Background:Autologous matrix-induced chondrogenesis (AMIC) has become an interesting treatment option for osteochondral lesions of the talus (OLTs) with promising clinical short- to midterm results...

Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A Clinical and Radiological 2- to 8-Year Follow-up Study.

Osteochondral damage from trauma or osteoarthritis is a general joint disease that can lead to an increased social and economic burden in the modern society. The inefficiency of osteochondral defects is mainly due to the absence of suitable tissue-engineered substrates promoting tissue regeneration and replacing damaged areas. The hydrogels are becoming a promising kind of biomaterials for tissue regeneration. The biomimetic hydrogel microenvironment can be tightly controlled by modulating a number of biophysical and biochemical properties, including matrix mechanics, degradation, microstructure, cell adhesion, and intercellular interactions. In particular, advances in stem cell-laden hydrogels have offered new ideas for the cell therapy and osteochondral repair. Herein, the aim of this review is to underpin the importance of stem cell-laden hydrogels on promoting the development of osteochondral regeneration, especially in the field of manipulation of biomimetic microenvironment and utilization growth factors with various delivery methods.

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Advances of Stem Cell-Laden Hydrogels With Biomimetic Microenvironment for Osteochondral Repair.

Osteochondral lesions of the talus (OCLT) are defined by damage to the talar articular cartilage and its subchondral bone. OCLT present a common ankle pathology and have been shown to occur in over 65% of chronic ankle sprains and up to 75% of ankle fractures [4, 5, 9]. An ankle sprain or fracture may cause a cartilage injury as the talar dome impacts on the distal tibial plafond. This may initiate the development of an osteochondral cyst through cracks in the subchondral plate, destabilise a previously stable osteochondral lesion or create an osteochondral fracture, leading to chronic deep ankle pain and disability in the medium to long term. In addition, possible genetic predisposition has been discussed as a possible cause of OCLT. The injuries may have a severe impact on the quality of life of active patients, due to deep ankle pain during weight-bearing and sporting activities. OCLT has the potential to progress into ankle joint osteoarthritis, and it is known that the vast majority of ankle joint osteoarthritis is posttraumatic [9]. Management of OCLT is not yet able to guarantee a successful return to pain-free weight-bearing and sporting activities. Non-surgical management, including physiotherapy, injection therapy, non-weight-bearing periods and immobilisation, may relieve symptoms temporarily, but seldom lead to a persistent return to sporting activities, however. Even in paediatric OCLT, a period of non-surgical treatment is known to lead to limited success. At the same time, it is also a fact that surgical treatment after a period of non-surgical management provides a higher success rate [14]. Surgical management of OCLT is dependent on a variety of aspects of the patient and the lesion: limb alignment, ankle joint instability, the size, location and morphological characteristics of OCLT (i.e. occurrence of cysts) and failed previous surgical treatment(s). For small primary defects, first-line surgical management options that are frequently applied consist of (arthroscopic) fixation, bone marrow stimulation and possibly retrograde drilling [3, 10]. Fixation is preferred because first it is proven that subchondral bone healing after fixation of an osteochondral talar defect is superior compared with bone marrow stimulation [3, 10, 13] and second bone marrow stimulation is still possible after a failed fixation. It appears from the recent study of Becher et al. that the addition of an acellular matrix to a bone marrow stimulation does not lead to a better result [1]. This study compared the results of arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis using a collagen I/III matrix (AMIC) and concluded that for defects as treated in this study, it is not beneficial to add the collagen I/III matrix to the microfracture procedure [1]. In their study, the Kennedy group showed that the overall return to play rate after bone marrow stimulation is very * J. Karlsson jon.karlsson@telia.com

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Osteochondral lesions of the talus.

The purpose of this study was to compare patients with osteochondral lesions of the talus (OCLT) with and without concomitant chronic ankle instability (CAI). Data from the German Cartilage Registry (KnorpelRegister DGOU) for 63 patients with a solitary OCLT were used. All patients received autologous matrix-induced chondrogenesis (AMIC) for OCLT treatment. Patients in group A received an additional ankle stabilisation, while patients in group B received AMIC alone. Both groups were compared according to demographic, lesion-related, and therapy-related factors as well as baseline clinical outcome scores at the time of surgery. The Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), and the Numeric Rating Scale for Pain (NRS) were used. Patients in group A were older compared to group B [median 34 years (range 20–65 years) vs. 28.5 years (range 18–72 years)]; the rate of trauma-associated OCLTs was higher (89.7% vs. 38.3%); more patients in group A had a previous non-surgical treatment (74.1% vs. 41.4%); and their OCLT lesion size was smaller [median 100 mm2 (range 15–600 mm2) vs. 150 mm2 (range 25–448 mm2)]. Most OCLTs were located medially in the coronary plane and centrally in the sagittal plane in both groups. Patients in group A had worse scores on the FAOS quality-of-life subscale compared to patients in group B. Patients with OCLT with concomitant CAI differ from those without concomitant CAI according to demographic and lesion-related factors. The additional presence of CAI worsens the quality of life of patients with OCLT. Patients with OCLT should be examined for concomitant CAI, so that if CAI is present, it can be integrated into the treatment concept. IV.

Concomitant ankle instability has a negative impact on the quality of life in patients with osteochondral lesions of the talus: data from the German Cartilage Registry (KnorpelRegister DGOU).

3D bioprinting modified autologous matrix-induced chondrogenesis(AMIC) technique for repair of cartilage defects

Microfracture is an established method to treat osteochondral defects of the talus. The value of the addition of an acellular matrix is still under debate. This study compared the results of arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis using a collagen I/III matrix (AMIC) in the management of articular cartilage defects of the talus. Patients with a minimum follow-up of 5 years after arthroscopic management for an articular cartilage defect of the talus with either microfracture alone or an additional acellular matrix were matched according to age, sex and BMI. The Hannover Scoring System for the ankle (HSS) and a Visual analog scale (VAS) for pain, function and satisfaction were used to evaluate the clinical outcome. Postoperative MRI was used to assess cartilage repair tissue based on the degree of defect repair and filling of the defect, integration to border zone, surface of the repair tissue, structure of the repair tissue, and subchondral bone alterations. Thirty-two patients (16 microfracture, 16 AMIC) were included. No significant between-group differences were observed in demographic data and preoperative score values. Both groups showed statistically significant improvement when comparing the pre- and postoperative score values. No statistically significant differences were identified between the median values of the groups with the HSS (microfracture: 82 (range 71–96) points; AMIC 88 (range 40–98) points). Accordingly, no significant differences were observed for the VAS pain (microfracture: 0.95 (range 0–3.8); AMIC: 1.0 (range 0–8.5)), VAS function (microfracture: 8.4 (range 3.5–10); AMIC: 9.0 (range 1.5–10)) and VAS satisfaction (microfracture: 8.9 (range 2.8–10); AMIC: 9.45 (range 1.5–10)). MRI showed regeneration of tissue in the treated area without differences between the two groups. Good clinical results were observed for arthroscopic microfracture with or without an additional acellular collagen I/III matrix in the treatment for articular cartilage defects of the talus. It appears that for defects as treated in this study, it is not worthwhile adding the collagen I/III matrix to the microfractures. III.

Moataz Mahmoud Ali

Papers

Arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis for the treatment of articular cartilage defects of the talus.