Abstract
Osteochondral lesions of the talus (OLTs) are common cause of postresidual pain after ankle injury. The “gold standard” has not been established over the years, which is why a variety of different methods of cartilage lesion treatment have been used. Microfracture and bone marrow stimulation, although offered fast return to sports, had worse results in a long-term follow-up. Autologous chondrocyte implantation (ACI) was a next step in treatment of OLTs. However, it is a complex and invasive two-step surgery that requires arthrotomy and, in most of the cases, a medial malleolus osteotomy. Furthermore, the cost of the full procedure is high. The evolution of tissue engineering and scaffold development provided an opportunity to change the surgery technique. A single-stage procedure with the use of hyaluronic acid-based scaffold combined with bone marrow-derived cells has become an alternative to the aforementioned techniques offering a good clinical outcome and satisfactory long-term results.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Shepherd DET, Seedhom BB. Thickness of human articular cartilage in joints of the lower limb. Ann Rheum Dis. 1999;58(1):27–34.
Murawski CD, Kennedy JG. Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2013;95(11):1045–54.
Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN. Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin. 2003;8(2):233–42.
Hunt SA, Sherman O. Arthroscopic treatment of osteochondral lesions of the talus with correlation of outcome scoring systems. Arthroscopy. 2003;19(4):360–7.
Robinson DE, Winson IG, Harries WJ, Kelly AJ. Arthroscopic treatment of osteochondral lesions of the talus. J Bone Joint Surg (Br). 2003;85(7):989–93.
Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy. 2006;22(10):1085–92.
Ferkel RD, Zanotti RM, Komenda GA, Sgaglione NA, Cheng MS, Applegate GR, Dopirak RM. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med. 2008;36(9):1750–62.
Giannini S, Battaglia M, Buda R, Cavallo M, Ruffilli A, Vannini F. 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. 2009;37(Suppl 1):112S–8S.
Kwak SK, Kern BS, Ferkel RD, Chan KW, Kasraeian S, Applegate GR. Autologous chondrocyte implantation of the ankle: 2- to 10-year results. Am J Sports Med. 2014;42(9):2156–64.
Pereterson L, Mandelbaum B, Gobbi A, Francisco R, Autologous Chondrocyte transplantation of the ankle, Basic science, clinical repair and reconstruction of articular cartilage defects: current status and prospects. Timeo. 2006:341–347.
Gobbi A, Karnatzikos G, Sankineani SR. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med. 2014;42(3):648–57.
O'Brien F. Biomaterials & scaffolds for tissue engineering. Mater Today. 2011;14(3):88–95.
Scotti C, Leumann A, Candrian C, et al. Autologous tissue-engineered osteochondral graft for talus osteochondral lesions: state-of-the-art and future perspectives. Tech Foot & Ankle Surg. 2011;10(4):163–8.
Frenkel S, Di Cesare P. Scaffolds for articular cartilage repair. Ann Biomed Eng. 2004;32(1):26–34.
Marcacci M, Berruto M, Brocchetta D, et al. Articular cartilage engineering with Hyalograft C: 3-year clinical results. Clin Orthop Relat Res. 2005;435:96–105.
Gobbi A, Kon E, Berruto M, et al. Patellofemoral full-thickness chondral defects treated with Hyalo-graft-C: a clinical, arthroscopic, and histologic review. Am J Sports Med. 2006;34:1763–73.
Gobbi A, Katzarnikos G, Lad D. Osteochondral lesions of the talar dome: matrix-induced autologous chondrocyte implantation. In: The foot and ankle: AANA advanced arthroscopic surgical techniques. Thorofare: Slack Inc; 2016. p. 37–48.
McCarthy HS, Roberts S. A histological comparison of the repair tissue formed when using either Chondrogide(®) or periosteum during autologous chondrocyte implantation. Osteoarthr Cartil. 2013;12:2048–57.
Valderrabano V, Miska M, Leumann A, et al. Reconstruction of osteochondral lesions of the talus with autologous spongiosa grafts and autologous matrix-induced chondrogenesis. Am J Sports Med. 2013;41(3):519–27.
