Autologous Chondrocyte Implantation of the Ankle

Abstract

Background Treatment of full-thickness talar cartilage defects that have failed previous surgery is problematic without a definitive solution. Purpose To report the first US prospective study of autologous chondrocyte implantation of the talus. Study Design Case series; Level of evidence, 4. Methods Eleven patients (6 women and 5 men; mean age, 33 years) underwent autologous chondrocyte implantation of the talus after previous failed surgical management. There were 9 medial and 2 lateral lesions, with a mean size of 21 × 13 mm (273 mm2). Five patients underwent autologous chondrocyte implantation of the talus alone; 6 had it with a “sandwich procedure.” Ten patients underwent a second-look arthroscopy with screw removal. Results Mean follow-up was 38 months. Preoperatively, 10 patients rated their ankles as poor and 1 as fair, using the simplified symptomatology evaluation. At latest follow-up, 3 patients were classified as excellent, 6 as good, and 2 as fair. Tegner activity level improved from 1.3 ± 1.0 (mean ± SE) preoperatively to 4.0 ± 1.6 (P <. 002) postoperatively. The Finsen score (modified Weber score) showed significant improvement in the total score (P <. 001). There was also overall agreement between the Finsen score and the American Orthopaedic Foot and Ankle Society ankle hindfoot score, with significant improvement from 47.4 ± 17.4 preoperatively to 84.3 ± 8.1 postoperatively (P <. 001). At repeat arthroscopy, complete coverage of the defect was seen in all patients. Conclusion Autologous chondrocyte implantation of the talus yields significant functional improvement; however, further investigation is necessary to determine the long-term structural and biomechanical properties of the repair tissue.