Supramalleolar osteotomy and AMIC cartilage reconstruction in severe cartilage lesion

Category: Ankle Introduction/Purpose: Severve cartilage lesion is defined by the author as: Cartilage substantial deterioration of the subchondral bone Kissing lesion, tibial and talar lesion. Gross cystic lesion Cartilage damage greater than 1/3 of the talar dome or the tibial platform Slerotic changes of the subchondral bone plate in arthritic cases in severe hindfoot varus or valgus alignment. This paper shows in a case series, exceptional cartilage lesions with the above mentioned pathological changes. The indications, strategies for osteotomies and the treatment strategies in malaligned bipolar, cystic and gross cartilage lesions is explained. Methods: 35 patients with severe circumscript varus / valgus arthritis have been operated by supramalleolar osteotomy (SMOT), 11 of them with (tibial & talar “kissing”) lesions. 70 patients presented bipolar (tibial & talar “kissing”) lesions with correct hindfoot axis. 18 patients had a gross cystic lesion and were additionally treated with filling of the cysts. 2 of them had a “kissing lesion”. Results: All patients received an AMIC procedure (hyaluronic matrix, Hyalofast©) for cartilage reconstruction. The biological healing support was in all cases bone marrow aspirate and ACP© growth factors. The subchondral bone plate was treated aggressively was a power raps or burr according to L. Johnson technique The importance of a supramalleolar and calcaneous osteotomy in a hindfoot malalignment (varus / valgus) as a treatment key aspect for load transfer is elaborated. Planned early implant removal with revision und biological boosting of the cartilage regeneration is a further cornerstone of the treatment. Followup were evaluated by FAOS score Conclusion: This cases series have shown the possibilities for a successfull managing of this severe lesions and offers also its limit in the over all results