Issue: Issue 4 2012
Perspective from Laszlo Hangody, MD, PhD, DSc
August 27, 2012
3 min read
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Significant foot, ankle lesion healing seen with combination of cartilage treatments

Researchers combined autologous matrix-induced chondrogenesis with microfracture and platelet-rich plasma for osteochondral lesions.

Issue: Issue 4 2012
Perspective from Laszlo Hangody, MD, PhD, DSc
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SAN DIEGO — Autologous matrix-induced chondrogenesis and microfracture procedures combined with platelet-rich plasma showed good results for patients with osteochondral lesions of the foot and ankle, according to results of a recently presented prospective study.

“In the study, I introduced the subtalar joint, the talonavicular joint, so we have potential for many joints, which could be an application for cartilage reconstruction,” Hajo Thermann, MD, PhD, told Orthopaedics Today Europe. “At the beginning we could cover larger defects. [The] hope is we can cover bigger lesions than we can today.”

Thermann presented results with the arthroscopic technique at the American Orthopaedic Foot and Ankle Society 2012 Annual Meeting.

This arthroscopic view shows the tibia plafond 

This arthroscopic view shows the tibia plafond (1), the medial talus with a covered defect (2) and the fibrin glue injection used to fix the collagen matrix (3) and seal the entire construct.

Image: Thermann H

Fluid that leaks into the subchondral bone causes pain, Thermann said. Therefore, his goal, and that of his colleague Ferzan Süzer, MD, was to develop a technique to seal the bone surface and prevent fluid leakage.

Thermann and Süzer prospectively studied 36 women and 22 men with osteochondral defects at various foot and ankle sites who were treated with the procedure. The patients had an average age of 36.5 years. Surgeons first debrided the lesions and then performed microfracture on the subchondral bone using special awls. Next, they filled the microfracture holes with platelet-rich plasma (PRP), applied a collagen matrix soaked in PRP on top the entire defect and sealed it with fibrin glue.

They followed up the patients postoperatively at 6 weeks, 3 months, 6 months, 12 months and 24 months.

Outcome measures used included the Hannover Scoring System (HSS) and Visual Analog Scale (VAS) scores for pain, function and satisfaction.

The HSS and VAS scores increased exponentially at each follow-up. The HSS went from 54.9 points at 6 weeks to 81.5 points at 12 months. The VAS pain score also improved from 4.3 points at 6 weeks after treatment to 8.1 points at 12 months. VAS function increased from 3.9 points at 6 weeks to 7.3 points at 12 months. VAS satisfaction was 2.7 at 6 weeks and 7.8 at 12 months. All of these differences were statistically significant, Thermann said.

Thermann and Süzer reported no complications or adverse reactions.

Eventually, they hope to use the procedure for larger osteochondral foot and ankle defects. In another prospective randomized study, Thermann said he expects to compare outcomes with two different matrices. “The most exciting study will be to compare autologous matrix-induced chondrogenesis with and without platelet-rich plasma.” – by Renee Blisard Buddle

Reference:
  • Thermann H, Suzer F. Novel surgical treatment for cartilage reconstruction in the foot and ankle. Presented at the American Orthopaedic Foot and Ankle Society 2012 Annual Meeting. June 20-23. San Diego.
For more information:
  • Hajo Thermann, MD, PhD, can be reached at the Centre for Hip, Knee and Foot Surgery, Sports Traumatology, ATOS-Klinik Heidelberg, Germany D-69115; email: hajo.thermann@me.com.
  • Disclosure: Thermann has no relevant financial disclosures.