Abstract
Osteochondral lesion (OLT) of the ankle joint is an injury involving the chondral layer and the subchondral bone, usually traumatic in etiology. OLT treatment is debated and no clear guidelines exist. Reparative procedures are effective in small-size lesions, but a fibrocartilage layer with low biomechanical properties is generated. Regenerative techniques, supplying a layer of hyaline cartilage, are welcomed. Open-field autologous chondrocytes implantation (ACI) was the first regenerative technique relying on cells to be adopted, but it was rich in technical drawbacks. Arthroscopic ACI was developed thanks to scaffold introduction and a specific instrumentation. The technique was simplified, and the clinical and MRI results were comparable with open-field ACI. Bone marrow-derived cells transplantation (BMDCT) was then developed to overcome the two-step surgery, the high costs, and the laboratoristic phase. BMDCT is based on autologous mesenchymal stem cells, more useful in case of large bony defects and even degenerated joint environment. The clinical, MRI, and histological outcomes were good at midterm follow-up. Regenerative techniques are reliable procedures: nevertheless, more biological studies are needed to understand the applicability and the possible improvements of these procedures.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
van Dijk CN, Reilingh ML, Zengerink M et al (2010) Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc 18(5):570–580. doi:10.1007/s00167-010-1064-x
Navid DO, Myerson MS (2002) Approach alternatives for treatment of osteochondral lesions of the talus. Foot Ankle Clin 7(3):635–649
Murawski CD, Kennedy JG (2013) Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 95(11):1045–1054. doi:10.2106/JBJS.L.00773
Bae S, Lee HK, Lee K et al (2012) Comparison of arthroscopic and magnetic resonance imaging findings in osteochondral lesions of the talus. Foot Ankle Int 33(12):1058–1062. doi:10.3113/FAI.2012.1058
Choi WJ, Park KK, Kim BS, Lee JW (2009) Osteochondral lesion of the talus: is there a critical defect size for poor outcome? Am J Sports Med 37(10):1974–1980. doi:10.1177/0363546509335765
Canale ST, Belding RH (1980) Osteochondral lesions of the talus. J Bone Joint Surg Am 62(1):97–102
Giannini S, Buda R, Faldini C et al (2005) Surgical treatment of osteochondral lesions of the talus in young active patients. J Bone Joint Surg Am 87(Suppl 2):28–41
Talusan PG, Milewski MD, Toy JO et al (2014) Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Clin Sports Med 33(2):267–284. doi:10.1016/j.csm.2014.01.003
Saxena A, Eakin C (2007) Articular talar injuries in athletes: results of microfracture and autogenous bone graft. Am J Sports Med 35(10):1680–1687
Verhagen RA, Struijs PA, Bossuyt PM et al (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 8(2):233–242, viii–ix
Giannini S, Vannini F (2004) Operative treatment of osteochondral lesions of the talar dome: current concepts review. Foot Ankle Int 25(3):168–175
Hangody L, Dobos J, Baló E et al (2010) Clinical experiences with autologous osteochondral mosaicplasty in an athletic population: a 17-year prospective multicenter study. Am J Sports Med 38(6):1125–1133. doi:10.1177/0363546509360405
Giannini S, Battaglia M, Buda R et al (2009) Surgical treatment of osteochondral lesions of the talus by open-field autologous chondrocyte implantation: a 10-year follow-up clinical and magnetic resonance imaging T2-mapping evaluation. Am J Sports Med 37(Suppl 1):112S–118S
Niemeyer P, Salzmann G, Schmal H et al (2012) Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc 20(9):1696–1703. doi:10.1007/s00167-011-1729-0
Giannini S, Buda R, Ruffilli A et al (2014) Arthroscopic autologous chondrocyte implantation in the ankle joint. Knee Surg Sports Traumatol Arthrosc 22(6):1311–1319. doi:10.1007/s00167-013-2640-7
Battaglia M, Vannini F, Buda R et al (2011) Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: mid-term T2-mapping MRI evaluation. Knee Surg Sports Traumatol Arthrosc 19(8):1376–1384. doi:10.1007/s00167-011-1509-x
Giannini S, Buda R, Battaglia M et al (2013) One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med 41(3):511–518. doi:10.1177/0363546512467622
Cavallo M, Buda R, Vannini F et al (2013) Subchondral bone regenerative effect of two different biomaterials in the same patient. Case Rep Orthop 2013:850502
Nho SJ, Pensak MJ, Seigerman DA, et al (2010) Rehabilitation after autologous chondrocyte implantation in athletes. Clin Sports Med 29(2):267–282, viii. doi:10.1016/j.csm.2009.12.004
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 ISAKOS
About this chapter
Cite this chapter
Giannini, S., Cavallo, M., Castagnini, F. (2015). Evolution of Surgical Treatment of Cartilaginous Lesions. In: Canata, G., van Dijk, C. (eds) Cartilage Lesions of the Ankle. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46332-1_3
Download citation
DOI: https://doi.org/10.1007/978-3-662-46332-1_3
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-46331-4
Online ISBN: 978-3-662-46332-1
eBook Packages: MedicineMedicine (R0)