Aims. Osteochondral lesions of the talus (OLT) are a common cause of disability and chronic ankle pain. Many operative treatment strategies have been introduced; however, they have their own disadvantages. Recently lesion repair using autologous cartilage chip has emerged therefore we investigated the efficacy of particulated autologous cartilage transplantation (PACT) in OLT. Methods. We retrospectively analyzed 32 consecutive symptomatic patients with OLT who underwent PACT with minimum one-year follow-up. Standard preoperative radiography and MRI were performed for all patients. Follow-up second-look arthroscopy or MRI was performed with patient consent approximately one-year postoperatively. Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score and International Cartilage Repair Society (ICRS) grades were used to evaluate the quality of the regenerated cartilage. Clinical outcomes were assessed using the pain visual analogue scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Scale (FAOS). Results. All patients had ICRS grade IV cartilage lesions, except for one (ICRS grade III). The paired MOCART scores significantly improved from 42.5 (SD 1.53) to 63.5 (SD 22.60) (p = 0.025) in ten patients. Seven patients agreed to undergo second-look arthroscopy; 5 patients had grade I (normal) ICRS scores and two patients had grade II (nearly normal) ICRS scores. VAS, FFI, and all subscales of FAOS were significantly improved postoperatively (p ≤ 0.003). Conclusion. PACT significantly improved the clinical, radiological, and morphological outcomes of OLT. We consider this to be a safe and effective surgical method based on the short-term clinical results of this study. Cite this article: Bone Jt Open 2023;4(12):942–947

Osteochondral lesions (OCL) of the talus occur in 38% of the patients with supination external rotation type IV ankle fractures and 6 % of ankle sprains. Osteoarthritis is reported subsequently in 8–48% of the ankles. Several marrow stimulation methods have been used to treat the symptomatic lesion, including arthroscopic debridement and micro fracture. Encouraging midterm results have been reported, but longterm outcome is unknown in relation to more invasive treatments such as transfer of autologous osteoarticular tissue from the knee or talus (OATS), autologous chondrocyte implantation (ACI), frozen and fresh allograft transplantation. Aim. The aim of our study was to review our long term results of arthroscopic treatment of osteochondral lesions of the talus. Materials and methods. 65 patients underwent arthroscopic treatment of the OCL between 1993 and 2000. There were 46(71%) men and 19(29%) women. The mean age at surgery was 34.2 years. The right side was affected in 43 patients and the left side in 22 patients. Results. 40/65(61.5%) patients who underwent arthroscopic treatment of the OCL were followed up. The mean follow-up was 13.1 years (9 to 18 years). The average age at final follow was 49.6 years (25–80 years). 15 (39.5%) patients reported poor, 14 (36.8%) fair, 9 (23.6%) good outcomes based on the Berndt and Harty criteria. 20/40 patients (50 %) needed further surgery. This appears a significant deterioration since this cohort were studied at 3.5 years, when the clinical results were 21.3% poor, 26.2% fair and 52.3% good, although losses to followup make exact comparison impossible. Conclusion. Arthroscopic treatment of osteochondral lesions of the talus gives medium term improvement in the majority of patients, but it appears that results deteriorate with time. Recurrence of symptoms sufficient to require further surgical intervention occurred in half the patients studied

Introduction. Autologous Matrix Induced Chondrogenesis (AMIC) for surgical treatment of osteochondral lesions of the talus (OCLT) has shown excellent clinical and radiological results at short term follow up two years after surgery. However, no mid-term follow up data is available. Aim. 1. To evaluate the clinical outcome after AMIC-aided reconstruction of osteochondral lesions of the talus at a minimum follow up time of five years. 2. To evaluate the morphology and quality of the regenerated cartilage by magnetic resonance imaging (MRI) at on at a minimum follow up time of five years. Methods. Seventeen patients prospectively underwent surgery receiving a AMIC-aided repair of OCLT consisting of debridement, autologous grafting, and sealing of the defect with a collagen scaffold (Chondro-Gide, Geistlich Surgery, Wolhusen, Switzerland). Clinical and radiological assessment was performed before and after a minimum of 60 months after surgery (average 78 months, range, 60–120). Clinical examination included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle score and the Visual Analogue Scale (VAS). Radiological imaging consisted of MRI. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was applied. Results. The AOFAS ankle score improved significantly from a mean of 60 points preoperatively (range, 17–79) to 91 points (range, 70–100) postoperatively (p< 0.01). The preoperative pain score averaged a VAS of 5 (range, 2–8), improving to an average of 1.1 (range 0–8) (p< 0.01). The MOCART score for cartilage repair tissue on postoperative MRI averaged 71 points (range, 50–90). Conclusion. The AMIC-procedure is safe for the treatment of OCLT with overall good clinical and magnetic resonance imaging results at five years follow up

