedics Medical University of South Carolina

Charleston, SC 2Department of Orthopaedic Surgery

Rush University Medical Center 3Department of Orthopaedic Surgery

Duke University Medical Center

cgross144@gmail.com Twitter: @FootAndAnkle_MD

NO CONFLICT TO DISCLOSE

Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte

Implantation

We have no potential conflicts with this presentation.

Introduction • Osteochondral lesion of the

talus (OLT) are frequent occurrences – traumatic and atraumatic – rate of up to 70% OLT in patients

who sustain an ankle sprain or fracture

• OLTs rarely treated non-operatively as results of non-operative treatment have shown a success rate of less than 50%.

Surgical Strategies • Reparative (<1.5cm2)

– Marrow stimulation

• Replacement (<2.5cm2) – Osteochondral auto/allograft – autologous chondrocyte

implantation (ACI) – matrix induced autologous

chondrocyte implantation (MACI) – periosteal autologous chondrocyte

implantation (PACI) – metallic implantation

Purpose To perform a systematic review of the literature to determine which surgical treatment option for OLT less than 2.5cm2 excluding microfracture provided the lowest complication rate, best clinic outcomes, and highest patients satisfaction rate

Hypothesis MACI would have the lowest complications rate and the highest patient satisfaction rate of the treatments examined.

Methods • Two reviewers independently conducted the search

on February 1, 2014 – Medline, Cochrane Central Register of Controlled

Trials, SportDiscus, and CINAHL. – (talus OR talar) AND (osteochondral OR cartilage OR

lesions) AND (chondrocyte OR autologous OR implantation OR chondrogenesis)

• Exclusion – Level V evidence, reviews, letters to the editor, basic

science, biomechanical studies, imaging, surgical technique, and classification studies

Methods • 218 studies 19 included in final analysis

– open MACI, arthroscopic MACI, open PACI – Clinical outcome scores, complications, re-operations

noted

• Statistics – Data was aggregated based on each treatment method

and weighted outcomes were calculated – Random effect model – Continuous data: Inverse Variance – Dichotomous data: Mantel-Haenzel

Results • 343 study subjects

Results • Regardless of the treatment option all studies

demonstrated a statistically significant improvement between pre-operative and post-operative AOFAS scores.

• Evaluation of post-operative AOFAS scores demonstrate no statistical difference between all MACI and PACI, but open MACI has a greater post-operative AOFAS score compared to arthroscopic MACI.

Re-operation and Complications • Reoperation: no statistical significant was noted between

MACI vs. PACI, – open MACI had a significantly lower rate of reoperation

compared to arthroscopic MACI. • No difference in complication rates between MACI and

PACI • Open MACI had a statistically significant increase in overall

complications for the open technique with a rate 18.18% compared to 0.78% for arthroscopic

• Rate of impingement was noted to be significantly higher for the open technique of MACI (vs. arthroscopic)

Complications of MACI vs. PACI

Complications of Open vs. Arthroscopic MACI

Conclusion • No procedure demonstrates superiority or inferiority

between the combination of open or arthroscopic MACI and PACI in the management of OLT less than 2.5 cm2.

• Although under the comparison of open and arthroscopic MACI, we found both advantages favoring open MACI.

• The measured benefits of open MACI come at the cost of higher complication rates.

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