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Copyright ©2014 Baishideng Publishing Group Inc.
World J Orthop. Jul 18, 2014; 5(3): 171-179
Published online Jul 18, 2014. doi: 10.5312/wjo.v5.i3.171
Table 1 Indications and contraindications for autologous chondrocyte transplantation of the talus (modified to[61])
symptomatic full-thickness chondral/osteochondral lesionsOsteoarthritis/rheumatoid arthritis
focal lesion > 1.5 cm2 in sizeso-called kissing lesions
lesion with necrotic bone/fibrous tissue baseligamentous instability (can be corrected in conjunction with the ACT procedure)
failed previous traditional surgeryaxial malalignment
(i.e., drilling or microfracture)(should be previously corrected)
patients younger than 45 yr of agechildren/teenagers
patients older than 45 yr of age
Table 2 Summary of treatment options for cartilage repair of the talus
ProcedureConceptIndicationPotential AdvantageWorth knowingEvidence
ConservativeUnload injured cartilageLow-grade OD in childrenHealing without surgical riskResults in literature low but recommended first-line treatment in low-grade lesionsPoor
Marrow stimulation techniquesRecruits mesenchymal stem cells from bone marrow Stimulates differentiation of repair tissueLesions < 150 mm2 with none/minimal subchondral involvementCan be administered arthroscopically Can be done repeatedlyFibrocartilaginous repair tissue Results deteriorate over timeFair
Autologous osteochondral transplantationResurfaces defect with viable hyaline cartilage + underlying boneOsteochondral defects (2-4 cm2)Reproduces mechanical, structural, biomechanical characteristics of primary cartilage One-stage procedureDonor site morbidity Potential need for osteotomyFair
Osteochondral allograft transplantationResurfaces defect with viable hyaline cartilage + underlying boneLarge-volume/ cystic lesionsNo limitations based on size of defect One-stage procedurePotential decrease in viable chondrocytes due to disease screeningPoor
Autologous chondrocyte transplantation (ACT)Cultured chondrocyte-like cells will stimulate a hyaline-like repair tissueSecond-line treatment in large defects (> 2 cm2)Nearly perfect fit with defect (no ”dead spaces”)Adverse effects of 1st generation MACT with better cell distribution Osseous defect has to be grafted before ACTPoor
Further treatment options (hyaluronic acid, PRP, mesenchymal stem cells)Not clear May function as an biological adjunctNot clear May be added to repair techniquesNot clear May improve final outcomeMode of function not completely understoodInsufficient