We aimed to assess the long term results of patients who underwent Autologous Chondrocyte Implantation (ACI) for osteochondral lesions of the talus. Between 1998 and 2006, 28 patients underwent ACI for osteochondral lesions of the talus. All these patients were prospectively reviewed and assessed for long term results. Outcomes were assessed using satisfaction scores, Mazur ankle score and the AOFAS score, and Lysholm knee score for donor site morbidity. The 28 patients who underwent the procedure included 18 males and 10 females. Follow up ranged from 1–9 years. In all patients, there was an improvement in the Mazur and AOFAS ankle scores and the Lysholm scores showed minimal donor site morbidity. Improvement in ankle score was independent of age and gender. The better the pre-op score the less the difference in post-op ankle scores. Patients were unlikely to benefit with pre-op ankle scores over 75. The mid to long term results of ACIs in the treatment of localised, contained cartilage defects of the talus are encouraging and prove that it is a satisfactory treatment modality for symptomatic osteochondral lesions of the talus. Complications are limited. However, in view of limited number of patients, a multi-centre randomised controlled study is required for further assessment

Introduction: Osteochondral lesions of the talus may cause persistent joint pain requiring surgical treatment, which today can be performed arthroscopically. The purpose of this study is to evaluate the effectiveness of arthroscopic treatment of these lesions. Material and Method: Seventeen patients (7 males and 10 females) underwent ankle arthroscopy from 1998 through June 2002 for treatment of osteochondral lesions of the talus. Their age ranged from 11 – 68 years. The right talus was affected in 12 and the left in 5 patients. All but one had a history of previous trauma, for which they had been treated conservatively for at least 6 months. Bone scanning, CT and MRI were performed for lesion staging according to Brent and Harty. One patient was stage I, 2 were stage II, 7 were stage III, and 7 were stage IV. The patients underwent ankle arthroscopy without use of a distractor. Inspection of the joint was followed by shaving and debridement of the lesion with or without drilling. Results: Follow-up had a mean duration of 15 months (range 8 – 24 months). Outcome was evaluated with the Ogilvie-Harris score for pain, swelling, stiffness, limp and patient activity level. All patients had excellent or good results. In all cases there was a reduction in lesion size. Conclusions: Arthroscopy is effective for treatment of osteochondral lesions of the talus. It causes less morbidity than open surgery and patients are able to follow an early mobilization and rehabilitation protocol. However, specialized surgical tools, as well as an in-depth knowledge of joint anatomy are required to avoid iatrogenic damage

Introduction: Osteochondral lesions of the talus (OCL III–IV°) need both extensive debridement for revitalisation and osteochondral reconstruction of the joint surface. This can be achieved by autologous cancellous bone-grafting and combination with a cell-free bioresorbable collagen-I/III scaffold. Our first results with this technique are presented. Methods: 25 patients (13 female, 12 male, mean age 30.9 years) with 26 osteochondral lesions of the talus (OCL III–IV°, 15 right, 11 left, 24 medial, 2 lateral, 1 bilateral case) were treated by minimal-invasive debridement, autologous cancellous bone-grafting and application of a porcine collagen-I/III scaffold (ChondroGide. ®. ) and evaluated prospectively by clinical scoring and MRI. The average follow-up was 23.2 (6–36) months. The mean defect size was 2.0 cm. 2. , the mean depth 0.7 cm. 14 defects have had at least one (1–3) operation on the defect before. By the use of a distractor a malleolar osteotomy could be avoided in all cases. Results: The AOFAS-score increased from 67.4 ± 12.2 to 89.5 ± 7.4 points (p< 0.01, t-test). On a visual 10-point scale pain decreased significantly from 6.2 to 1.7 while subjective ankle function improved from a mean of 4.4 ± 1.9 to 7.2 ±1.5. The results were rated excellent in 10/26 cases (38.4%), good in 14/26 (53.8) and fair in 2/26 (7.8%) cases. MRI follow-ups showed a complete or nearly complete defect filling. In two ankles a second-look arthroscopy unveiled the defects filled completely by a regenerative tissue with a smooth surface and good bonding. Full-core biopsies showed a mixed, mostly fibrocartilagenous tissue. Conclusion: By combination of cancellous bone-grafting with a cell-free collagen-I/III scaffold typical osteochondral lesions of the talus can be adressed effectively in a minimal-invasive one-step procedure. By utilizing mesenchymal stem cells (MSC) for an autogenous reparation process the use of expensive cultured chondrocytes is not necessary. The results concerning clinical functional improvement, pain reduction and patients’ satisfaction as well as defect filling in MRI are promising