Albano D, Martinelli N, Bianchi A, Messina C, Malerba F, Sconfienza LM. Clinical and imaging outcome of osteochondral lesions of the talus treated using autologous matrix-induced chondrogenesis technique with a biomimetic scaffold. BMC Musculoskelet Disord. 2017;18(1):306.
Christensen BB, Foldager CB, Jensen J, Jensen NC, Lind M. Poor osteochondral repair by a biomimetic collagen scaffold: 1- to 3-year clinical and radiological follow-up. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2380–7.
Giannini S, Buda R, Battaglia M, et al. One-step repair in talar osteochondral lesions:4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med. 2013;41:511–8.
Cavallo C, Desando G, Cattini L, et al. Bone marrow concentrated cell transplantation: rationale for its use in the treatment of human osteochondral lesions. J Biol Regul Homeost Agents. 2013;27(1):165–75.
Mesenchymal CA. Stem cells. The past, the present, the future. Cartilage. 2010;1(1):6–9.
Buda R, Vannini F, Castagnini F, et al. Regenerative treatment in osteochondral lesions of the talus: autologous chondrocyte implantation versus one-step bone marrow derived cells transplantation. Int Orthop. 2015;39:893–900.
Gobbi A, Karnatzikos G, Scotti C, et al. One-step cartilage repair with bone marrow aspirate concentrated cells and collagen matrix in full-thickness knee cartilage lesions: results at 2-year follow-up. Cartilage. 2011;2(3):286–99.
Gobbi A, Whyte GP. Osteochondritis dissecans: pathoanatomy, classification, and advances in biologic surgical treatment. In: Bio-orthopedics. Berlin, Heidelberg: Springer; 2017. p. 489–501.
Murray IR, Robinson PG, West CC, et al. Reporting standards in clinical studies evaluating bone marrow aspirate concentrate: a systematic review. Arthrosc J Arthrosc Relat Surg. 2018;34(4):1366–75.
Kasten P, Beyen I, Egermann M, et al. Instant stem cell therapy: characterization and concentration of human mesenchymal stem cells in vitro. Eur Cell Mater. 2008;16:47–55.
Nehrer S, Domayer SE, Hirschfeld C, Stelzeneder D, Trattnig S, Dorotka R. Matrix-associated and autologous chondrocyte transplantation in the ankle: clinical and MRI follow-up after 2 to 11 years. Cartilage. 2011;2(1):81.
Sadlik B, Gobbi A, Puszkarz M, Klon W, Whyte GP. Biologic inlay osteochondral reconstruction: arthroscopic one-step osteochondral lesion repair in the knee using morselized bone grafting and hyaluronic acid-based scaffold embedded with bone marrow aspirate concentrate. Arthrosc Tech. 2017;6(2):e383.
Rothrauff BB, Murawski CD, Angthong C, et al. Scaffold-based therapies: proceedings of the international consensus meeting on cartilage repair of the ankle. Foot Ankle Int. 2018;39:41S–7S.
Giannini S, Buda R, Vannini F, Cavallo M, Grigolo B. One-step bone marrow-derived cell transplantation in talar osteochondral lesions. Clin Orthop Relat Res. 2009;467(12):3307–20.
Vannini F, Cavallo M, Ramponi L, et al. Return to sports after bone marrow–derived cell transplantation for osteochondral lesions of the talus. Cartilage. 2017;8(1):80–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 ISAKOS
About this chapter
Cite this chapter
Gobbi, A., Nehrer, S., Neubauer, M., Herman, K. (2019). Tissue Engineering for the Cartilage Repair of the Ankle. In: Canata, G., d'Hooghe, P., Hunt, K., Kerkhoffs, G., Longo, U. (eds) Sports Injuries of the Foot and Ankle. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58704-1_10
Download citation
DOI: https://doi.org/10.1007/978-3-662-58704-1_10
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-58703-4
Online ISBN: 978-3-662-58704-1
eBook Packages: MedicineMedicine (R0)