Abstract
Category:
Ankle, Ankle Arthritis
Introduction/Purpose:
Joint arthritis is one of the leading musculoskeletal disorders in the adult population. The surgical treatment for end-stage ankle arthritis generally includes arthrodesis, distraction arthroplasty and total replacement. Recently, new therapeutic approaches, including the use of biologics, have been developed. Among the many sources, the adipose tissue is considered a greater chondrogenic potential and thus a lot of attention is being placed on it in the treatment of arthritis. Although several studies reported good clinical outcomes of adipose-based therapies for knee arthritis, there is a paucity of studies reporting the effects of adipose-based therapies for ankle arthritis. The purpose of this study is to evaluate the effect of intra- articular injection of autologous micronized adipose tissue in patients with end-stage ankle arthritis.
Methods:
A retrospective cohort study investigating consecutive patients treated with arthroscopic debridement and micronized adipose tissue injection for end-stage ankle arthritis was performed. Micronized adipose tissue was obtained from abdomen using a minimal manipulation technique in a closed system (Lipogems) without the addition of enzymes or any other additives. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS), Short-Form 12 (SF-12), and visual analog scale (VAS) scores preoperatively and at final follow-up.
Results:
Total of 12 patients were included. The mean age was 57.5 years and mean follow-up time was 13.1 months. Mean symptoms, pain, daily activities and quality of life scores in FAOS significantly improved from 44.5, 41.3, 58.9, and 20.6 preoperatively to 76.2, 70.1, 80.9, and 60.7 postoperatively, respectively at final follow-up (p<0.001). The mean SF-12 and VAS score significantly improved (33.8 to 63.4, 7.2 to 2.9, respectively, p<0.001). One patient did not receive any benefits. In 4 patients, although they had symptomatic relief in early stage, FAOS and VAS scores deteriorated to baseline by 6 months after procedure. Total 4 patients were not satisfied with the procedures. No adverse events or relevant complications were reported.
Conclusion:
The current study demonstrates that arthroscopic debridement and micronized adipose tissue injection is a safe and beneficial procedure in the treatment of end-stage ankle arthritis. However, in 4 of 12 patients in this small cohort, the deterioration of clinical outcomes to the baseline was observed by 6 months after procedures. All of these patients had mechanical malalignment of hindfoot, suggesting that mechanical alignment may be one of the prognostic factors of this procedure. Further studies investigating longer-term effects in larger cohort should be warranted to confirm the benefit of micronized adipose tissue injection for end-stage ankle arthritis.