2021 ISAKOS Biennial Congress Paper
Autologous Matrix-Induced Chondrogenesis (AMIC) With Concomitant Lateral Ligament Stabilization For Osteochondral Lesions Of The Talus In Patients With Ankle Instability
Jakob Ackermann, MD, Zurich SWITZERLAND
Fabio A Casari, MD, Winterthur SWITZERLAND
Christoph Germann, MD, Zurich SWITZERLAND
Lizzy Weigelt, MD, Zurich SWITZERLAND
Stephan Hermann Wirth, MD, Zurich, Zurich SWITZERLAND
Arnd Viehöfer, MD, Zurich SWITZERLAND
Balgrist University Hospital, University of Zurich, Zurich, SWITZERLAND
FDA Status Not Applicable
Summary
Concurrently performed AMIC and LLS in patients with OLT and ankle instability results in a clinical outcome that is comparable to isolated AMIC if postoperative ankle stability is achieved.
Abstract
Background
Autologous matrix-induced chondrogenesis (AMIC) has shown to result in favorable clinical outcome in patients with osteochondral lesions of the talus (OLT). Yet, the influence of ankle instability on cartilage repair of the ankle has still to be determined. This study sought to compare the clinical and radiographic outcome in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that patients with concomitant LLS for the treatment of coexistent symptomatic ankle instability show comparable results to patients who underwent isolated AMIC for the treatment of OLT.
Methods
This study evaluated AMIC that were implanted in patients for the treatment of symptomatic OLT with and without concomitant ankle instability. Postoperative MRI, Tegner, AOFAS and Cumberland Ankle Instability Tool (CAIT) were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART 1 and 2.0 scores. Patients were stratified into two groups based on whether they underwent concomitant LLS for ankle instability. Patients without LLS served as controls. Patients were matched 1:1 for BMI, lesion size, follow-up and age.
Results
Twenty-six patients that underwent AMIC with a mean follow-up of 4.2 +/- 1.5 years were enrolled in this study (13 with and 13 without concomitant ankle instability). Patients’ mean age was 33.4 +/- 12.7 years with a BMI averaging 26.2 +/- 3.7. Patients with concomitant LLS showed worse clinical outcome measured by AOFAS (85.1 +/- 14.4 vs. 96.3 +/- 5.8, p=0.034) and Tegner (3.8 +/- 1.1 vs. 4.4 +/- 2.3, p=0.012). Postoperative CAIT and AOFAS scores significantly correlated in patients with concomitant LLS (r=0.766, p=0.002). A CAIT score of > 24 (no functional ankle instability) resulted in AOFAS scores comparable to scores in patients with isolated AMIC (90.1 +/- 11.6 vs. 95.3 +/- 6.6; p=0.442). No difference was seen between both groups regarding MOCART 1 and 2.0 scores (p=0.714 and p=0.371, respectively).
Conclusion
Concurrently performed AMIC and LLS in patients with OLT and ankle instability results in a clinical outcome that is comparable to isolated AMIC if postoperative ankle stability is achieved. Residual ankle instability, however, was associated with worse postoperative outcome highlighting the need for adequate stabilization of ankle instability in patients with OLT.