Abstract
We report the case of a 24-year-old driving instructor with osteonecrosis of the talus
and a large articular cartilage and osseous defect. The cystic lesion was caused by
villonodular synovitis. After magnetic resonance imaging detection and arthoscopic
analysis, the defect was filled with a bone graft, followed by matrix-associated autologous
chondrocyte transplantation (MACT) combined with a total synovectomy. In general,
lesions similar to the one described in this case are treated using osteochondral
autografts, but in our case the osseous defect was too large to perform an osteochondral
autograft. Our choice of treatment with an iliac crest bone graft combined with a
MACT simultaneously has not yet been published, as far as we know. The patient returned
to his former activities of daily living and sport activities, without restrictions
or complaints, and with only a slight deficit in range of motion. Morphological and
biochemical magnetic resonance imaging 12 months after surgery showed excellent bone
healing with no intraosseous edema. The MACT resulted in a good clinical outcome,
with 100% defect filling and excellent integration and surface and signal intensity
of the cartilage repair tissue, and the American Orthopaedic Foot and Ankle Society
Ankle-Hindfoot score increased from 47 to 79 points.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: November 21, 2011
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
