One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus
Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Osteochondral lesions of the talus (OLTs) present a challenging clinical problem. Hyaluronic acid assisted autologous membrane-induced chondrogenesis (H-AMIC) is a technique where a polyglycolic acid and hyaluronin membrane scaffold (Ch...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-12-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011423S00361 |
| _version_ | 1797375272685666304 |
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| author | Anil Haldar MBBS BSc(Hons) FRCS PGCert Amir Hossain Gahanbani Ardakani BSc (Hons), MBBS Shelain Patel FRCS(Orth) Matthew J. Welck MD. MSc. BSc Karan Malhotra MBChB (Hons), MRCS, FRCS (Tr&Orth) Nicholas Cullen MBBs, BSc, FRCS(Tr&Orth) |
| author_facet | Anil Haldar MBBS BSc(Hons) FRCS PGCert Amir Hossain Gahanbani Ardakani BSc (Hons), MBBS Shelain Patel FRCS(Orth) Matthew J. Welck MD. MSc. BSc Karan Malhotra MBChB (Hons), MRCS, FRCS (Tr&Orth) Nicholas Cullen MBBs, BSc, FRCS(Tr&Orth) |
| author_sort | Anil Haldar MBBS BSc(Hons) FRCS PGCert |
| collection | DOAJ |
| description | Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Osteochondral lesions of the talus (OLTs) present a challenging clinical problem. Hyaluronic acid assisted autologous membrane-induced chondrogenesis (H-AMIC) is a technique where a polyglycolic acid and hyaluronin membrane scaffold (Chondrotissue ® ) is affixed over an area of talar bone marrow stimulation. Our study aims to assess the efficacy of this technique. Methods: We undertook a prospective study on consecutive adult patients at our unit who had H-AMIC procedures between January 2020 and November 2021 to treat single, symptomatic OLTs, >1.5cm 2 , refractory to previous management. Data was collected on patient reported outcomes (MOxFQ, EQ5D, satisfaction), ankle range of movement, and complications at 1-year post-surgery. Fifteen patients were included in this study with a mean age of 33.8±20.9 years. Mean duration of symptoms was 7.9±5.2 years, with a mean of 1.5 previous procedures (range 0 to 3). All patients had osteotomies to gain access to the OLT (13 medial malleolar, 2 fibular). Results: Mean improvements greater than the minimum clinically important difference (MCID) were seen in MOxFQ-Pain (61.7±26.1 to 48.3±21.8, p=0.112), MOxFQ-Walking (64.6±21.8 to 46.6±23.9, p=0.067), MOxFQ-Social (63.67±22.5 to 41.8±29.2, p=0.055), although none reached statistical significance. No difference was seen in EQ5D. Overall improvements were seen in MOxFQ-Pain in 58.3%, MOxFQ-Walking in 75%, and MOxFQ-Social in 83.3% of patients. Overall, 11 patients (73.3%) were satisfied with the procedure. Patients displayed improvement in plantarflexion from 33.1±5.5 to 42.0±7.9 degrees (p=0.002) and no change to dorsiflexion. There were no complications. Conclusion: The H-AMIC procedure is a promising and safe option for larger osteochondral lesions of the talus. Early results suggest improved range of motion despite osteotomy and clinically (but not statistically) significant improvement in function in a group of patients with longstanding symptoms and previous failed surgery. Larger, adequately powered cohorts may establish statistical efficacy of this technique compared with alternative techniques. |
| first_indexed | 2024-03-08T19:19:54Z |
| format | Article |
| id | doaj.art-d3d832daf5d9420baf96372906c390bf |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-03-08T19:19:54Z |
| publishDate | 2023-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-d3d832daf5d9420baf96372906c390bf2023-12-26T19:06:06ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142023-12-01810.1177/2473011423S00361One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the TalusAnil Haldar MBBS BSc(Hons) FRCS PGCertAmir Hossain Gahanbani Ardakani BSc (Hons), MBBSShelain Patel FRCS(Orth)Matthew J. Welck MD. MSc. BScKaran Malhotra MBChB (Hons), MRCS, FRCS (Tr&Orth)Nicholas Cullen MBBs, BSc, FRCS(Tr&Orth)Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Osteochondral lesions of the talus (OLTs) present a challenging clinical problem. Hyaluronic acid assisted autologous membrane-induced chondrogenesis (H-AMIC) is a technique where a polyglycolic acid and hyaluronin membrane scaffold (Chondrotissue ® ) is affixed over an area of talar bone marrow stimulation. Our study aims to assess the efficacy of this technique. Methods: We undertook a prospective study on consecutive adult patients at our unit who had H-AMIC procedures between January 2020 and November 2021 to treat single, symptomatic OLTs, >1.5cm 2 , refractory to previous management. Data was collected on patient reported outcomes (MOxFQ, EQ5D, satisfaction), ankle range of movement, and complications at 1-year post-surgery. Fifteen patients were included in this study with a mean age of 33.8±20.9 years. Mean duration of symptoms was 7.9±5.2 years, with a mean of 1.5 previous procedures (range 0 to 3). All patients had osteotomies to gain access to the OLT (13 medial malleolar, 2 fibular). Results: Mean improvements greater than the minimum clinically important difference (MCID) were seen in MOxFQ-Pain (61.7±26.1 to 48.3±21.8, p=0.112), MOxFQ-Walking (64.6±21.8 to 46.6±23.9, p=0.067), MOxFQ-Social (63.67±22.5 to 41.8±29.2, p=0.055), although none reached statistical significance. No difference was seen in EQ5D. Overall improvements were seen in MOxFQ-Pain in 58.3%, MOxFQ-Walking in 75%, and MOxFQ-Social in 83.3% of patients. Overall, 11 patients (73.3%) were satisfied with the procedure. Patients displayed improvement in plantarflexion from 33.1±5.5 to 42.0±7.9 degrees (p=0.002) and no change to dorsiflexion. There were no complications. Conclusion: The H-AMIC procedure is a promising and safe option for larger osteochondral lesions of the talus. Early results suggest improved range of motion despite osteotomy and clinically (but not statistically) significant improvement in function in a group of patients with longstanding symptoms and previous failed surgery. Larger, adequately powered cohorts may establish statistical efficacy of this technique compared with alternative techniques.https://doi.org/10.1177/2473011423S00361 |
| spellingShingle | Anil Haldar MBBS BSc(Hons) FRCS PGCert Amir Hossain Gahanbani Ardakani BSc (Hons), MBBS Shelain Patel FRCS(Orth) Matthew J. Welck MD. MSc. BSc Karan Malhotra MBChB (Hons), MRCS, FRCS (Tr&Orth) Nicholas Cullen MBBs, BSc, FRCS(Tr&Orth) One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus Foot & Ankle Orthopaedics |
| title | One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus |
| title_full | One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus |
| title_fullStr | One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus |
| title_full_unstemmed | One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus |
| title_short | One Year Outcomes of the H-AMIC Procedure for Osteochondral Lesions of the Talus |
| title_sort | one year outcomes of the h amic procedure for osteochondral lesions of the talus |
| url | https://doi.org/10.1177/2473011423S00361 |
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