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Matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st MTP joint
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Abstract 13: Chondral Lesions / Foot and Ankle Surgery 22S (2016) 51–53
110 FI2016_ChondralLesions_03 Talar osteochondral lesions: Treatment with bone graft and autologous matrix-induced chondrogenesis M. Kinkelin *, H. Waizy Hessingklinik Augsburg, Germany *Corresponding author. Aims: We developed a cohort study to evaluate the outcome of a standardized AMIC-procedure (autologous matrix-induced chondrogenesis) for a stage-related therapy of talar osteochondral lesions, using an acellular membrane and autogenous bone graft. Methods: Between 2013 and 2015, 41 patients with talar osteochondral lesions were surgically treated. Preoperative evaluation included weight-bearing anteroposterior and lateral radiographs of the foot and ankle, hindfoot Saltzman view and high-resolution MRI. After curettage of the lesion through an arthrotomy (without malleolar osteotomy), it was filled with autogenous bone graft and sealed with a cell-free collagen membrane. Pathologies of the hindfoot and ligament instabilities were addressed surgically at the same time. For clinical evaluation we collected data of the EQ-5D, the visual analogue scale and the FAOS (Foot and Ankle Outcome Score) preoperatively, 6 weeks and 3–6 months postoperatively. Results: Refixation of the ostochondral flake was performed in 3 cases. Additional procedures: lengthening calcaneal osteotomy (n = 3), varisation of the calcaneus (n = 4), reconstruction of lateral ankle ligaments (n = 6), in combination with a stabilization of the syndesmosis (n = 2). 2 patients developed an anterior impingement postoperatively which was addressed arthroscopically. We found a significant improvement of the clinical scores postoperatively and a high patients’ satisfaction. Conclusion: The results show an improvement of the clinical scores and patients’ satisfaction after surgical treatment of osteochondral lesions with the AMIC-procedure and autogenous bone graft. In combination with a low rate of complications we recommend this surgical technique as a successful procedure to treat osteochondral lesions. http://dx.doi.org/10.1016/j.fas.2016.05.123
111 FI2016_ChondralLesions_04 Early results of talar articular cartilage repair using Trufit plugs R. Shahid *, M. Maqsood Lincoln County Hospital, UK *Corresponding author. Problem description: Management of talar dome osteochondral lesions presents a challenging problem to the orthopaedic surgeons. Numerous treatment options are available for the management of this pathology. For stage-I and II lesions, the management is usually nonoperative. However, for advanced lesions, surgical intervention is usually required. Nonetheless, little information is available regarding treatment options for individuals with recurrent or advanced talar lesions.
Design: Eleven patients with talar dome lesions that were treated with a biosynthetic scaffold (Trufit plugs). Control group: None. Material: 11 patients, age 20–50 years. Methods: Preoperatively MRI scan and plain radiographs were done. A medial malleolar osteotomy was performed to approach the lesion, which was then identified and measured. After reaming, the implant was placed in the defect, flushed to the adjacent articular surface. Osteotomy repaired using partially threaded cancellous screws. Outcome was measured using The Foot & Ankle disability (FADI) score and SF-36 score at 3 and 6 months, and followed up to 2 years. MRI scans repeated at 6 months post-operatively and all patients had physiotherapy. Results: All patients in the study had good to excellent results and went back to their normal activity level along with normal gait pattern and pain free ankle, accept one patient who was still experiencing pain from the screw head of osteotomy fixation. All osteotomies healed well. Conclusions: Early results of Trufit plugs in isolated osteochondral defect are promising. Long term data needed to determine if early results are maintained and whether onset of osteoarthritis is delayed. http://dx.doi.org/10.1016/j.fas.2016.05.124
112 FI2016_ChondralLesions_05 Matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st MTP joint S. Zech *, S. Meissner, M. Richter Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Germany *Corresponding author. Background: The aim of the study was to assess the 2-yearfollowup of matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st MTP. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April 1st 2009 to March, 30th, 2013 were analyzed. The size and location of the chondral defects, range of motion (ROM), and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at followup were registered. Stem cell-rich blood was harvested from the ipsilateral pelvic bone marrow and centrifuged (10 min, 1500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue. Results: 25 defects in 20 patients were included in the study. The age of the patients was 42 years on average (range, 35–62 years), 14 (70%) were male. The VAS FA before surgery was 50.5 on average (range, 18.3–78.4). The defects were located as follows, medial metatarsal head, n = 7; lateral metatarsal head, n = 18 (medial and lateral metatarsal head, n = 5). The defect size was 0.7 cm2 (range, .4–1.5 cm2). ROM was 10.2/0/18.88. All patients completed 2-year-followup. VAS FA improved to 91.5 (range, 74.2– 100; t-test, p = .01). ROM improved to 32.5/0/25.5 (p = .05). Conclusions: MAST led to good clinical scores and improved range of motion. Even though a control group is missing, we conclude that MAST is a safe and effective method for the treatment of chondral defects of the 1st MTP joint. http://dx.doi.org/10.1016/j.fas.2016.05.125
