Arthroscopic Autologous Chondrocyte Implantation in Osteochondral Lesions of the Talus: Surgical Technique and Results

Background Autologous chondrocyte implantation (ACI) in the ankle was considered up to now an extremely technically demanding surgery with considerable morbidity for the patients. Hypothesis Hyalograft C scaffold allows arthroscopic ACI, thanks to a specifically designed instrumentation. Study Design Case series; Level of evidence, 4. Methods Forty-six patients with a mean age of 31.4 years (range, 20–47) underwent operation from 2001 to 2004. They had posttraumatic talar dome lesions, type II or IIA. In the first step of surgery, an ankle arthroscopy was performed, with cartilage harvest from the detached osteochondral fragment or from the margins of the lesion. Chondrocytes were cultured on a Hyalograft C scaffold. In the second step of surgery, the Hyalograft C patch was arthroscopically implanted into the lesion, with a specifically designed instrumentation. Lesions >5 mm deep were first filled with autologous cancellous bone. Patients were evaluated clinically with the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at 12 and 36 months after surgery. At a mean time interval of 18 months, the first 3 patients underwent a second-look arthroscopy with cartilage harvest from the implant and histological examination. Results The mean preoperative AOFAS score was 57.2 ± 14.3. At the 12-month follow-up, the mean AOFAS score was 86.8 ± 13.4 (P < .0005), while at 36 months after surgery, the mean score was 89.5 ± 13.4 (P < .0005). Clinical results were significantly related to the age of patients and to previous operations for cartilage repair. The results of the histological examinations revealed hyaline-like cartilage regeneration. Conclusions The Hyalograft C scaffold and the specifically designed instrumentation allowed arthroscopic implantation of chondrocytes, with excellent clinical and histological results.