Comparison of autologous matrix-induced chondrogenesis and mosaicplasty in the treatment of osteochondral defects of the talus

Abstract

Objective: This study aimed to compare the medium- to long-term results of mosaicplasty and autologous matrix-induced chondrogenesis (AMIC) in treating osteochondral defects of the talus (OCD).

Methods: Fifty patients treated for talus OCD were evaluated between 2010 and 2020. Patients were divided into 2 groups: patients who underwent mosaicplasty (Group I) and those who underwent AMIC (Group II). The OCD was graded according to the Berndt-Hardy and Hepple classification systems. The size of the OCD area, the number of osteochondral plugs, and the size of the collagen matrix were determined from the surgical data. The effects of patients aged below and above 45, defect areas smaller or larger than 1.5 cm2 , and gender on functional outcomes were analyzed in both groups. Range of motion (ROM), The American Orthopaedic Foot & Ankle Society score (AOFAS), the Freiburg ankle Index score (FAI), the Tegner activity scale, and the visual analog scale (VAS) were used for the functional evaluations.

Results: Group I included 28 patients, and group II included 22 patients. The mean age was 41.6 years; the mean follow-up period was 69.9 months. In the final examination of the patients, both methods could provide significant improvement in all functional scores (P < .001). Although it was not statistically significant, group II had better functional values. The size of the defect area independently negatively affected the preoperative AOFAS (P=.001 and P=.011, respectively) and FAI (P=.001 and P=.008, respectively) scores. Besides that, age and gender did not affect the results (P > .05).

Conclusion: Both methods can provide successful results; however, the AMIC method can achieve better results than mosaicplasty in similarly sized defects without causing additional morbidity.

Keywords: Autologous; Chondrogenesis; Mosaicplasty; Osteochondral defects; Talus.

Figure 1.

Presentation of the patients participating in our study in the form of a flow chart according to the inclusion and exclusion criteria.

Figure 2.

A-C: Measurement of the talus OCD area using magnetic resonance imaging. Sagittal (A), axial (B), and coronal (C) T1- and T2-weighted MR images show the measurement method of the OCD defect area.

Figure 3.

A-C: Intraoperative images of our patients who underwent mosaicplasty. Harvesting of the osteochondral graft from the superolateral incision of the knee joint (A), preparation of the OCD area (B), and insertion of the osteochondral graft into the defective area (C).

Figure 4.

A, B: Anterior (A) and lateral (B) ankle X-ray show complete union of the osteotomy line and no arthrosis in the 2nd year of our patient who underwent surgery with the AMIC method.

Figure 5.

A, B: Intraoperative second-look arthroscopy image (A) and pathological examination image (B) showing complete healing and hyaline cartilage formation in the articular cartilage after AMIC.