Abstract
BackgroundThe purpose of our study was to assess the clinical and imaging outcome of autologous matrix-induced chondrogenesis (AMIC) technique consisting of microfractures followed by the filling of osteochondral lesions of the talus (OLTs) with a cell-free biphasic collagen-hydroxyapatite osteochondral scaffold (MaioRegen).MethodsSixteen patients (eight males, age: 42.6 ± 18.4, range 14–74) with OLT repaired using AMIC technique, with implantation of MaioRegen, were clinically evaluated through the American Orthopedic Foot and Ankle Society Score (AOFAS) and a 10-point Visual Analogue Scale (VAS) pain score after a mean follow-up of 30 ± 16.9 months. The MRI examinations were performed 12 and 24 months after surgery. A paired t-test was applied to compare pre- and post-operative clinical findings (VAS and AOFAS) and Magnetic resonance observation of cartilage repair tissue (MOCART) score changes in the follow-up. To assess the correlation between variation of AOFAS and MOCART scores, the Pearson’s correlation coefficient was calculated.ResultsNo complications after surgery were encountered. From pre-operative to post-operative values, there was a significant (P < 0.001) reduction of mean VAS pain score (6.3 ± 0.9,range: 4–8 and 2.9 ± 1.8,range: 0–6, respectively) and increase of AOFAS score (60.2 ± 7.8,range: 50–74 and 77.4 ± 16.2,range: 50–100, respectively). Among 16 patients, six (37%) were not satisfied at the end of follow-up, six (37%) were moderately satisfied and four (25%) were highly satisfied. The treatment was considered failed in five out of 16 patients (31%). Among them, four (25%) required re-interventions with implantation of ankle prostheses, whereas one patient was treated with a further AMIC technique combined with autologous bone graft and platelet-rich plasma. The mean MOCART score was 41.9 ± 14.6 (25–70) 12 months after surgery and 51.9 ± 11.6 (30–70) after 24 months, with a statistically significant increase (P = 0.012). However, no correlation was seen between AOFAS and MOCART changes (r = 0.215, p = 0.609).ConclusionThe high rates of treatment failure encountered in our study using MaioRegen need to be confirmed by larger studies and should induce the scientific community questioning the reliability of this biomimetic scaffold for the treatment of OLTs.
Highlights
The purpose of our study was to assess the clinical and imaging outcome of autologous matrix-induced chondrogenesis (AMIC) technique consisting of microfractures followed by the filling of osteochondral lesions of the talus (OLTs) with a cell-free biphasic collagen-hydroxyapatite osteochondral scaffold (MaioRegen)
Autologous matrix-induced chondrogenesis (AMIC) is a procedure consisting of microfractures followed by osteochondral defect filling using a scaffold that allows the regeneration of articular cartilage from bone marrow mesenchymal stem cells [5]
Our main finding was that the AMIC technique with MaioRegen implant failed in 31% of our patients who required re-intervention with implantation of ankle prostheses, we found a progressive significant improvement of AOFAS, Visual Analogue Scale (VAS) and Magnetic resonance observation of cartilage repair tissue (MOCART) scores overall
Summary
The purpose of our study was to assess the clinical and imaging outcome of autologous matrix-induced chondrogenesis (AMIC) technique consisting of microfractures followed by the filling of osteochondral lesions of the talus (OLTs) with a cell-free biphasic collagen-hydroxyapatite osteochondral scaffold (MaioRegen). Osteochondral lesions of the talus (OLT) are defects of the chondral layer and subchondral bone, which commonly affect the talar articular surface. Their etiology remains unclear, a relation with post-traumatic instability of the ankle has been postulated [1]. Autologous matrix-induced chondrogenesis (AMIC) is a procedure consisting of microfractures followed by osteochondral defect filling using a scaffold that allows the regeneration of articular cartilage from bone marrow mesenchymal stem cells [5]. Controversial results have been reported for osteochondral defect repair in the knee [7, 8]
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