Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation
Category: Arthroscopy Introduction/Purpose: Osteochondral lesions of the talus (OLT) are frequent occurrences when patients sustain both traumatic and atraumatic ankle injuries with a report rate of up to 70% OLT in patients who sustain an ankle sprain or fracture. Surgical treatment options for OLT...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2016-08-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011416S00218 |
| _version_ | 1818619619137552384 |
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| author | Christopher E. Gross MD Brandon J. Erickson MD Yale A. Fillingham MD Michael D. Hellman MD Samuel B. Adams MD Selene G. Parekh MD, MBA |
| author_facet | Christopher E. Gross MD Brandon J. Erickson MD Yale A. Fillingham MD Michael D. Hellman MD Samuel B. Adams MD Selene G. Parekh MD, MBA |
| author_sort | Christopher E. Gross MD |
| collection | DOAJ |
| description | Category: Arthroscopy Introduction/Purpose: Osteochondral lesions of the talus (OLT) are frequent occurrences when patients sustain both traumatic and atraumatic ankle injuries with a report rate of up to 70% OLT in patients who sustain an ankle sprain or fracture. Surgical treatment options for OLT is either reparative or replacement and are dictated by characteristics of the lesion, including size and presence or absence of cysts. Periosteal-autologous chondrocyte implantation (P-ACI) or MACI (matrix-induced autologous chondrocyte implantation) is useful for lesions with or without cysts under 2.5cm2. We hypothesize that MACI will have the lowest reoperation rate and highest patient satisfaction rate in treating OLT. Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available free databases. Therapeutic clinical outcome investigations reporting OLT outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student’s t-tests, one-way ANOVA, chi-squared, and two-proportion Z-tests. Results: Nineteen articles met our inclusion criteria, which resulted in a total of 343 patients. Six studies pertained to arthroscopic MACI, 8 to open MACI, and 5 studies to open PACI. All studies were Level IV evidence. Due to study quality, imprecise and sparse data, and potential for reporting bias, the quality of evidence is low. In comparison of open and arthroscopic MACI, we found both advantages favoring open MACI (AOFAS and MOCART score). However, open MACI had higher complication rates versus arthroscopic (18.18% vs 0.78%, p = 0.002). In addition, the rate of impingement was noted to be significantly higher for the open technique of MACI with a rate of 10.61% as opposed to 0.78% for the arthroscopic technique (p = 0.01). 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. Ultimately well-designed randomized trials are needed to address the limitation of the available literature and further our understanding of the optimal treatment options. |
| first_indexed | 2024-12-16T17:40:22Z |
| format | Article |
| id | doaj.art-5f897b5a2378477bac2bdbc4e26df332 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-12-16T17:40:22Z |
| publishDate | 2016-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-5f897b5a2378477bac2bdbc4e26df3322022-12-21T22:22:37ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142016-08-01110.1177/2473011416S00218Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte ImplantationChristopher E. Gross MDBrandon J. Erickson MDYale A. Fillingham MDMichael D. Hellman MDSamuel B. Adams MDSelene G. Parekh MD, MBACategory: Arthroscopy Introduction/Purpose: Osteochondral lesions of the talus (OLT) are frequent occurrences when patients sustain both traumatic and atraumatic ankle injuries with a report rate of up to 70% OLT in patients who sustain an ankle sprain or fracture. Surgical treatment options for OLT is either reparative or replacement and are dictated by characteristics of the lesion, including size and presence or absence of cysts. Periosteal-autologous chondrocyte implantation (P-ACI) or MACI (matrix-induced autologous chondrocyte implantation) is useful for lesions with or without cysts under 2.5cm2. We hypothesize that MACI will have the lowest reoperation rate and highest patient satisfaction rate in treating OLT. Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available free databases. Therapeutic clinical outcome investigations reporting OLT outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared between continents and countries. Statistics were calculated using Student’s t-tests, one-way ANOVA, chi-squared, and two-proportion Z-tests. Results: Nineteen articles met our inclusion criteria, which resulted in a total of 343 patients. Six studies pertained to arthroscopic MACI, 8 to open MACI, and 5 studies to open PACI. All studies were Level IV evidence. Due to study quality, imprecise and sparse data, and potential for reporting bias, the quality of evidence is low. In comparison of open and arthroscopic MACI, we found both advantages favoring open MACI (AOFAS and MOCART score). However, open MACI had higher complication rates versus arthroscopic (18.18% vs 0.78%, p = 0.002). In addition, the rate of impingement was noted to be significantly higher for the open technique of MACI with a rate of 10.61% as opposed to 0.78% for the arthroscopic technique (p = 0.01). 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. Ultimately well-designed randomized trials are needed to address the limitation of the available literature and further our understanding of the optimal treatment options.https://doi.org/10.1177/2473011416S00218 |
| spellingShingle | Christopher E. Gross MD Brandon J. Erickson MD Yale A. Fillingham MD Michael D. Hellman MD Samuel B. Adams MD Selene G. Parekh MD, MBA Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation Foot & Ankle Orthopaedics |
| title | Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation |
| title_full | Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation |
| title_fullStr | Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation |
| title_full_unstemmed | Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation |
| title_short | Management of Osteochondral Lesions of the Talus Using Autologous Chondrocyte Implantation |
| title_sort | management of osteochondral lesions of the talus using autologous chondrocyte implantation |
| url | https://doi.org/10.1177/2473011416S00218 |
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