AMIC for traumatic focal osteochondral defect of the talar shoulder: a 5 years follow-up prospective cohort study.

BACKGROUND: Autologous Matrix-Induced Chondrogenesis (AMIC) is addressed to osteochondral defects of the talus. However, evidence concerning the midterm efficacy and safety of AMIC are limited. This study assessed reliability and feasibility of AMIC at 60 months follow-up. We hypothesize that AMIC leads to good clinical outcome at midterm follow-up. METHODS: Surgeries were approached with an arthrotomy via malleolar osteotomy. A resorbable porcine I/III collagen membrane (Chondro-Gide®, Geistlich Pharma AG, Wolhusen, Switzerland) was used. Patients were followed at 24 and 60 months. The primary outcome of interest was to analyse the Foot Function Index (FFI), and the subscale hindfoot of the American Orthopaedic Foot and Ankle Score (AOFAS). Complications such as failure, revision surgeries, graft delamination, and hypertrophy were also recorded. The secondary outcome of interest was to investigate the association between the clinical outcome and patient characteristics at admission. RESULTS: Data from 19 patients were included. The mean age at admission was 47.3 ± 13.2 years, and the mean BMI 24.1 ± 4.9 kg/m2. 53% (10 of 19 patients) were female. At a mean of 66.2 ± 11.6 months, the FFI decreased at 24-months follow-up of 22.5% (P = 0.003) and of further 1.3% (P = 0.8) at 60-months follow-up. AOFAS increased at 24-months follow-up of 17.2% (P = 0.003) and of further 3.4 (P = 0.2) at 60-months follow-up. There were two symptomatic recurrences within the follow-up in two patients. There was evidence of a strong positive association between FFI and AOFAS at baseline and the same scores last follow-up (P = 0.001 and P = 0.0002, respectively). CONCLUSION: AMIC enhanced with cancellous bone graft demonstrated efficacy and feasibility for osteochondral defects of the talus at five years follow-up. The greatest improvement was evidenced within the first two years. These results suggest that clinical outcome is influenced by the preoperative status of the ankle. High quality studies involving a larger sample size are required to detect seldom complications and identify prognostic factors leading to better clinical outcome. LEVEL OF EVIDENCE: II, prospective cohort study.

AMIC for Focal Osteochondral Defect of the Talar Shoulder.

BACKGROUND: The management of a focal osteochondral lesion of the talus (OLT) is challenging. Evidence concerning the role of the autologous matrix-induced chondrogenesis (AMIC) procedure in patients with focal OLT is promising. The purpose of the present study was to investigate clinical outcomes and radiographic findings of the AMIC technique for focal unipolar OLT. MATERIAL AND METHODS: The present study was performed according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Twenty-four patients who underwent AMIC for focal OLT were prospectively recruited at our institution. All the surgeries were performed by two experienced surgeons through malleolar osteotomy and autologous cancellous bone grafting. The outcomes of interest were the American orthopedic foot and ankle score (AOFAS), the foot-function index (FFI), and the magnetic resonance observation of cartilage repair tissue (MOCART). Surgical duration, hospitalization length, and complications were also collected. RESULTS: 24 patients were included in the present study. The mean follow-up was 25.17 ± 13.1 months. The mean age of the patients at surgery was 46.75 ± 15.2 years, the mean BMI 26.92 ± 5.7 kg/m2, and 50% (12 of 24) of patients were female. The right ankle was involved in 62.5% (15 of 24) of patients. The mean defect size was 6.95 ± 2.9 mm2. The mean surgical duration was 112 ± 20 min while the mean hospitalization 5.58 ± 1.7 days. At last follow-up, the AOFAS increased by 27.8 points (p < 0.0001), while the FFI reduced by 25.3 points (p < 0.0001) and the MOCART score increased by 28.33 points (p < 0.0001). No complications were observed. CONCLUSION: The AMIC procedure for focal osteochondral defects of the talar shoulder is feasible and reliable at midterm follow-up.

Atypical extensive extratemporal hyperpneumatization of the skull base including the cervical spine: case report and review of the literature.

STUDY DESIGN: Case report and clinical discussion. OBJECTIVE: To describe a rare case of hyperpneumatization of the skull base including the cervical spine with the atlas bone. SUMMARY OF BACKGROUND DATA: Initial imaging studies of physically traumatized patients consist of conventional radiographs. An atypical radiolucency is often misdiagnosed as a primary malignancy or a secondary osteolytic metastasis. Further imaging studies may reveal an underlying atypical hyperpneumatization as a very rare benign differential diagnosis. Pathophysiologically, embryological developmental anomalies as well as an elevated pressure to the middle and inner ear are discussed. METHODS: We present a symptomatic 40-year-old man with conventional radiographs, after computed tomography and magnetic resonance imaging examinations. RESULTS: Imaging studies reveal an uncommon radiolucency of the skull base including the atlas bone, free air beneath the mastoid bone, stylomastoid foramen, epidural air adjacent to the atlas bone, and surrounding soft-tissue emphysema. CONCLUSION: Atypical radiolucency may represent a very rare benign hyperpneumatization of the skull base, which may include the craniocervical junction. Because of microfractures of the thinned and consecutive, less stable bones, this also can lead to free air and soft-tissue emphysema, which has not been described previously. Special care should be taken to identify epidural free air because of a possible communication of the epidural space with the external environment. Harmful activities and especially high-speed trauma could result in fractures of the cervical spine due to decreased stability of the hyperpneumatized bones.