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. 2023 Mar 31;8(1):24730114231164150.
doi: 10.1177/24730114231164150. eCollection 2023 Jan.

Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC)

Manuel Waltenspül  1   2 , Michel Meisterhans  1 , Jakob Ackermann  1 , Stephan Wirth  1
Affiliations

Typical Complications After Cartilage Repair of the Ankle Using Autologous Matrix-Induced Chondrogenesis (AMIC)

Manuel Waltenspül et al. Foot Ankle Orthop. .

Abstract

Background: Autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLT) results in favorable clinical outcomes, yet high reoperation rates. The aim of this study was to report and analyze typical complications and their risk factors after AMIC for OLT.

Methods: A total of 127 consecutive patients with 130 AMIC procedures for OLT were retrospectively assessed. All AMIC procedures were performed in an open fashion with 106 (81.5%) cases requiring a malleolar osteotomy (OT) to access the OLT. Seventy-one patients (54.6%) underwent subsequent surgery. These cases were evaluated at a mean follow-up of 3.1 years (±2.5) for complications reviewing postoperative imaging and intraoperative findings during revision surgery. Six patients (8.5%) were lost to follow-up. Regression model analysis was conducted to identify factors that were associated with AMIC-related complications.

Results: Among the 65 (50%) patients who required revision surgery, 18 patients (28%) demonstrated AMIC-related complications with deep fissuring (83%) and thinning (17%) of the AMIC graft. Conversely, 47 patients (72%) underwent subsequent surgery due to AMIC-unrelated reasons including isolated removal of symptomatic hardware (n = 17) and surgery addressing concomitant pathologies with (n = 25) and without hardware removal (n = 5). Previous prior cartilage repair surgery was significantly associated with AMIC graft-associated complications in patients undergoing revision surgery (P = .0023). Among age, body mass index, defect size, smoking, and bone grafting, smoking was the only factor showing statistical significance with an odds ratio of 3.7 (95% CI 1.24, 10.9; P = .019) to undergo revision surgery due to graft-related complications, when adjusted for previous cartilage repair surgery.

Conclusion: The majority of revision surgeries after AMIC for OLT are unrelated to the performed AMIC graft but frequently address symptomatic hardware and concomitant pathologies. Both smoking and previous cartilage repair surgery seem to significantly increase the risk of undergoing revision surgery due to AMIC-related complications.

Level of evidence: Level IV, case series.

Keywords: AMIC; ankle; autologous matrix-induced chondrogenesis; bone marrow stimulation; cartilage repair; talus.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
(A, B) Preoperative coronal and sagittal T2- and T1-weighted magnetic resonance image of the ankle of a 38-year-old female patient showing a large OLT on the medial talar dome. (C) Intraoperative view after medial malleolar osteotomy with a defect with intact border of cartilage suitable for autologous matrix-induced chondrogenesis (AMIC) technique.
Figure 2.
Figure 2.
Flowchart of study participants.
Figure 3.
Figure 3.
(A) Osteochondral defect of the talus after debridement of loose cartilage fragments and microdrilling creating a well-bordered defect area with vital subchondral bone. (B) Complete cartilage repair after fixation of the bilayer type I/III collagen matrix with fibrin glue.
Figure 4.
Figure 4.
Typical morphology of AMIC graft complication with (A) deep fissuring and (B) thinning.
See this image and copyright information in PMC

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