Treatment of deep articular talus lesions by matrix associated autologous chondrocyte implantation-results at five years

Treatment of focal full-thickness chondral or osteochondral defects of the talus remains a challenge. The aim of this study was to evaluate the postoperative success and the long-term efficacy of matrix associated autologous chondrocyte implantation in these defects. Matrix associated autologous chondrocyte implantation (MACI) was applied in 22 consecutive patients (mean age 23.9 years) with full-thickness chondral or osteochondral lesions of the talus. The average defect-size was 1.94 cmA(2) (range 1-6). In case of osteochondritis dissecans (n = 13) an autologous bone graft was performed simultaneously. Follow-ups were routinely scheduled up to 63.5 (+/- 7.4) months, consisting of clinical evaluation and magnetic resonance imaging. The AOFAS score improved significantly from 70.1 to 87.9/92.6/93.5/95.0/95.5 and 95.3 points at three, six, 12, 24, 36 and 63.5 months, respectively. On a visual analogue scale, pain intensity decreased from 5.7 (+/- 2.6) to 0.9 (+/- 0.8) while subjective function increased from 5.3 (+/- 2.3) to 8.9 (+/- 0.9) at final follow-up (each p < 0.001). The Tegner score rose significantly from 2.4 (+/- 1.2) to 4.7 (+/- 0.6). The MOCART score improved from 62.6 (+/- 19.4) at three months to 83.8 (+/- 9.4) at final follow-up. No significant differences were found between lesions caused by osteochondritis dissecans or trauma and between first- or second-line treatments. For all scores, the most benefit was seen within the first 12 months with stable results afterwards. No major complications were noted. Matrix associated autologous chondrocyte implantation is capable of significant and stable long-term improvement of pain and functional impairment caused by focal full-thickness chondral and osteochondral talus lesions.