Arthroscopic one-step matrix-assisted bone marrow stimulation for the treatment of osteochondral defects of the talus.

OBJECTIVE

All arthroscopic one-step treatment of osteochondral defects of the talus with matrix-assisted bone marrow stimulation with a cell-free hyaluronic acid 3D matrix.

INDICATIONS

Symptomatic osteochondral defects of the talus (1-2 cm, ICRS III-IV).

CONTRAINDICATIONS

Large non-shouldered osteochondral defects (2 cm) of the talus, arthritis, kissing lesions of the distal tibia, metabolic arthropathies, non-reconstructable defects, hindfoot malalignment, chronic inflammatory systemic disorders.

SURGICAL TECHNIQUE

Arthroscopic examination of the ankle joint and visualization of the osteochondral defect of the talus to confirm the indication via standard portals. First, debridement of the osteochondral defect with arthroscopic curette or shaver, removal of loose fragments, resection of the sclerotic bone via shaver and measurement of the defect size. Second, multiple perforation of the subchondral plate to recruit mesenchymal stem cells from the underlying bone marrow by an microfracturing awl to stimulate the differentiation of fibrocartilaginous repair tissue in the defect zone. Then, the cell-free hyaluronic acid 3D matrix is placed into the defect via arthroscopic forceps and modulated by a probe to avoid detachment of the matrix by ankle joint movement.

POSTOPERATIVE MANAGEMENT

Postoperative management includes movement restrictions for pro- and supination but free passive dorsal extension and plantar flexion. No weight-bearing is allowed for 6 weeks.

RESULTS

Twenty-three patients (male: 11/women: 12) with a mean age of 33 years (range: 18-56) and a minimum follow-up of 24 months were included in this retrospective two-center study. The mean values for Foot and Ankle Outcome Score (FAOS) were 79 (range 33-93), for Tegner score 3 (range: 1-5) and the Visual analog scale (VAS) pain 1 (range: 0-3) and VAS function 2 (range: 0-5). At follow-up, MRI was available in 17 of 23 patients. MRI results showed a mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score of 81 (range: 65-90). Complications were not observed during the follow-up period.