Autologous chondrocite implantation in osteochondral lesions of the talus

Abstract

Background: The damaged human hyaline cartilage has a very limited potential of healing. Fibrocartilage is often the most common reaction of this process, resulting from medullar cells’ stimulation, which is capable of healing small regions and has properties inferior to those of the original cartilage. Many attempts of developing methods to treat articular lesions by hyaline cartilage have been made. The aim of this study was to examine the results of autologous chondrocyte implantation in the treatment of talus osteochondral lesions through clinical practice, histology and imaging methods. Methods: Five patients with osteochondral lesions underwent the procedure after being included in the study. Three patients were female and two were males; mean age at the time of the operation was 28 years old, ranging from 20 to 39. All of them had failed previous surgical treatment. The procedure was divided into three phases: knee and ankle arthroscopy to collect healthy hyaline cartilage samples and to evaluate the ankle; chondrocytes cultivation; implantation of chondrocytes into a sandwich-like double layer periosteal sac. The evaluation was made prospectively following a predetermined protocol in which radiographs and MRI were taken at 90th and 180th days; an arthroscopic second-look and biopsy of the restored tissue were performed at the end of the first postoperative year. Clinical evaluation was made by Visual Analog Scale (VAS) with respect to pain, and by ankle/hind foot AOFAS score. Results: The average follow-up period was 67 months (minimum: 55 months; maximum: 75 months) with a substantial improvement in the AOFAS score, as mean score was 41.2 in the preoperative period and 92.8 in the postoperative period; the pain score was 8.0 preoperatively and 1.6 postoperatively. Radiographs demonstrated consolidation of tibial osteotomy in all patients, and MRI analysis obtained at the 180th postoperative day showed filling of the lesions, although irregularities were observed in two patients (40%). The follow-up revealed that patients had returned to their routine activities 12 months later – including practicing sports – without complaints or limitations related to the surgery. Arthroscopy showed the recovering of the lesion by a tissue with the same macroscopic features of the whole cartilage, but a little smoother. Histological analysis demonstrated hyaline cartilage in all patients. Conclusions: Despite the small size of the sample, the excellence of results suggests that the chondrocyte autologous implantation is a safe and effective method for the treatment of talus osteochondral lesions.