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Arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus

  • ANKLE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Microfracture is an established method to treat osteochondral defects of the talus. The value of the addition of an acellular matrix is still under debate. This study compared the results of arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis using a collagen I/III matrix (AMIC) in the management of articular cartilage defects of the talus.

Methods

Patients with a minimum follow-up of 5 years after arthroscopic management for an articular cartilage defect of the talus with either microfracture alone or an additional acellular matrix were matched according to age, sex and BMI. The Hannover Scoring System for the ankle (HSS) and a Visual analog scale (VAS) for pain, function and satisfaction were used to evaluate the clinical outcome. Postoperative MRI was used to assess cartilage repair tissue based on the degree of defect repair and filling of the defect, integration to border zone, surface of the repair tissue, structure of the repair tissue, and subchondral bone alterations.

Results

Thirty-two patients (16 microfracture, 16 AMIC) were included. No significant between-group differences were observed in demographic data and preoperative score values. Both groups showed statistically significant improvement when comparing the pre- and postoperative score values. No statistically significant differences were identified between the median values of the groups with the HSS (microfracture: 82 (range 71–96) points; AMIC 88 (range 40–98) points). Accordingly, no significant differences were observed for the VAS pain (microfracture: 0.95 (range 0–3.8); AMIC: 1.0 (range 0–8.5)), VAS function (microfracture: 8.4 (range 3.5–10); AMIC: 9.0 (range 1.5–10)) and VAS satisfaction (microfracture: 8.9 (range 2.8–10); AMIC: 9.45 (range 1.5–10)). MRI showed regeneration of tissue in the treated area without differences between the two groups.

Conclusion

Good clinical results were observed for arthroscopic microfracture with or without an additional acellular collagen I/III matrix in the treatment for articular cartilage defects of the talus. It appears that for defects as treated in this study, it is not worthwhile adding the collagen I/III matrix to the microfractures.

Level of evidence

III.

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Funding

The authors received no financial support for the research, authorship, and publication of this article.

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Authors and Affiliations

  1. HKF-International Center for Hip-, Knee-and Foot Surgery, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany

    Christoph Becher, Michael Alexander Malahias, Moataz Mahmoud Ali & Hajo Thermann

  2. Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH) im Diakovere Annastift, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany

    Christoph Becher

  3. Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy

    Nicola Maffulli

  4. Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK

    Nicola Maffulli

  5. Institute of Science and Technology in Medicine, Stoke on Trent, Keele University School of Medicine, Keele, UK

    Nicola Maffulli

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  1. Christoph Becher
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  2. Michael Alexander Malahias
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Correspondence to Christoph Becher.

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The authors declare that they have no conflict of interest.

Ethical approval

Ethical approval was obtained from the Institutional Review Board (IRB) from the ATOS Clinic Heidelberg.

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Informed consent was obtained from all individual participants included in the study.

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Becher, C., Malahias, M.A., Ali, M.M. et al. Arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus. Knee Surg Sports Traumatol Arthrosc 27, 2731–2736 (2019). https://doi.org/10.1007/s00167-018-5278-7

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  • DOI: https://doi.org/10.1007/s00167-018-5278-7

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