Matrix-associated Autologous Chondrocyte Transplantation Combined with Iliac Crest Bone Graft for Reconstruction of Talus Necrosis due to Villonodular Synovitis

Abstract

We report the case of a 24-year-old driving instructor with osteonecrosis of the talus and a large articular cartilage and osseous defect. The cystic lesion was caused by villonodular synovitis. After magnetic resonance imaging detection and arthoscopic analysis, the defect was filled with a bone graft, followed by matrix-associated autologous chondrocyte transplantation (MACT) combined with a total synovectomy. In general, lesions similar to the one described in this case are treated using osteochondral autografts, but in our case the osseous defect was too large to perform an osteochondral autograft. Our choice of treatment with an iliac crest bone graft combined with a MACT simultaneously has not yet been published, as far as we know. The patient returned to his former activities of daily living and sport activities, without restrictions or complaints, and with only a slight deficit in range of motion. Morphological and biochemical magnetic resonance imaging 12 months after surgery showed excellent bone healing with no intraosseous edema. The MACT resulted in a good clinical outcome, with 100% defect filling and excellent integration and surface and signal intensity of the cartilage repair tissue, and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score increased from 47 to 79 points.