The December 2014 Foot & Ankle Roundup360 looks at: Charcot feet, biomarkers and diabetes; weight bearing following Achilles tendon rupture; endobuttons and mal-reduced diastasis; evidence for stem cell therapies in osteochondral lesions of the talus; syndesmosis fixation in SER ankle fractures; and self-reporting for foot and ankle outcomes

Introduction. The purpose of this study was to examine trends in patient characteristics and clinical outcomes that occur with age as a statistical variable when performing autologous osteochondral transplantation (AOT) for the treatment of osteochondral lesions of the talus (OLT). Methods. A retrospective cohort study for AOT procedures on 78 patients from 2006 to 2019. was conducted Clinical outcomes were evaluated via FAOS scores. A multivariable linear regression was used to assess the independent factors predictive of the first post-operative FAOS after AOT. The independent variables included pre-operative FAOS, age, defect size, shoulder lesion, cystic lesion, prior traumatic injury, and history of microfracture surgery. A p-value <.05 was considered significant and 95% confidence limits (95% CL) for regression coefficient estimates (est.) were calculated. Results. 78 patients were included with a mean age of 35.5 ± 13.6years at a mean follow-up was 54.4 ± 18.9 months. The mean pre-operative FAOS was 54.3 ± 19.4 and the mean post-operative FAOS was 83.4 ± 13.6. The mean defect size was 109.3±62.4 mm2. The multivariable linear regression showed that the pre-operative FAOS was associated with a higher post-operative FAOS (est., 95% CL: 0.16, 0.012 – 0.307; p=0.034). Defect size (est., 95% CL: −0.05, −0.097 – −0.003; p=0.0358), having a shoulder lesion (est., 95% CL: −9.068, −15.448 – −2.688; p=0.006), or having a prior microfracture surgery (est., 95% CL: −7.07, −13.118 – −1.021; p=0.0226) were associated with a lower post-operative FAOS. Conclusion. Patient age was not an independent risk factor for inferior clinical outcomes after AOT for OLT. Additionally, cystic lesions, or lesions with a traumatic aetiology were not significantly associated with post-operative FAOS. Having a shoulder lesion had the largest marginal effect on post-operative FAOS. These findings provide important information for providers when counseling and selecting patients for AOT procedure for treatment of OLT

Introduction: Symptomatic osteochondral lesions of the talus have been managed with a variety of operative techniques involving open or arthroscopic approaches to the ankle joint. The purpose of this study is to report our technique of drilling stable osteochondral lesions of the talus via a percutaneous retrograde approach using computed tomography for guidance. Materials and Methods: Seven adult patients with Berndt and Harty Stage 2 or 2A/5 (subchondral cyst positive) talar osteochondral lesions, confirmed by magnetic resonance imaging, had retrograde drilling with CT guidance performed under local anaesthesia. Follow-up MR imaging was performed to investigate radiological evidence of healing. Results: All retrograde drillings performed were technically successful. Discussion: The concept of retrograde drilling is to preserve intact articular cartilage while encouraging revascularisation of the osteochondral fragment. The use of CT allowed drilling without conventional direct visualisation of the articular surface via arthrotomy or arthroscopy. The procedure can therefore potentially be performed in an outpatient setting. Suggestions are made from review of the literature as to improve further the technique for future studies

