Reconstruction of focal cartilage defects in the talus with miniarthrotomy and collagen matrix

Abstract

SURGICAL PRINCIPAL AND OBJECTIVE: Treatment of focal cartilage defects (traumatic or osteochondrosis dissecans) of the talus using a collagen matrix. The goal is to stabilize the superclot formed after microfracturing to accommodate cartilage repair. The procedure can be carried out via miniarthrotomy, without medial malleolus osteotomy.INDICATIONS: International Cartilage Repair Society (ICRS) grade III and IV focal cartilage defects of the talus > 1.5 cm(2).CONTRAINDICATIONS: Generalized osteoarthritis, inflammatory joint disease, gout, neuroarthropathy.SURGICAL TECHNIQUE: Miniarthrotomy to open the ankle joint. Debridement of unstable cartilage and necrotic bone, curettage of cysts. Filling of the bone defects with autologous cancellous bone. Sealing of reconstructed bone with fibrin glue and attachment of a collagen matrix shaped to precisely fit the defect.POSTOPERATIVE REGIMEN: Immobilization for 48 h. Partial weight bearing of 10 kg for 6 weeks, with continuous passive motion. Increasing weight bearing from 7 weeks onwards.RESULTS: Follow-up of at least 30 months in 14 patients showed improvement in the Score of the American Orthopedic Foot and Ankle Society (AOFAS) from 50 to 89 points, with equal mobility on both sides of the upper ankle joint.