Favorable Short-Term Outcomes of Matrix-Associated Autologous Chondrocyte Implantation for Osteochondral Lesions of the Talus: A Systematic Review.

Abstract

To synthesize the available research on matrix-associated autologous chondrocyte implantation (MACI) for osteochondral lesions of the talus (OLTs) by specifically focusing on clinical outcomes, patient-reported outcomes (PROs), return to activity/sport (RTA/RTS), and rates of complications/revisions. A search following the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed in three databases for studies including MACI repair for OLTs. Study variables included title, author, publication date, study year, number of patients/ankles, mean age, mean follow-up time, RTA/RTS, PROs, and rates of complications/revisions. In total, 11 studies including 166 patients who underwent MACI with an age range of 17.7 to 45.8 years, a defect size range of 1.21 to 3.4 cm², and a follow-up time of 21.1 to 144 months were included. Lesions treated were classified as Outerbridge III-IV, Hepple 3-4, International Cartilage Repair Society III-IV, or chronic-type lesions. The mean preoperative ranges for American Orthopedic Foot and Ankle Score (AOFAS) (9 studies) and Magnetic Resonance Observation of Cartilage Repair Tissue (1 study) were 36.9 to 70.1 and 62.4, respectively. The mean postoperative ranges for AOFAS (9 studies) and Magnetic Resonance Observation of Cartilage Repair Tissue (4 studies) were 78.3 to 95.3 and 62 to 83.8, respectively. Rates for RTA (1 study) and RTS (3 studies) were 81.8% and 50% to 82.4%, respectively. Complications and revisions ranged from 0% to 59% and 0% to 45%, respectively. MACI for OLTs is associated with improved AOFAS scores and RTA/RTS rates at short-term follow-up. Reported complication and revision rates ranged from 0% to 59% and 0% to 45%, respectively. No included studies reported minimal clinically important difference, patient acceptable symptom state, or substantial clinical benefit metrics, limiting the interpretation of patient-level clinical improvements. Level IV, systematic review of Level III and IV studies.