Introduction. Osteochondral lesions of the talus are common injuries following acute and chronic ankle sprains and fractures, the treatment strategies of which include both reparative and restorative techniques. Recently, restorative techniques (i.e., autologous osteochondral transplantation) have been become increasingly popular as a primary treatment strategy, in part due to the potential advantages of replacing “like with like” in terms of hyaline cartilage at the site of cartilage repair. The current study examines the functional results of autologous osteochondral transplantation of the talus in 72 patients. Methods. Between 2005 and 2009, 72 patients underwent autologous osteochondral transplantation under the care of the care of the senior author. The mean patient age at the time of surgery was 34.19 years (range, 16–85 years). The mean follow-up time was 28.02 months (range, 12–64 months). Patient-reported outcome measures were taken pre-operatively and at final-follow-up using the Foot and Ankle Outcome Score and Short-Form 12 general health questionnaire. Quantitative T2-mapping MRI was also performed on select patients at 1-year post-operatively. Results. The mean FAOS scores improved from 52.67 points pre-operatively to 86.19 points post-operatively (range, 71–100 points). The mean SF-12 scores also improved from 59.40 points pre-operatively to 88.63 points post-operatively (range, 52–98 points). Three patients reported donor site knee pain after surgery. Quantitative T2-mapping MRI demonstrated relaxation times that were not significantly different to those of native cartilage in both the superficial and deep halves of the repair tissue. Discussion and Conclusion. Autologous osteochondral transplantation is a reproducible and primary treatment strategy for large osteochondral lesions of the talus and provides repair tissue that is biochemically similar to that of native cartilage on quantitative T2-mapping MRI. This may ultimately allow the ankle joint to function adequately over time

Introduction and Objectives: Osteochondral lesions of the talus are difficult to treat due to difficult access, vascularisation, and because the head of the talus is a region with significant mechanical load. Among the therapeutic options for osteochondral lesions of the head of the talus, we present a treatment alternative using mosaicplasty with an autologous osteochondral graft taken from the knee. Materials and Methods: We have treated 8 patients affected with osteochondral lesions of the head of the talus (7 medial and 1 lateral) of greater than 7mm diameter, younger than 45 years of age, and with no instability of the ligament. The talus was approached in all cases by means of osteotomy of the malleolus. Osteocartilaginous cores were collected from the ipsilateral lateral condyle of the ipsilateral knee with minimal arthrotomy. Rehabilitation began between days 3 and 5 with no weight bearing before the 6th week. Results were measured by means of CTscan, MRI, and pathology, and clinically using the Maryland scale. Results: All patients presented with evidence of osteointegration of the osteochondral graft. All were classified as excellent or good on the Maryland scale. Functional results were good with flexion and extension movements of the ankle practically symmetrical with the healthy limb. There were no complications in the donor site or infections. None of the patients has required repeat treatment except in the cases in which material for osteosynthesis was removed from the malleolus. Discussion and Conclusions: We believe that in view of the results of mosaicplasty with an autologous osteochondral graft taken from the knee, this provides a new therapeutic approach to treatment of grade III and IV osteochondral lesions of the talus. The most significant advantages of this technique include the repair of articular cartilage with type II collagen and an earlier discharge time due to osseous integration. The most important disadvantages were potential morbidity associated with the donor site and the technical difficulty in achieving convexity

Patients with osteochondral lesions of the talus have traditionally been difficult to treat. Autologous chondrocyte implantion (ACI) may provide predictable repair through restoring an articular surface. We reviewed our results of Ankle ACI in eight ACI plus two ACI and mosaicplasty combined with an average age of 40 years (32 to 62) performed over four years. The patients were assessed with a modified Mazur ankle score, patient satisfaction score and Lysholm knee score, pre- and post-operatively. Ankle arthroscopic assessment was performed in patients at 12 months post surgery. The average time to follow up was 24 months (range two to 52). The osteochondral lesions were post traumatic in seven cases, with seven lesions situated medially and three anterolaterally. The average size of the talar defects at surgery was 2.25cm (range 1 to 4 cm.). Patient satisfaction scores in eight patients were either “extremely pleased” or “pleased” with the operation which was sustained in the patients at up to four years follow up. The Mazur scores increased by 23 points at mean 24 months follow up. Six patients with over 12 months follow up maintained a markedly improved ankle score. Patients were noted to rehabilitate twice as quickly as patients receiving ACI to the knee. The Lysholm knee scores returned to the preoperative level in four patients, with the remaining six patients showing a reduced score (mean 12 points), suggesting there may be some donor site morbidity. Five had ankle arthroscopy at one year and were shown to have filled defects and stable cartilage. A biopsy taken from the graft site showed hyaline like cartilage and fibrocartilage to be present These early results suggest that ankle ACI is an appropriate treatment for large symptomatic osteochondral lesions in the talus

