Ahmet Fevzi Kekeç1, Ahmet Yıldırım2

1Department of Orthopedics and Traumatology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Türkiye
2Department of Orthopedics and Traumatology, University of Health Sciences, Konya Health Application and Research Center , Konya, Türkiye

Keywords: American Orthopaedic Foot and Ankle Society, magnetic resonance observation of cartilage repair tissue, osteochondral lesion, scaffold, talus.


Objectives:This study aims to investigate the effectiveness of arthroscopic autologous matrix-induced chondrogenesis (AMIC) procedure with or without polyglycolic acid-hyaluronic acid (PGA-HA)-based cell-free scaffold (CFS) in Bristol Stage 4 and Stage 5 osteochondral lesion of the talus (OLT) ranging between 1.5 and 3 cm2 .

Patients and methods: Between March 2018 and March 2021, a total of 47 patients with OLTs (29 males, 18 females; mean age: 22.8±2.3 years; range, 18 to 65 years) were retrospectively analyzed. The patients were divided into two groups based on the procedures applied. Patients in the first group (Group 1, n=23) underwent the AMIC procedure alone (curettage, microfracture, and grafting), while patients in the second group (Group 2, n=24) underwent AMIC procedure with PGA-HA-based CFS. The localization of the lesions was evaluated. All OLTs were diagnosed with preoperative radiography and magnetic resonance imaging (MRI). During the preoperative period, lesion stages were evaluated based on the Bristol staging system, and the postoperative results were evaluated based on the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system.

Results: The mean follow-up was 36.2±5.6 months. In the early period, the three-month functional scores were comparable between the groups. While a significant increase was observed in the American Orthopaedic Foot and Ankle Society (AOFAS) scores from the mean preoperative of 62.71±4.44 points to the postoperative of 86.00±6.58 points in Group 1, a significant increase in the AOFAS score was observed from 65.28±7.91 points to 95.42±4.41 points in Group 2 at 12-month follow-up (p=0.016, p=0.011, respectively). The functional scores tended to progress after 12 months. Radiologically, a complete defect filling was observed in a mean of 10.5±2.7 months. No graft hypertrophy was recorded in any patients. The AOFAS and MOCART scores in Group 2 were found to be statistically significantly higher than that in Group 1 (p=0.034 for AOFAS 1/AOFAS 2 and p=0.006 for MOCART 1/MOCART 2). Overall, there was a positive, but weak, significant correlation between the final AOFAS scores and MOCART scores (r=0.347, p<0.001).

Conclusion: Arthroscopic AMIC procedure in deep OLTs between 1.5 cm2 and 3 cm2 can yield a statistically significant improvement both clinically and radiologically; however, the use of a PGA-HA-based CFS in addition to this procedure can improve the clinical and radiological recovery.

Citation: Kekeç AF, Yıldırım A. Mid-term results of autologous matrix-induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study. Jt Dis Relat Surg 2023;34(3):613-619. doi: 10.52312/jdrs.2023.1197

Ethics Committee Approval

The study protocol was approved by the Necmettin Erbakan University Pharmaceutical and Non-Medical Device Research Ethics Committee (date: 22.07.2022, no: 2022-3904). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept: A.F.K., A.Y.; Design: A.F.K., A.Y.; Control/supervision: A.F.K., A.Y.; Data collection and/or processing: A.F.K., A.Y; Analysis and/or interpretation: A.F.K., A.Y.;Literature review: A.F.K., A.Y; Writing the article: A.F.K., A.Y.; Critical review: A.F.K., A.Y.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.


We thank Assoc. Prof. Duygu Ilke Yıldırım for her support in the statistical data analysis and tables part of the study

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.