Systematic review and meta-analysis of the AMIC procedure using Chondro Gide® for osteochondral lesions of the talus

Objectives To systematically review and evaluate the outcomes of the AMIC procedure using the Chondro-Gide membrane to treat osteochondral lesions of the ankle, Grade III/IV, and evaluate via meta-analysis the early and midterm clinical and functional improvement versus preoperative status.

Methods An electronic literature search (Pubmed, Embase) was conducted. Studies with a minimum follow-up of 1 year and minimal sample size over 5, that provided clinical results of AMIC repair in the ankle were included. Methodological quality of the included studies was assessed by the modified Coleman Methodology Score (mCMS) and aggregate data were generated. The meta-analysis was performed using studies which compared the pain VAS (Visual Analogic score) the American Foot and Ankle Society (AOFAS), the Foot Function Index (FFI) between baseline and follow-up after one or two years, or baseline and follow-up after between 3 and 5 years.

Results and Conclusion After duplicate and similar cohort articles being eliminated, 12 studies (454 patients) reporting the clinical outcomes after AMIC procedure in the ankle were included. The mCMS demonstrated a suboptimal study design with ranking ranging between 42 and 73, and a mean value of 61.5. This mCMS was strongly affected by the frequent need of associated surgeries, which are part of the standard of care in osteochondral lesions of the talus. Based on the 454 patient population, the mean age was of 35 years (12 to 73 years), the mean defect size was 1.51 cm2 (0.2 to 6 cm2). Significant pain relief was reported in all studies involving ankle cartilage defects treated with AMIC, as VAS decreased from a range of 2-10 preoperatively to a range of 0-6 at 5 years postoperatively. AOFAS ankle score improved from 16-79 preoperatively to 28-100 within 5 years postoperatively. MOCART scoring was reported only in 5 of 12 studies. Values increased from 19-66 at the first postoperative year to 20-95 within the 5 postoperative years. The results from the random effects model indicate a significant change in mean VAS from baseline to follow-up after 1 or 2 years of -4.20 and -4.6 at year 3-5 versus baseline. The treatment effect was highly significant with a 95% confidence interval of (-5.18; -4.02). Similarly, the AOFAS changes from baseline versus year 1 or 2, or versus year 3-5, showed a highly significant improvement of 31.69 and 32.47 respectively with a 95% CI of (27.65;37.30). Finally, the FFI change from baseline to year 3-5 of 30.93 is highly significant with a 95% CI of (22.85;39.01).

Results from random effects model comparing AOFAS baseline versus year 1 or 2(A) and year 3-5 (B)

In the meta-analysis, the AMIC procedure in the ankle appeared to provide a significant improvement of the clinical status and functional scoring versus preoperative stage.

Stichwörter Osteochondral, OCL, Talus, Cartilage,

Publication History

Article published online:
15 October 2020