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(AMIC) Compared to Microfractures for Chondral Defects of the Talar Shoulder: a Five-Year Follow-Up Prospective Cohort Study

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(AMIC) Compared to Microfractures for Chondral Defects of the Talar Shoulder: a Five-Year Follow-Up Prospective Cohort Study life Communication Autologous Matrix Induced Chondrogenesis (AMIC) Compared to Microfractures for Chondral Defects of the Talar Shoulder: A Five-Year Follow-Up Prospective Cohort Study Filippo Migliorini 1 , Jörg Eschweiler 1, Nicola Maffulli 2,3,4,5,* , Hanno Schenker 1, Arne Driessen 1 , Björn Rath 1,6 and Markus Tingart 1 1 Department of Orthopedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, 52064 Aachen, Germany; [email protected] (F.M.); [email protected] (J.E.); [email protected] (H.S.); [email protected] (A.D.); [email protected] (B.R.); [email protected] (M.T.) 2 School of Pharmacy and Bioengineering, Keele University School of Medicine, Staffordshire ST4 7QB, UK 3 Barts and the London School of Medicine and Dentistry, London E1 2AD, UK 4 Centre for Sports and Exercise Medicine, Queen Mary University of London, Mile End Hospital, London E1 4DG, UK 5 Department of Orthopedics, Klinikum Wels-Grieskirchen, A-4600 Wels, Austria 6 Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy * Correspondence: [email protected] Abstract: Introduction: Many procedures are available to manage cartilage defects of the talus, Citation: Migliorini, F.; Eschweiler, J.; including microfracturing (MFx) and Autologous Matrix Induced Chondrogenesis (AMIC). Whether Maffulli, N.; Schenker, H.; Driessen, AMIC or MFx are equivalent for borderline sized defects of the talar shoulder is unclear. Thus, the A.; Rath, B.; Tingart, M. Autologous present study compared the efficacy of primary isolated AMIC versus MFx for borderline sized Matrix Induced Chondrogenesis focal unipolar chondral defects of the talar shoulder at midterm follow-up. Methods: Patients (AMIC) Compared to Microfractures undergoing primary isolated AMIC or MFx for focal unipolar borderline sized chondral defects of for Chondral Defects of the Talar the talar shoulder were recruited prospectively. For those patients who underwent AMIC, a type Shoulder: A Five-Year Follow-Up I/III collagen resorbable membrane was used. The outcomes of interest were: Visual Analogic Scale Prospective Cohort Study. Life 2021, 11, 244. https://doi.org/10.3390/ (VAS), Tegner Activity Scale, American Orthopedic Foot and Ankle Score (AOFAS). The Magnetic life11030244 Resonance Observation of Cartilage Repair Tissue (MOCART) was assessed by a blinded radiologist, who had not been involved in the clinical management of the patients. Data concerning complication Academic Editor: William rate and additional procedures were also collected. Results: The mean follow-up was 43.5 months. John Ribbans The mean age of the 70 patients at operation was 32.0 years, with a mean defect size of 2.7 cm2. The mean length of hospitalization was shorter in the MFx cohort (p = 0.01). No difference was found Received: 2 February 2021 between the two cohorts in terms of length of prior surgery symptoms and follow-up, mean age and Accepted: 15 March 2021 BMI, sex and side, and defect size. At a mean follow-up of 43.5 months, the AOFAS (p = 0.03), VAS Published: 16 March 2021 (p = 0.003), and Tegner (p = 0.01) scores were greater in the AMIC group. No difference was found in the MOCART score (p = 0.08). The AMIC group evidenced lower rates of reoperation (p = 0.008) Publisher’s Note: MDPI stays neutral and failure (p = 0.003). Conclusion: At midterm follow-up, AMIC provides better results compared with regard to jurisdictional claims in to MFx. published maps and institutional affil- iations. Keywords: talus; ankle; chondral defect; autologous matrix induced chondrogenesis; AMIC; mi- crofractures; management; surgery Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. 1. Introduction This article is an open access article distributed under the terms and Focal chondral defects of the talar shoulder are common [1,2]. Given the limited self- conditions of the Creative Commons healing capability of cartilage, chondral defects are debilitating, often requiring surgical Attribution (CC BY) license (https:// management [3–5]. Isolated microfractures (MFx) are recommended for defects smaller 2 creativecommons.org/licenses/by/ than 2.5 cm [6–10]. For bigger defects, several different surgical techniques have been 4.0/). Life 2021, 11, 244. https://doi.org/10.3390/life11030244 https://www.mdpi.com/journal/life Life 2021, 11, x FOR PEER REVIEW 2 of 10 Life 2021, 11, 244 2 of 9 been described [11–14]. Osteochondral allo- or autograft transplantation (OAT) has been extensively performed as management of such chondral defects [15–17]. While autografts requiredescribed a harvest [11–14]. site, Osteochondral allografts