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Emerging Techniques Put a New Twist on Ankle Repair
Date:7/1/2009

splanted to the talus. In the authors' experience, an osteotomy is not necessary to implant the cells.

Of these two techniques, the newer MACI technique may offer the most benefits to the patient, according to Dr. Mitchell.

"Both ACI and MACI show a lot of promise, but I think the advantage of MACI is that an osteotomy is not necessary in order to successfully implant the matrix," he said. "You only need to make an incision to place the graft, which decreases the morbidity of the procedure quite a bit."

"In my experience so far with this emerging technique in Australia, the results have been as good as, or better than, other restorative techniques," he added. MACI is currently considered investigational by the FDA in the United States.

Traditional restorative techniques involve removing a cartilage donor plug from the knee and implanting it over the ankle injury, or "lesion." This requires an operation on the knee and cutting the bone (osteotomy) of the tibia to accommodate the graft. As a result, these traditional techniques involve potential problems, including:

  • pain in the donor knee
  • tissue damage in the donor knee
  • tissue damage in the ankle as a result of osteotomy

"In most individuals, results are favorable with reparative techniques, such as debridement and drilling," said Dr. Mitchell. "The lesions that are problematic and which don't respond well to reparative treatments are lesions that are larger, and those which are fairly deep, as well as lesions which have a cyst-like structure. Whether or not an ankle "lesion" requires additional treatment after an initial reparative procedure often depends upon several factors, including: size, depth and structure of the legion.

"Once you've performed a reparative technique and the patient
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SOURCE American Academy of Orthopaedic Surgeons
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