AUTOLOGOUS CHONDROCYTE IMPLANTATION WITH AND WITHOUT A HYALURONIC ACID MATRIX IN THE TREATMENT OF ARTICULAR CARTILAGE INJURIES OF ANKLE

Abstract

Introduction and Objectives: Autologous chondrocyte suspension implantation (ACSI) has yielded good to excellent results in the treatment of cartilaginous defects of the knee. Thus far, studies on the ankle, analysing fewer subjects, offer promising results. Use of this technique in the ankle joint requires medial malleolar arthrotomy and osteotomy. Matrix-induced chondrocyte implantation (MICI) is a new technique involving the use of a hyaluronic acid-based matrix containing cultured chondrocytes.

Materials and Methods: Eight patients (4 male, 4 female) with an average age of 31 years (21–43) with defects in the talus were treated using ACSI and MICI. Average defect size was 1.9 cm. All patients had previously undergone surgery, and MRI showed Outerbridge grade IV osteochondral lesions on the talus. After clinical and radiological evaluation, arthroscopic surgery was performed to biopsy the articular cartilage of the talus. Later, a second surgery was performed with a mini-arthrotomy and debridement and cleaning of the defect. In ACSI, the defect is covered by suturing a periosteal graft to the cartilage, and the chondrocyte suspension is injected underneath. In MICI, a sheet of hyaluronic acid matrix with autologous chondrocytes of the same size as the defect is placed on the defect site and attached with fibrin glue. Patients were examined 28 months after implantation and evaluated using the Hannover Scoring system for the ankle.

Results: Follow-up results on the 8 patients verified an improvement of joint function and a reduction of pain in all cases. Hannover Scores increased in all patients. The osteotomy of the malleolus healed in all 8 cases. One patient was able to return to active competition in decathlon events.

Discussion and Conclusions: MICI requires a less complex surgical procedure and allows for a smaller incision. This technique therefore represents a broader application of tissue engineering in the treatment of cartilaginous defects of the ankle.