Review Scaffolds for cartilage repair of the ankle joint: The impact on surgical practice Francesca Vannini MD, PhD a , Giuseppe Filardo MD b , Elizaveta Kon MD b , Alice Roffi BSD b, *, Maurilio Marcacci MD, Prof. b , Sandro Giannini MD, Prof. a a II Clinic of Orthopaedics and Traumatology, Rizzoli Orthopaedic Institute, University of Bologna, Via GC Pupilli 1, 40136 Bologna, Italy b III Clinic of Orthopaedics and Traumatology, Biomechanics Laboratory, Rizzoli Orthopaedic Institute, University of Bologna, Via GC Pupilli 1, 40136 Bologna, Italy Contents 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2. Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Scaffolds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4.1. Two-step procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.1.1. MACI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.1.2. Hyalograft C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 4.1.3. Atelocollagen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 4.1.4. Tissucol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 4.2. One-step procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 4.2.1. BMDCs + PRP on scaffold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 4.2.2. AMIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 5. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 6. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1. Introduction Osteochondral lesions of the talus (OLT) are defects of the cartilaginous surface and underlying subchondral bone of the talar dome [1,2]. These lesions are often caused by a single or multiple traumatic event, mostly inversion or eversion ankle sprains in young, active patients [3,4]. Chondral tissue has poor healing abilities, therefore, the damage may be irreversible and lead to chronic symptoms and early osteoarthritis [5–9]. Widely published treatment strategies of symptomatic osteo- chondral lesions include the non-surgical treatment with rest or Foot and Ankle Surgery 19 (2013) 2–8 A R T I C L E I N F O Article history: Received 5 March 2012 Received in revised form 17 May 2012 Accepted 26 July 2012 Keywords: Osteochondral lesions of the talus/ankle Scaffold Autologous chondrocyte implantation Cartilage repair/regeneration A B S T R A C T Background: Ideal management of osteochondral lesions in the ankle joint is still theme of debate. Scaffold-based repair is emerging as a new approach for regenerative treatment. Methods: Articles published in PubMed from 2000 to January 2012 addressing cartilage scaffold-based treatment were identified, including levels I–IV evidence clinical trials with measures of functional, clinical or imaging outcome. Results: The analysis showed a progressively increasing number of articles from 2000. The number of selected papers was 19:15 focusing on two-step and 4 on one-step procedures; no randomized studies, 3 comparative studies, 11 case series and 5 case reports were identified. Conclusions: Regenerative surgical approach with scaffold-based procedures is emerging as a potential therapeutic option for the treatment of chondral lesions of the ankle. One step treatments simplify the procedure and the results reported are very close to the previous techniques. However, well-designed studies are lacking, and randomized long-term trials are necessary to confirm the potential of these techniques. Level of evidence: Review – IV. ß 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +39 051 6366567; fax: +39 051 583789. E-mail address: a.roffi@biomec.ior.it (A. Roffi). Contents lists available at SciVerse ScienceDirect Foot and Ankle Surgery jou r nal h o mep age: w ww.els evier .co m/lo c ate/fas 1268-7731/$ – see front matter ß 2012 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.fas.2012.07.001