Because hyaline cartilage permits to withstand a big amount of pressure thank its surface, it is mandatory to restore it in presence of osteochondral defect. Articular cartilage disorders remain a challenging problem for orthopaedic surgeons, because their limited healing potential. Current surgical techniques for ankle joint permit a wide choice, reserved to high biological response population. Middle aged to elderly healthy population with performance demanding expectations, risks to be neglected for a durable repair. The use of artificial scaffolds represent a valid answer to withstand load immediately, to repair chondral defects, reaching in time mesenchymal cells induced response inside a biological 3-dimensional structure.
On a group of 31 patients affected by chondral disorders, Authors present a selected group of 11 patients operated with TruFit CB plug arthroscopic procedure, between July 2007 and February 2009. Because the increased expectation of life, higher activity and sport demand by a larger elderly population, the authors has been reserved this treatment to patients from 45 to 58 years (51.5 average), for those defects placed on talar dome or tibial plafond, isolated lesions independently their width and placement, no kissing lesions, with good and intact surrounding cartilage. Ten patients presented talar dome defect: 6 antero-medial, 2 antero-lateral, 2 postero-medial: one was placed on anteromedial area of tibial plafond. All have been submitted both to plain x-ray and MRI scan, to check the defected area characteristics, its placement, width and depth. To check the plug maturation and ingrowth, patients have been submitted to 6 and 12 months postoperative MRI. All patients have been clinically controlled every 30 days until complete recovery and return to their former activities.
The surgical procedure was performed totally arthroscopically, allowing to treat all intra-articular accompanying disorders. During surgery, patients with anterior lesions were assessed supine, adding anterosuperior portal opened medially or laterally to anterior regular portals, for the posterior ones patients were assessed prone opening 2 posterior portals. The x-ray and MRI exams, repeated 6 and 12 months after surgery, showed total graft ingrowth with apparent restore of cartilage layer at same level of the surrounding one. Patients has been followed with clinical controls every 30 days, until recovery and complete return former activities. All patients have been evaluated with AOFAS score scale (from 65.3 points at mean to a final 91.6 at 12 months evaluation). No arthroscopic “second-look” nor histological exams has been done because there was no authorization by the Ethical Committee.
Current surgical techniques based on stimulation of new blood vessels (microfractures, perforations, chondroabrasion) produced a defect coverage by fibrocartilage, decreasing the results in few years. Autologous chondrocytes transplantation (ACI, MACI) present some lack of hyaline cartilage by time and periosteal patch hypertrophy, but the procedure is opened and results are proportional to patient's biological response. Osteochondral autografting permit to cartilage surface restoring, with some concerns on integration and donor-site morbidity. Artificial biological scaffolds can support to withstand load immediately, having in time a biological response by mesenchymal cells inside a biological 3-dimensional structure, giving a solution to a middle age to elderly healthy population with performance demanding requests.
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.