Abstract
Introduction Talar dome lesions are a common accompaniment of ankle injury resulting in ongoing symptoms and functional disability with current management resulting in fibrocartilaginous repair and failure to reconstitute the articular surface. In this study, the application of autologous chondrocyte implantation (ACI) for talar dome lesions was evaluated.
Methods Between August 2001 and February 2003, eight patients with osteochondral lesions of the talus were treated with ACI. All patients underwent initial arthroscopy to harvest healthy chondrocytes for cultivation. Cells were re-implanted after three to four weeks, with a medial or lateral malleolar osteotomy using a periosteal patch harvested from the distal tibia. Post-operatively, early ankle motion was allowed but non-weight bearing advised until union of osteotomy. Clinical assessment was pre-operatively and at three, six, nine, and 12 months post-operatively. Second-look arthroscopy with biopsy for histological examination was performed at removal of internal fixation. Four males and four females with a mean age of 40 years (range 22 to 59) are presented. Pre and postoperative clinical evaluation was done using the American Orthopaedic Foot and Ankle Society Hindfoot Score.
Results The mean pre-operative score was 58.4 (range 26 to 97); at three months, it was 62 (range 32 to 84); at six months 70.6 (range 66 to 92); at nine months 79 (range 66 to 92) and at 12 months 81.5 (range 79 to 84). MRI done in four patients at three months post-ACI showed good fill in three and slight over fill in one. Minimal subchondral edema was evident in one patient. Two patients with MRI 12 months post-ACI also revealed good fill with residual bone marrow oedema. Second-look arthroscopy and biopsy at implant removal in five patients were done at a mean of six months (range 2.5 to 9) post-ACI. Arthroscopy showed the transplants were level with the surrounding tissue. Four patients had biopsies showing hyaline-like cartilage which has all the properties of normal hyaline except for the increased cell density while one biopsy revealed fibro-hyaline tissue. Marginal biopsies taken demonstrated integration of neo-cartilage to adjacent cartilage.
Conclusions This study although with a limited sample, demonstrates the viability of ACI as treatment for osteochondral defects of the talus. Short-term results demonstrated clinical improvement from pre-operative to post-operative condition compatible with findings at second-look arthroscopy and histologic examination.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
