Istituto Ortopedico Rizzoli University of Bologna head: Prof. Sandro Giannini Evolution of ankle osteochondral lesion surgery

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1 Istituto Ortopedico Rizzoli University of Bologna head: Prof. Sandro Giannini Evolution of ankle osteochondral lesion surgery S. Giannini, R. Buda, M. Cavallo, A. Ruffilli, F. Vannini

2 Evolution of ankle osteochondral lesion surgery Prof. Sandro Giannini My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.

3 OSTEOCHONDRAL LESIONS Chronic type II-IIIA lesions of Giannini classification (2005): Indication for a regenerative procedure: Autologous Chondrocyte Implantation (ACI) Open technique (I generation) Arthroscopic technique (II generation) Bone Marrow Derived Cells Transplantation (III generation)

4 OPEN FIELD ACI (MEAN AOFAS SCORE, 10 PATIENTS) PRE-OP : 41,2 ± 14.5 PTS 12 MONTHS : 79.4, ±12.6 (p<0,0005) 36 MONTHS : 85.3 ±11.0 (p<0,0005) 10 YEARS : 88.3 ±17.0 (p<0,0005) ANKLE HIND FOOT SCORE (100 POINTS)

5 OPEN FIELD ACI: CASE REPORT MALE 40 yrs ACI open 8 yrs FU AOFAS score 87 Excellent cartilage regeneration hyaline-like (45 msc) focus with no signal both between 20 and 50 msc and between 50 and 80 Once the signal was extend, it appeared as a bony focus biopsy site?

6 ARTHROSCOPIC ACI Chondrocytes expansion seed onto the biomaterial (MEAN AOFAS SCORE, 46 PATIENTS) PRE-OP : 41,2 ± 14.5 POINTS 12 MONTHS : 79.4, ±12.6 (p<0,0005) 36 MONTHS : 85.3 ±11.0 (p<0,0005) 7 YEARS : 88.3 ±17.0 (p<0,0005) ANKLE HIND FOOT SCORE (100 POINTS)

7 ARTHROSCOPIC ACI: CASE REPORT High T2 area suggestive for hyaline cartilage in the regenerated site Male 32 years : MRI T2 mapping at 5 yrs FU

8 ONE-STEP TECHNIQUE 1) Platelet gel production 2) Bone marrow harvesting and concentration 3) Biomaterial preparation 4) Arthroscopic implantation

9 CASE SERIES: ANKLE 202 patients Mean age 28.3 yrs (min 15 yrs, max 46) Aofas pre-op: 64.4 (min 35- max 79) Mean f-u 29.8 months (Min 6 months, max 57 months) All the patients received a completely arthroscopic treatment 3 biopses at 1 year of follow up with patients consent AOFAS score: progressive significant improvement over time. Safranin-O staining of the biopsy specimen shows a chondral tissue. Proteoglicans are highly express (red) while collagen component (green) is less represented The presence of underlying bone is evident in specimens

10 MRI T2 MAPPING Hyaline regenerate in 80% of regenerated area correlate with higher clinical score (89 ± 16 points) at 48 months FU (p=0.06) The presence of fibrocartilage regenerate (T2 map<35 ms) had a negative influence on the clinical score at 48 months (p=0.06)

11 CONCLUSIONS The arthroscopic BMDC transplantation demonstrated to be able to obtain good results under clinical, MRI and histological aspects in osteochondral lesions of the ankle Main advantages of this procedure are: Less morbidity: only one step is required Less invasivity: use of arthroscopy Good results Regeneration of both cartilage and subchondral bone Lower costs

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