Surgical management of large talar osteochondral defects using autologous chondrocyte implantation

Foot Ankle Surg. 2018 Apr;24(2):131-136. doi: 10.1016/j.fas.2017.01.002. Epub 2017 Jan 17.


Background: Talar osteochondral lesions (OLT) occur frequently in ankle sprains and fractures. We hypothesize that matrix-induced autologous chondrocyte implantation (MACI) will have a low reoperation rate and high patient satisfaction rate in treating OLT less than 2.5cm2.

Methods: A systematic review was registered with PROSPERO and performed with PRISMA guidelines using three publicly available free databases. Clinical outcome investigations reporting OLT outcomes with levels of evidence I-IV were eligible for inclusion. All study, subject, and surgical technique demographics were analyzed and compared. Statistics were calculated using Student's t-tests, one-way ANOVA, chi-squared, and two-proportion Z-tests.

Results: Nineteen articles met our inclusion criteria, which resulted in a total of 343 patients. Six studies pertained to arthroscopic MACI, 8 to open MACI, and 5 studies to open periosteal ACI (PACI). All studies were Level IV evidence. Due to study quality, imprecise and sparse data, and potential for reporting bias, the quality of evidence is low. In comparison of open and arthroscopic MACI, we found both advantages favoring open MACI. However, open MACI had higher complication rates.

Conclusions: No procedure demonstrates superiority or inferiority between the combination of open or arthroscopic MACI and PACI in the management of OLT less than 2.5cm2. Ultimately, well-designed randomized trials are needed to address the limitation of the available literature and further our understanding of the optimal treatment options.

Keywords: Autologous chondrocyte implantation; Osteochondral lesion; Talus.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Ankle Injuries / complications
  • Ankle Injuries / surgery*
  • Cartilage Diseases / etiology
  • Cartilage Diseases / surgery*
  • Chondrocytes / transplantation*
  • Humans
  • Talus / injuries
  • Talus / surgery*
  • Transplantation, Autologous