Gottschalk et al astutely noted that talar osteochondritis dissecans (OCD) >150 mm2 or >15 mm in diameter requires treatment other than microfracture. The use of the
osteochondral autograft transfer system involves a second operative site and/or the
cost of an allograft. Autologous chondrocyte implantation involves a second surgery
and increased cost. The study by Gottschalk et al involves a 1-stage procedure with
curettement and drilling or microfracture of the lesion, autogenous bone grafting
into the talar OCD, and coverage with a collagen membrane sealed with fibrin glue.
To their credit, they reassessed their 21 patients for whom they had complete data
at 5 years postoperatively, including repeat studies with magnetic resonance imaging
(MRI). Very few studies have performed such reassessments. However, we might receive
“push back” from insurance companies on this side of the Atlantic regarding repeat
imaging.
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References
- Functional medium-term results after autologous matrix-induced chondrogenesis for osteochondral lesions of the talus: a 5-year prospective cohort study.J Foot Ankle Surg. 2017; 56: 930-936
- Autogenous bone grafting for the treatment of talar dome lesions.J Foot Ankle Surg. 2000; 39: 15-22
- Articular talar injuries in athletes: results of microfracture and autogenous bone graft.Am J Sports Med. 2007; 35: 1680-1687
- Natural history of nonoperatively treated osteochondral lesions of the talus.Foot Ankle Int. 2015; 36: 24-31
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- Functional Medium-Term Results After Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Prospective Cohort StudyThe Journal of Foot and Ankle SurgeryVol. 56Issue 5
- PreviewAutologous matrix-induced chondrogenesis (AMIC) has gained popularity in the treatment of osteochondral lesions of the talus. Previous studies have presented promising short-term results for AMIC talar osteochondral lesion repair, a 1-step technique using a collagen type I/III bilayer matrix. The aim of the present study was to investigate the mid-term effects. The 5-year results of a prospective cohort study are presented. All patients underwent an open AMIC procedure for a talar osteochondral lesion.
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