Influence of the medial malleolus osteotomy on the clinical outcome of AMIC in medial talar osteochondral lesion - data from the German cartilage registry (Knorpelregister DKOU)

Objectives Osteochondral lesions of the talus are common injuries. One of the leading treatment options is the autologous membrane induced chondrogenesis (AMIC) procedure. Not unusual is the osteotomy of the medial malleolus to access the lesion. Since this holds the risk of malunion or irritation by the hardware, this study aimed to evaluate the influence on the clinical results of AMIC usage using the database of the German Cartilage Society.

Methods The German Cartilage Register database includes 718 patients. 45 patients met the inclusion criteria. All patients were treated with an AMIC procedure of the medial talus, 30 without and 15 with an osteotomy of the medial malleolus. The follow up includes different scores like FAAM, FOAS, and VAS.

Results and Conclusion Forty-five patients (22 male, 23 female), aged between 14-69 (mean: ±34) that underwent surgery between October 2014 and June 2018 were included in this study.

Between preoperative and 12 months postoperative, the scores of all patients for FAAM ADL increased significantly by 13(32; p < 0.001) points to 80(38), FAAM Sports increased significantly by 16(44; p = 0.004) points to 31(63), FAOS stiffness increased by 9(28; p = 0.047) points to 70(42), FAOS pain increased significantly by 14(28; p = 0.001) to 78(42), FAOS ADL increased significantly by 9(29; p = 0.002) to 87(31), FOAS Sport increased significantly by 20(48; p = 0.001) points to 50(68), FAOS Quality of Life increased 9(36; p = 0.009) points to 38(55), and VAS decreased by 1(4) point to 3(4; p = 0.113) points.

The results show that there is a significant improvement for the patients after AMIC procedure. The improvement has been seen in the FAAM and FOAS, not in the VAS. No statistical difference was found between patients with or without a medial malleolar osteotomy. But further long-time studies might be necessary to see a long-term effect more detailed.

Stichwörter AMIC, microfracture, osteochondral lesion, osteochondral defects, osteochondrosis dissecans, medial malleolar osteotomy, talus

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Artikel online veröffentlicht:
15. Oktober 2020