Combining Microfractures,Autologous Bone Graft,and Autologous Matrix-Induced Chondrogenesis for the Treatment of Juvenile Osteochondral Talar Lesions

Abstract

Background:

The purpose of this study was to evaluate the clinical and radiologic outcomes of patients younger than 20 years, treated with the arthroscopic-talus autologous matrix-induced chondrogenesis (AT-AMIC) technique and autologous bone graft for osteochondral lesion of the talus (OLT).

Methods:

Eleven patients under 20 years (range 13.3-20.0) underwent the AT-AMIC procedure and autologous bone graft for OLTs. Patients were evaluated preoperatively (T₀) and at 6 (T₁), 12 (T₂), and 24 (T₃) months postoperatively, using the American Orthopaedic Foot & Ankle Society Ankle and Hindfoot (AOFAS) score, the visual analog scale and the SF-12 respectively in its Mental and Physical Component Scores. Radiologic assessment included computed tomographic (CT) scan, magnetic resonance imaging (MRI) and intraoperative measurement of the lesion. A multivariate statistical analysis was performed.

Results:

Mean lesion size measured during surgery was 1.1 cm³ ± 0.5 cm³. We found a significant difference in clinical and radiologic parameters with analysis of variance for repeated measures (P < .001). All clinical scores significantly improved (P < .05) from T₀ to T₃. Lesion area significantly reduced from 119.1 ± 29.1 mm² preoperatively to 77.9 ± 15.8 mm² (P < .05) at final follow-up as assessed by CT, and from 132.2 ± 31.3 mm² to 85.3 ± 14.5 mm² (P < .05) as assessed by MRI. Moreover, we noted an important correlation between intraoperative size of the lesion and body mass index (BMI) (P = .011).

Conclusions:

The technique can be considered safe and effective with early good results in young patients. Moreover, we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life.

Level of Evidence:

Level IV, retrospective case series.