Introduction Osteochondral lesions of the talus are a common occurrence especially in sports injuries. The biomechanical nature of the ankle joint makes it susceptible to sprains which can cause damage not only to the capsulo-ligamentous structures, but also to the joint cartilage and subchondral bone. As it is known, joint cartilage is a highly specialized and multitask tissue. Because joint cartilage has poor reparative capability, damage may be irreversible and as a consequence, can also lead to osteoarthritis. The purpose of this study is to review the results of a series of patients treated with autologous chondrocytes implantation (A.C.I.) and to describe the evolution in surgical technique that we have been implemented in the last 8 years. Methods Thirty-nine patients with a mean age of 27 8 years affected by osteochondral lesions of the talus > 1.5 cm2, were treated by autologous chondrocyte implantation. All patients were checked clinically and by MRI up to 4 years follow-up. The first 9 patients received the ACI by open technique and the remaining 30, arthroscopically. In the last 10 patients the cartilage harvested from the detached osteochondral fragment was used for the colture. All patients were checked clinically (AOFAS score), radiographically and by MRI, before surgery, at 12 months and at follow-up. Eleven patients underwent a second arthroscopy with a bioptic cartilage harvest at 1 year follow-up. Samples were stained with Safranin-O and Alcian Blue. Immunohistochemical analysis for collagen type II was also performed. Results Before surgery the mean score was 48.4 17 points, at 12 months 90.9 12 (p< 0.0005), while at follow up was 93.8 8 (p< 0.0005) demonstrating an improvement over time. The histological and immunohistological analyses performed on the cartilage samples using Safranin-O, Alcian Blue staining and anti-human collagen type II antibody respectively showed a typical cartilage morphology, were positive for collagen type II and for proteoglycans expression. Conclusions The clinical and histological results have confirmed the validity of the technique utilized, with laboratory data confirming the newly formed cartilage was of hyaline type for all the cases evaluated

The purpose of this study is to demonstrate the validity of the autologous chondrocytes transplantation (A.C.T.) technique implemented over the last 6 years in the treatment of osteochondral lesions of the talus. Our case study included 22 patients (12 males and 10 females), with an average age of 27 years affected by osteochondral lesions of the talus surface. All lesions were > 1.5 cm2, monofocal, and post-traumatic in origin. The first 9 patients received ACT (Genzyme technique) and the remaining 13 patients received ACT with an arthroscopic technique. In 6 of the patients, the cartilage harvested from the detached osteochondral fragment was used for culturing, avoiding the first step arthroscopy in the knee. Before surgery, all patients were assessed clinically, radiographically, and using MRIs. For clinical evaluation patients were assessed using the American Foot & Ankle Society 100 point score. Before surgery the mean score was 48.4 points. 11 patients underwent second-look arthroscopy at one year during which a biopsy was harvested for histologic analysis of the reconstructed cartilage. Of these, 9 patients (Genzyme technique) also had hardware removed. The mean follow-up of the 22 patients was 36 months. At follow-up, all patients but one were satisfied with their results. With regards to the clinical results evaluated using the American Foot and Ankle Society score, an average of 90.5 was obtained at 24 months, while at 36 months the average score (19 patients) was 94.0 (range 54–100). During follow-up arthroscopy, 4 patients had mild fibrosis and 1 patient required regularization of flap overgrowth causing pain. The clinical and histological results have confirmed the validity of the surgical technique utilized with no subjective nor objective complications. An improvement of the symptoms and of articular function has also been observed: laboratory data confirmed the histological appearance of the newly formed hyaline cartilage in all cases evaluated. Immunohistochemistry showed a positive staining for collagen type II located in the extracellular matrix and in the chondrocytes in the healthy and transplanted cartilage biopsies. All the specimens studied were also positive for proteoglycans expression as was the Alcian blue reaction, which highlighted the presence of these fundamental components of a cartilaginous matrix

