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MEDICINA E CHIRURGIA DELLA CAVIGLIA E DEL PIEDE
A Journal on Physiopathology and Surgery of the Foot
Indexed/Abstracted in: EMBASE, Scopus
Chirurgia Del Piede 2009 April;33(1):3-9
Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus
Giannini S. 1, Vannini F. 1, Di Caprio F. 1, Ruffilli A. 1, Cavallo M. 1, Luciani D. 2, Grigolo B. 3
1 Istituti Ortopedici Rizzoli VI Divisione di Ortopedia e Traumatologia, Bologna, Italia
2 Istituti Ortopedici Rizzoli Laboratorio di Analisi del Movimento, Bologna, Italia
3 Istituti Ortopedici Rizzoli Laboratorio di Immunologia e Genetica, Bologna, Italia
Aim. Osteochondral lesions of the talus represent a challenging pathology. Autologous Chondrocyte Implantation (ACI) showed good results in the treatment of these lesions but it was considered up to now as an extremely technically demanding surgery with significant morbidity for the patients. Aim of this study was to describe an original arthroscopic procedure for ACI in the ankle with analysis of the results.
Methods. 35 patients (mean age: 32.3 years) were operated from 2001 to 2003. They had post-traumatic talar dome lesions, type II-IIA. In the first step surgery, arthroscopic cartilage harvest from the margins of the lesion was performed. Chondrocytes were cultured on a Hyaff-11 scaffold. In the second step surgery the Hyalograft-C patch was arthroscopically implanted into the lesion, with a specifically designed instrumentation. Patients were evaluated clinically with AOFAS score pre-operatively and at 12 and 36 months after surgery. At a mean time interval of 18 months, the first 3 patients underwent a second-look arthroscopy with cartilage harvest from the implant and histological examination.
Results. The mean pre-operative AOFAS score was 56.0±15.6. At the 12 months follow-up the mean AOFAS score of 87.9±14.1 (p<0.0005), while At 36 months after surgery the mean score was 90.3±14.0 (p<0.0005). Clinical results were significantly related to the age of patients and to previous operations for cartilage repair. The results of the histological examinations revealed hyaline-like cartilage regeneration.
Conclusion. The Hyalograft-C scaffold and the specifically designed instrumentation allowed arthroscopic implantation of chondrocytes, with excellent clinical and histological results.