Regenerative treatment in osteochondral lesions of the talus: autologous chondrocyte implantation versus one-step bone marrow derived cells transplantation
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Osteochondral lesions of the talus (OLT) usually require surgical treatment. Regenerative techniques for hyaline cartilage restoration, like autologous chondrocytes implantation (ACI) or bone marrow derived cells transplantation (BMDCT), should be preferred. The aim of this work is comparing two clusters with OLT, treated with ACI or BMDCT.
Eighty patients were treated with regenerative techniques, 40 with ACI and 40 with BMDCT. The two groups were homogenous regarding age, lesion size and depth, previous surgeries, etiology of the lesion, subchondral bone graft, final follow-up and pre-operative AOFAS score. The two procedures were performed arthroscopically. The scaffold was a hyaluronic acid membrane in all the cases, loaded with previously cultured chondrocytes (ACI) or with bone marrow concentrated cells, harvested in the same surgical session (BMDCT). All the patients were clinically and radiologically evaluated, using MRI Mocart score and T2 mapping sequence.
Clinical results were similar in both groups at 48 months. No statistically significant influence was reported after evaluation of all the pre-operative parameters. The rate of return to sport activity showed slightly better results for BMDCT than ACI. MRI Mocart score was similar in both groups. MRI T2 mapping evaluation highlighted a higher presence of hyaline like values in the BMDCT group, and lower incidence of fibrocartilage as well.
To date, ACI and BMDCT showed to be effective regenerative techniques for the treatment of OLT. BMDCT could be preferred over ACI for the single step procedure, patients’ discomfort and lower costs.
KeywordsAnkle Osteochondral lesions Regenerative techniques Bone marrow Autologous chondrocytes implantation T2 mapping
Conflict of interest
The authors declare that there is no conflict of interest.
- 1.Bosien WR, Staples OS, Russel SW (1995) Residual disability following acute ankle sprains. J Bone Joint Surg Am 37:1237–1243Google Scholar
- 5.Giannini S, Buda R, Cavallo M, Ruffilli A, Cenacchi A, Cavallo C, Vannini F (2010) Cartilage repair evolution in post-traumatic osteochondral lesions of the talus: from open field autologous chondrocyte to bone-marrow-derived cells transplantation. Injury 41(11):1196–1203. doi: 10.1016/j.injury.2010.09.028 CrossRefPubMedGoogle Scholar
- 6.Giannini S, Battaglia M, Buda R, Cavallo M, Ruffilli A, Vannini F (2009) Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10-year follow-up clinical and magnetic resonance imaging T2-mapping evaluation. Am J Sports Med 37(Suppl 1):112S–118S. doi: 10.1177/0363546509349928 CrossRefPubMedGoogle Scholar
- 8.Giannini S, Buda R, Faldini C, Vannini F, Bevoni R, Grandi G, Grigolo B, Berti L (2005) Surgical treatment of osteochondral lesions of the talus (OLT) in young and active patients: guidelines for treatment and evolution of the technique. J Bone Joint Surg Am 87(suppl 2):28–41CrossRefPubMedGoogle Scholar
- 17.Giannini S, Buda R, Battaglia M, Cavallo M, Ruffilli A, Ramponi L, Pagliazzi G, Vannini F (2013) One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med 41(3):511–518. doi: 10.1177/0363546512467622 CrossRefPubMedGoogle Scholar
- 18.Marlovits S, Singer P, Zeller P, Mandl I, Haller J, Trattnig S (2006) Magnetic resonance observation of cartilage repair tissue (MOCART) for the evaluation of autologous chondrocyte transplantation: determination of interobserver variability and correlation to clinical outcome after 2 years. Eur J Radiol 57(1):16–23CrossRefPubMedGoogle Scholar
- 20.Battaglia M, Rimondi E, Monti C, Guaraldi F, Sant’Andrea A, Buda R, Cavallo M, Giannini S, Vannini F (2011) Validity of T2 mapping in characterization of the regeneration tissue by bone marrow derived cell transplantation in osteochondral lesions of the ankle. Eur J Radiol 80(2):e132–e139. doi: 10.1016/j.ejrad.2010.08.008 CrossRefPubMedGoogle Scholar
- 21.Domayer SE, Kutscha-Lissberg F, Welsch G, Dorotka R, Nehrer S, Gäbler C, Mamisch TC, Trattnig S (2008) T2 mapping in the knee after microfracture at 3.0 T: correlation of global T2 values and clinical outcome—preliminary results. Osteoarthritis Cartilage 16(8):903–908. doi: 10.1016/j.joca.2007.11.014 CrossRefPubMedGoogle Scholar
- 22.Loveday D, Clifton R, Robinson A (2010) Interventions for treating osteochondral defects of the talus in adults. Cochrane Database Syst Rev. (8):CD008104Google Scholar
- 24.Niemeyer P, Salzmann G, Schmal H, Mayr H, Südkamp NP (2012) Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc 20(9):1696–1703. doi: 10.1007/s00167-011-1729-0 CrossRefPubMedGoogle Scholar