are allo- expensiv or autografte and have transplantation greater risk (OAT) of failure has been[18,19]. ex- Autologoustensively performed chondrocyte as management implantation of such(ACI) chondral has been defects widely [15 used–17]. Whileto address autografts talar chondralrequire a defects harvest [20,21]. site, allografts ACI is a are two expensive sessions andsurgery have which greater requires risk of the failure harvest [18,19 of]. cells Au- andtologous external chondrocyte chondrocytes implantation expansion (ACI) [22,23]. has beenAutologous widely usedMatrix-Induced to address talarChondrogen- chondral esisdefects (AMIC) [20,21 has]. ACI been is arecently two sessions introduced surgery [2 which,24]. AMIC requires does the not harvest require of cellsa harvest and exter- site, nal chondrocytes expansion [22,23]. Autologous Matrix-Induced Chondrogenesis (AMIC) cell expansion, and is performed in a single surgical session [25,26]. AMIC is combined has been recently introduced [2,24]. AMIC does not require a harvest site, cell expansion, with MFx covering the lesions with a resorbable membrane to stabilize the resulting and is performed in a single surgical session [25,26]. AMIC is combined with MFx covering blood clot [27,28]. Thus, AMIC exploits the regenerative potential of bone mar- the lesions with a resorbable membrane to stabilize the resulting blood clot [27,28]. Thus, row-derived mesenchymal stem cells arising from the subchondral bone [25,29]. AMIC exploits the regenerative potential of bone marrow-derived mesenchymal stem cells Whether AMIC performed better than MFx for borderline sized defects (2.2 to 2.8 arising from the subchondral bone [25,29]. cm2) of the talar shoulder is unclear. The present study compared the efficacy of primary Whether AMIC performed better than MFx for borderline sized defects (2.2 to 2.8 cm2) isolated AMIC versus MFx for borderline sized focal unipolar chondral defects of the of the talar shoulder is unclear. The present study compared the efficacy of primary isolated talar shoulder at midterm follow-up. We hypothesized that AMIC provides better out- AMIC versus MFx for borderline sized focal unipolar chondral defects of the talar shoulder comes compared to MFx. at midterm follow-up. We hypothesized that AMIC provides better outcomes compared to MFx. 2. Material and Methods 2.1.2. Material Patients andRecruitment Methods 2.1. PatientsThe present Recruitment study was performed according to Strengthening the Reporting of Ob- servationalThe present Studies study in Epidem was performediology: the according STROBE to Statement Strengthening [30].the In Reportingour setting, of for Obser- pa- tientsvational with Studies defect in sized Epidemiology: 2 to 3 cm2, both the STROBE AMIC or Statement isolated MFx [30]. were In our routinely setting, forperformed. patients Fromwith defect2012, sizedpatients 2 to undergoing 3 cm2, both primary AMIC or isol isolatedated AMIC MFx were or MFx routinely for focal performed. unipolar From bor- derline2012, patients sized chondral undergoing defects primary of the isolated talar shoulder AMIC or (Figure MFx for 1), focal were unipolar recruited borderline and fol- lowed-upsized chondral prospectively. defects of The the inclusion talar shoulder criteria (Figure were:1 (1)), were symptomatic recruited chondral and followed-up defect of theprospectively. talar shoulder, The (2) inclusion single focal criteria defect were: sized (1) symptomatic2 to 3 cm2, (3) chondral MRI evidence, defect (4) of thepatients talar ableshoulder, to understand (2) single the focal nature defect of the sized treatmen 2 to 3t cm and2, (3)the MRIstudy. evidence, The exclusion (4) patients criteria able were: to (1)understand kissing lesions, the nature (2) bilateral of the treatmentlesions, (3) andmultifocal the study. lesions, The (4) exclusion previous criteria ankle surgeries, were: (1) (5)kissing any bone lesions, disease, (2) bilateral (6) any lesions, skeletal (3) malformation, multifocal lesions, (7) any (4) other previous relevant ankle pathology surgeries, that (5) couldany bone have disease, influenced (6) any the skeletal study. malformation, Suitable patients (7) any were other informed relevant pathologyabout the thatpros could and conshave of influenced both techniques, the study. and Suitable were left patients free to were decide informed their own about procedure. the pros The and present cons of studyboth techniques, was approved and wereand registered left free to by decide the ethic their committee own procedure. of the The RWTH present University study was of Aachenapproved (project and registered ID EK 438-20), by the ethic and committeeconducted of according the RWTH to University the principles of Aachen expressed (project in theID EKDeclaration 438-20), and of conductedHelsinki. All according patients to were the principles
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