Department of Orthopedics, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland.
Am J Sports Med. 2019 Jun;47(7):1679-1686. doi: 10.1177/0363546519841574. Epub 2019 May 14.
Autologous matrix-induced chondrogenesis (AMIC) has become an interesting treatment option for osteochondral lesions of the talus (OLTs) with promising clinical short- to midterm results.
To investigate the clinical and radiological outcome of the AMIC procedure for OLTs, extending the follow-up to 8 years.
Case series; Level of evidence, 4.
Thirty-three patients (mean age, 35.1 years; body mass index, 26.8) with osteochondral lesions of the medial talar dome were retrospectively evaluated after open AMIC repair at a mean follow-up of 4.7 years (range, 2.3-8.0 years). Patients requiring additional surgical procedures were excluded. All OLTs (mean size, 0.9 cm; range, 0.4-2.3 cm) were approached through a medial malleolar osteotomy, and 28 patients received subchondral autologous bone grafting. Data analysis included the visual analog scale for pain, the American Orthopaedic Foot and Ankle Society score for ankle function, the Tegner score for sports activity, and the MOCART (magnetic resonance observation of cartilage repair tissue) scoring system for repair cartilage and subchondral bone evaluation.
Mean ± SD visual analog scale score improved significantly from 6.4 ± 1.9 preoperatively to 1.4 ± 2.0 at latest follow-up ( P < .001). The mean American Orthopaedic Foot and Ankle Society score was 93.0 ± 7.5 (range, 75-100). The Tegner score improved significantly from 3.5 ± 1.8 preoperatively to 5.2 ± 1.7 at latest follow-up ( P < .001), and 79% returned to their previous sports levels. The MOCART score averaged 60.6 ± 21.2 (range, 0-100). Complete filling of the defect was seen in 88% of cases, but 52% showed hypertrophy of the cartilage layer. All but 1 patient showed persistent subchondral bone edema. The patient's age and body mass index, the size of the osteochondral lesion, and the MOCART score did not show significant correlation with the clinical outcome. There were no cases of revision surgery for failed AMIC. Fifty-eight percent underwent reoperation, mainly for symptomatic hardware after malleolar osteotomy.
AMIC for osteochondral talar lesions led to significant pain reduction, recovery of ankle function, and successful return to sport. The MOCART score did not correlate with the good clinical results; the interpretation of postoperative imaging remains therefore challenging.
自体诱导软骨再生（AMIC）已成为治疗距骨骨软骨病变（OLTs）的一种有吸引力的治疗选择，具有有前景的短期至中期临床结果。
研究 AMIC 手术治疗 OLTs 的临床和影像学结果，随访时间延长至 8 年。
病例系列；证据水平，4 级。
回顾性分析了 33 例（平均年龄 35.1 岁；体重指数 26.8）经内侧距骨穹隆切开暴露行开放式 AMIC 修复后的患者资料，平均随访 4.7 年（2.3-8.0 年）。排除需要进一步手术治疗的患者。所有 OLTs（平均大小 0.9cm；范围 0.4-2.3cm）均通过内踝切开入路，28 例患者接受了软骨下自体骨移植。数据分析包括疼痛视觉模拟评分、踝关节功能美国矫形足踝协会评分、运动活动 Tegner 评分以及软骨和软骨下骨修复的 MOCART（磁共振软骨修复组织观察）评分系统。
平均±标准差视觉模拟评分从术前的 6.4±1.9 显著改善至末次随访时的 1.4±2.0（P<0.001）。美国矫形足踝协会平均评分 93.0±7.5（范围 75-100）。Tegner 评分从术前的 3.5±1.8 显著改善至末次随访时的 5.2±1.7（P<0.001），79%的患者恢复到之前的运动水平。MOCART 评分平均为 60.6±21.2（范围 0-100）。88%的病例完全填充了缺损，但 52%的病例出现软骨层肥大。除 1 例患者外，所有患者均存在持续性软骨下骨水肿。患者年龄和体重指数、骨软骨病变大小以及 MOCART 评分与临床结果无显著相关性。无 AMIC 修复失败的翻修手术。58%的患者再次手术，主要是因为踝切开术后有症状的内固定。
AMIC 治疗距骨骨软骨病变可显著减轻疼痛、恢复踝关节功能并成功恢复运动。MOCART 评分与良好的临床结果无关；因此，术后影像学的解释仍然具有挑战性。