Abstract 13: Chondral Lesions / Foot and Ankle Surgery 22S (2016) 51–53
110 FI2016_ChondralLesions_03 Talar osteochondral lesions: Treatment with bone graft and autologous matrix-induced chondrogenesis M. Kinkelin *, H. Waizy Hessingklinik Augsburg, Germany *Corresponding author. Aims: We developed a cohort study to evaluate the outcome of a standardized AMIC-procedure (autologous matrix-induced chondrogenesis) for a stage-related therapy of talar osteochondral lesions, using an acellular membrane and autogenous bone graft. Methods: Between 2013 and 2015, 41 patients with talar osteochondral lesions were surgically treated. Preoperative evaluation included weight-bearing anteroposterior and lateral radiographs of the foot and ankle, hindfoot Saltzman view and high-resolution MRI. After curettage of the lesion through an arthrotomy (without malleolar osteotomy), it was filled with autogenous bone graft and sealed with a cell-free collagen membrane. Pathologies of the hindfoot and ligament instabilities were addressed surgically at the same time. For clinical evaluation we collected data of the EQ-5D, the visual analogue scale and the FAOS (Foot and Ankle Outcome Score) preoperatively, 6 weeks and 3–6 months postoperatively. Results: Refixation of the ostochondral flake was performed in 3 cases. Additional procedures: lengthening calcaneal osteotomy (n = 3), varisation of the calcaneus (n = 4), reconstruction of lateral ankle ligaments (n = 6), in combination with a stabilization of the syndesmosis (n = 2). 2 patients developed an anterior impingement postoperatively which was addressed arthroscopically. We found a significant improvement of the clinical scores postoperatively and a high patients’ satisfaction. Conclusion: The results show an improvement of the clinical scores and patients’ satisfaction after surgical treatment of osteochondral lesions with the AMIC-procedure and autogenous bone graft. In combination with a low rate of complications we recommend this surgical technique as a successful procedure to treat osteochondral lesions. http://dx.doi.org/10.1016/j.fas.2016.05.123
111 FI2016_ChondralLesions_04 Early results of talar articular cartilage repair using Trufit plugs R. Shahid *, M. Maqsood Lincoln County Hospital, UK *Corresponding author. Problem description: Management of talar dome osteochondral lesions presents a challenging problem to the orthopaedic surgeons. Numerous treatment options are available for the management of this pathology. For stage-I and II lesions, the management is usually nonoperative. However, for advanced lesions, surgical intervention is usually required. Nonetheless, little information is available regarding treatment options for individuals with recurrent or advanced talar lesions.
Design: Eleven patients with talar dome lesions that were treated with a biosynthetic scaffold (Trufit plugs). Control group: None. Material: 11 patients, age 20–50 years. Methods: Preoperatively MRI scan and plain radiographs were done. A medial malleolar osteotomy was performed to approach the lesion, which was then identified and measured. After reaming, the implant was placed in the defect, flushed to the adjacent articular surface. Osteotomy repaired using partially threaded cancellous screws. Outcome was measured using The Foot & Ankle disability (FADI) score and SF-36 score at 3 and 6 months, and followed up to 2 years. MRI scans repeated at 6 months post-operatively and all patients had physiotherapy. Results: All patients in the study had good to excellent results and went back to their normal activity level along with normal gait pattern and pain free ankle, accept one patient who was still experiencing pain from the screw head of osteotomy fixation. All osteotomies healed well. Conclusions: Early results of Trufit plugs in isolated osteochondral defect are promising. Long term data needed to determine if early results are maintained and whether onset of osteoarthritis is delayed. http://dx.doi.org/10.1016/j.fas.2016.05.124
112 FI2016_ChondralLesions_05 Matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st MTP joint S. Zech *, S. Meissner, M. Richter Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Germany *Corresponding author. Background: The aim of the study was to assess the 2-yearfollowup of matrix-associated stem cell transplantation (MAST) in chondral defects of the 1st MTP. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April 1st 2009 to March, 30th, 2013 were analyzed. The size and location of the chondral defects, range of motion (ROM), and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at followup were registered. Stem cell-rich blood was harvested from the ipsilateral pelvic bone marrow and centrifuged (10 min, 1500 RPM). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Guide). The matrix was fixed into the chondral defect with fibrin glue. Results: 25 defects in 20 patients were included in the study. The age of the patients was 42 years on average (range, 35–62 years), 14 (70%) were male. The VAS FA before surgery was 50.5 on average (range, 18.3–78.4). The defects were located as follows, medial metatarsal head, n = 7; lateral metatarsal head, n = 18 (medial and lateral metatarsal head, n = 5). The defect size was 0.7 cm2 (range, .4–1.5 cm2). ROM was 10.2/0/18.88. All patients completed 2-year-followup. VAS FA improved to 91.5 (range, 74.2– 100; t-test, p = .01). ROM improved to 32.5/0/25.5 (p = .05). Conclusions: MAST led to good clinical scores and improved range of motion. Even though a control group is missing, we conclude that MAST is a safe and effective method for the treatment of chondral defects of the 1st MTP joint. http://dx.doi.org/10.1016/j.fas.2016.05.125