March 13th, 2004
AOSSM Specialty Day

Autologous Chondrocyte Implantation of the Ankle: 2-5 Year Follow-Up

Authors:
  1. Ellis K. Nam MD, Southern California Orthopaedic Institute, Van Nuys, CA
  2. Richard D. Ferkel MD, Southern California Orthopaedic Institute, Van Nuys, CA
Objective:  To report the first U.S. prospective study of ACI of the talus.
Methods:  Eleven patients (6 f, 5 m) with a mean age of 33 years (range, 21-47) underwent ACI (1) of the talus after previous failed surgical management. There were: 8 medial, 2 lateral, and 1 central lesion. The average size of the lesion was 20.7 mm x 13.1 mm (range, 8-28 mm). Five patients underwent ACI of the talus, and 6 patients had an ACI plus bone grafting (sandwich procedure). All patients underwent a second-look arthroscopy with screw removal.
Results:  The mean follow-up for all patients was 36 months (range, 24-58). Patients were scored pre- and post-operatively with 4 scoring methods. There was a statistically significant improvement in the: mean AOFAS hindfoot score (52 to 86) (p<.01), mean Finsen score (13 to 4) (p<.001), and mean Tegner score (1.3-3.3) (p<.001). Patient subjective ratings were: 3 excellent, 6 good, 2 fair, and 0 poor results (2). At second-look there was evidence of progressive healing at the site of chondrocyte implantation in all specimens, with improved cartilage integrity seen with longer follow-up.
Conclusions:  ACI 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.
References:  
  1. Grande DA, Pitman MI, Peterson L, et al. The repair of experimentally produced defects in rabbit articular cartilage by autologous chondrocyte transplantation. J Orthop Res. 7: 208-218, 1989.
  2. Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med. 331: 889-895, 1994.
Keywords:
  1. Cartilage
 Categories:
  1. CLINICAL: Ankle/Foot