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Autologous chondrocyte implantation via scaffold shows promising short-term results for talar osteochondral defects

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SAN FRANCISCO — German investigators reported early success with using a hyaluronan-based scaffold seeded with autogenous chondrocytes for treating osteochondral lesions of the talus. However, not all cases treated achieved homogeneous coverage of the defect.

The prospective study included a review of the ankles of nine patients who averaged 28 years of age. All patients had osteochondral lesions and received the Hyalograft C scaffold (Fidia Advanced Biopolymers), which was seeded with expanded autologous chondrocytes.

Follow-up averaged 3.7 years, and patients were evaluated pre- and postoperatively using the Hannover Scoring System and a Visual Analog Scale (VAS). The investigators recorded preoperative MRI and postoperative ICRS Cartilage Repair Assessment scores.

"All the patients were assessed for previous treatments including antegrade drilling, microfracture and cancellous bone grafting," said Christoph Becher, MD, of Heidelberg. His comments came during the American Orthopaedic Foot and Ankle Society Specialty Day Meeting, held here.

In all cases, the defects were located medially, Becher noted.

Overall, the researchers found that five patients were rated as excellent and four rated as good based on their Hannover scores. VAS scores also revealed improvements in pain, function and satisfaction.

In addition, follow-up MRIs indicated complete filling of the defect in four cases, graft hypertrophy in four cases and incomplete filling in one case. Also, seven cases showed complete integration to the border zone, and the surface and structure were regarded intact in three cases.

"According to the ICRS scores, all patients were graded as nearly normal," Becher said.

Based on the results of the study, the investigators concluded that autologous chondrocyte implantation after failed primary treatment for osteochondritis of the talus showed good-to-excellent results, but due to the lack of complete defect coverage, they suggested more long-term evaluation.

For more information:

• Becher C, Kammerer KP. Autogenous chondrocyte transplantation for osteochondral defects of the talus after failed primary treatment: Early clinical and MRI results. Presented at the American Orthopaedic Foot and Ankle Society Specialty Day Meeting. March 8, 2008. San Francisco.