Introduction. Osteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is one such treatment described for larger lesions >15mm2 or failed alternative therapies. This cohort study describes a medium-term review of the outcomes of talar lesions treated with MAST. Methods. A review of all patients treated with MAST by a single surgeon was conducted. Preoperative radiographs, MRIs and FAOS outcome questionnaire scores were conducted. Intraoperative classification was undertaken to correlate with imaging. Postoperative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment and progression to arthritis/fusion surgery. Results. 58 MAST procedures in 57 patients were identified in this cohort. The mean follow up was 5 years. There were 20 females and37males, with a mean age of 37 years (SD 9.1). 22 patients had lateral OCLS were and 35 patients had medial OCLs. Of this cohort 32patients had previous surgery and 25 had this procedure as a primary event. 15 patients had one failed previous surgery, 9 patients had two, four patients had three previous surgeries and three patients had four previous surgeries. 12 patients had corrective or realignment procedures at the time of surgery. In terms of complications 3 patients of this cohort went on to have an ankle fusion and two of these had medial malleolar metal work taken out prior to this, 5 patients had additional procedures for arthrofibrotic debridements, 1 patient had a repeat MAST procedure, 1 additional patients had removal of medial malleolar osteotomy screws for pain at the osteotomy site, there were 2 wound complications one related to the ankle and one related to pain at the iliac crest donor site. Conclusion. MAST has demonstrated positive results in lesions which prove challenging to treat, even in a “ failed microfracture” cohort. RCT still lacking in field of orthobiologics for MAST. Longer term follow up required to evaluate durability

Injuries to the lateral ligamentous complex of the ankle are common. The most commonly injured ligament is the anterior talofibular ligament (ATFL) followed by the calcaneofibular ligament (CFL). The posterior talofibular ligament (PTFL) is less commonly injured. There are few studies reporting the incidence of PTFL injury and less data available which describes the significance of this injury. We aim to establish an incidence of PTFL injury and allude to the possible significance of such an injury. Methods. A retrospective review of patient notes and magnetic resonance (MR) scans dating from September 2007 to present day was undertaken. Patients complaining of acute or chronic ankle pain, swelling, and instability were included in the study. Exclusion criteria consisted of patients that had undergone previous surgery to the ankle. Routine MR was performed on all patients with oblique axial, coronal and sagittal views taken. Results. 312 patients were included in the study. The incidence of PTFL injury was 10.9%. The PTFL never ruptured in isolation. In 12.3% of patients the PTFL had ruptured with the ATFL and in 28.6% of patients it had ruptured with the CFL. Osteochondral defects were also present in the majority of patients with PTFL failure (57.1%). Conclusion. This study confirms that the PTFL rupture is rare. It is never injured in isolation. The frequency of incidental findings in those patients with PTFL injury is high. The commonest associated injury was an osteochondral lesion of the talus. The inference of our findings is that patients with a PTFL rupture have sustained a more significant ankle injury

Advantages of arthroscopic surgery in orthopaedic practice are well documented. The use and scope of ankle arthroscopy has evolved in the last decade. Its role in both the evaluation and treatment of chronic ankle pain has become more important with identification of newer pathologies. We aimed to identify the indications and complications of ankle arthroscopy in chronic ankle pain and to correlate the arthroscopic findings with pre-operative MRI/CT. A retrospective analysis of all procedures done in our unit from 2005-2009. Patient records, X- rays and scans were reviewed. 77 patients were included in the study (46 male/31 female). The commonest age group was the 4. th. decade. There was a male preponderance in the younger age group (<50y), and a female preponderance in the older age groups (>50y). The commonest indication was impingement syndrome (44%/mean age 38y), followed by osteochondral lesions of the talus (23%/mean age 36y) and Osteoarthritis (22%/mean age56y). Other pathology included synovitis, Rheumatoid Arthritis, instability, AVN and combined pathologies. Pre-op MRI scans correlated with arthroscopic findings in 59%. The pathology most missed by MRI was impingement. 1 patient developed wound infection and another iatrogenic tendon rupture. 78% reported improvement in their symptoms following the procedure. Ankle arthroscopy is a safe and effective procedure. It is particularly useful in the diagnosis and treatment of impingement syndromes and osteochondral lesions. Although there are serious recognised complications, their incidence is low. Patients with chronic symptoms and normal MRI/CT may have treatable pathology on arthroscopy

