Deiss Lukas, Walther Markus, Pfahl Kathrin, Hörterer Hubert, Mehlhorn Alexander, Röser Anke, Gottschalk Oliver
Center for Foot and Ankle Surgery, Schön Klinik München Harlaching-FIFA Medical Centre of Excellence, Munich, Germany.
Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München, Munich, Germany.
Cartilage. 2024 Dec 12:19476035241301896. doi: 10.1177/19476035241301896.
A gold standard surgical treatment for osteochondral lesions (OCLs) of the talus still needs to be established. Still, autologous matrix-induced chondrogenesis (AMIC) is a commonly applied 1-stage procedure that has achieved good short- and mid-term results. The present cohort study aimed to assess whether the long-term, 10-year results can confirm the previous findings.
All patients underwent an open AMIC procedure using a collagen type I/III bilayer matrix for a talar OCL. General demographic data, preoperative magnetic resonance imaging findings, intraoperative details, and German version of the Foot Function Index (FFI-D) scores preoperatively and at 1, 5, and 10 years as well as European Foot and Ankle Society (EFAS) and American Orthopedic Foot & Ankle Society (AOFAS) scores at 10 years after surgery were analyzed. The primary outcome variable was the procedure's longitudinal effect, and several variables' influence on the outcome was tested.
Of 47 consecutive patients, 18 (38%) were included. Of the 18 patients, 6 (33%) were female, and 12 (67%) were male, with a mean age of 39 ± 15 (range = 15-62) and an average body mass index (BMI) of 26 ± 5 (range = 20-38) kg/m². The mean defect size was 1.4 ± 0.9 (range = 0.2-4) cm². The FFI-D total score showed a significant decrease from preoperatively to 1 year postoperatively (56 ± 19 to 34 ± 27; = 0.001) with a further nonsignificant decrease to the 5-year (34 ± 27 to 21 ± 20; = 0.16) and 10-year follow-up (21 ± 20 to 15 ± 13; = 1.00). All the single items decreased significantly from preoperatively to the 5- and 10-year mark. Although not significant, most items improved from 5 to 10 years postoperatively. Age positively correlated with the preoperative, 5-year, and 10-year follow-up FFI-D total score.
AMIC, as a single-step surgical intervention, is a viable long-term treatment option. Patient selection regarding symptoms and findings is vital to achieve satisfying results.
距骨骨软骨损伤（OCLs）的金标准手术治疗方法仍有待确立。不过，自体基质诱导软骨形成术（AMIC）是一种常用的一期手术，已取得良好的短期和中期效果。本队列研究旨在评估10年的长期结果是否能证实先前的研究结果。
所有患者均接受了开放性AMIC手术，使用I/III型胶原双层基质治疗距骨OCL。分析了一般人口统计学数据、术前磁共振成像结果、术中细节，以及术前、术后1年、5年和10年的德文版足部功能指数（FFI-D）评分，以及术后10年的欧洲足踝协会（EFAS）和美国矫形足踝协会（AOFAS）评分。主要结局变量是该手术的纵向效果，并测试了几个变量对结局的影响。
连续47例患者中，18例（38%）被纳入研究。18例患者中，女性6例（33%），男性12例（67%），平均年龄39±15岁（范围15 - 62岁），平均体重指数（BMI）为26±5（范围20 - 38）kg/m²。平均缺损面积为1.4±0.9（范围0.2 - 4）cm²。FFI-D总分从术前到术后1年显著下降（56±19降至34±27；P = 0.001），到5年时进一步非显著下降（34±27降至21±20；P = 0.16），10年随访时（21±20降至15±13；P = 1.00）。所有单项从术前到5年和10年时均显著下降。虽然不显著，但大多数项目在术后5年到10年有所改善。年龄与术前、5年和10年随访时的FFI-D总分呈正相关。
AMIC作为一种单步手术干预，是一种可行的长期治疗选择。根据症状和检查结果进行患者选择对于取得满意结果至关重要。