Objective: Different. Methods: have been proposed to date to achieve the regeneration of hyaline cartilage in osteochondral lesions of the talus (OLT). The aim of this study was to present a new one-step arthroscopic procedure with the use of mesenchimal stem cells (MSC) supported on a collagen scaffold and Platelet Rich Fibrin (PRF). Methods: 14 patients with a diagnosis of OLT underwent this procedure. The MSC were harvested from the posterior iliac crest and concentrated directly in the operating room. An ankle arthroscopy was performed with lesion detection and curettage. The cell concentrate was mixed with a collagen paste as scaffold and with PRF as a pool of growth factors in order to have a final composite to fill the lesion site. Partial weight bearing for 2 months and early ROM was advised postoperatively. Results: According to the American Orthopaedic Foot and Ankle Score (AOFAS) system the patients had a preoperative score of 65.1 (range 35–79), a postoperative of 69.4 (range 61–97) at 6 months and of 83.6 (range 65–100) at 12 months follow up. MRI control at 6 and 12 months showed a progression of the reparative process in the osteochondral lesions. Histological and immuno-hystochemical analysis on a sample biopsed during a control arthroscopy at 12 months confirmed the hyaline quality of the regenerated cartilage. Conclusions: This one-step technique demonstrated to be capable to regenerate hyaline cartilage, with the advantages of a reduced surgical time, lower costs and lower patient’s morbidity

Introduction: Qualitative evaluation of postoperative outcome in cartilage repair techniques is an issue due to morbidity of bioptic second look. T2 mapping is becoming increasingly popular in the knee, providing information about the histological and biochemical contents of healthy or reparative tissue. Nevertheless, little is known about its applicability to the ankle due to thinner cartilage layer. Aim of this study was to investigate the validity of T2 mapping in ankle cartilage characterization. Materials and Methods: 20 healthy volunteers and 30 patients affected by osteochondral lesions of the talus and previously treated by different cartilage repair techniques, were evaluated by T2 mapping. Reparative procedures included microfractures, Autologous Chondrocyte Implantation (open or arthroscopic) and Bone Marrow Derived Cell’s Transplantation. DPFSE with or without fat suppression, T2FSE with or without fat suppression, 3D SPGR and T2-Mapping using a dedicated phased array coil and 1.5 T MR scanner were used as MRI acquisition protocol. MRI results were correlated with clinical score (AOFAS) in the cases who received a cartilage reconstruction treatment. Results: A statistically significant correlation (p< 0.05) was shown between MRI and clinical results. A reduced mean T2 value, suggestive for fibrocartilage features, was shown at repair sites in microfractures, whereas no significative differences with healthy hyaline cartilage mean T2 value, were found in other repair techniques with good to excellent clinical score. Conclusions: T2 mapping demonstrated to be adequate in characterizing cartilage tissue in the ankle. Further studies are required to implement a tool which may over time be a valuable non-invasive alternative to bioptic evaluation

Introduction: Ideal treatment of osteochondral lesions of the talus (OLT) is still controversial. Aim of this study is to review the 10 years follow-up clinical and MRI results of open field Autologous Chondrocytes Implantation in the treatment of OLT. Methods: From December 1997 to November 1999, 10 patients, age 25.8 +/−6.4 years, affected by OLT, received open field Autologous Chondrocytes Implantation. The mean size of the lesions was 3.1 cm. 2. (2.2 – 4.3). All patients were evaluated clinically (AOFAS score), radiographically and by MRI pre-operatively and at established intervals up to a mean follow-up of 119+/−6.5 months. At the final follow-up MRI T2 mapping evaluation was performed. A bioptic sample was harvested in 5 cases during hardware removal 12 months after implantation. Results: Before surgery the mean score was 37.9 +/−17.8 points, at 24 months it was 93.9 +/−8.5, while at final follow-up it was 92.7 +/−9.9 (p< 0.0005). Bioptic samples showed cartilaginous features at various degrees of remodelling, positivity for collagen type II and for proteoglycans expression. No degenerative changes of the joint at follow-up were found radiographically. MRI showed well-modelled restoration of the articular surface. The regenerated cartilage showed a mean T2 mapping value of 46 msec with no significant difference compared to that of normal hyaline cartilage. Conclusions: The clinical and histological results have confirmed the validity of the technique utilized with a durability of the results over time. T2 mapping was adequate in detecting the quality of the regenerated tissue coherently with the bioptic results