Human Amniotic Allograft in Use on Talar Dome Lesions: A Prospective Report of 37 Patients

John Joseph Anderson, Zflan Swayzee, Myron Holbert Hansen

New Mexico Bone and Joint Institute, Alamogordo, USA.
Private Practice—Cactus Foot and Ankle, Chandler, USA.

DOI: 10.4236/scd.2014.43006                

Abstract

One of the most challenging joint conditions facing ankle surgeons today is the treatment of Osteochondritis Dissecans (OCD) of the talar dome. The use of human amniotic allograft (HAA) in various surgical procedures, has been proven to facilitate bone growth and both soft tissue and cartilage healing. The authors of this paper propose the addition of HAA to the surgical repair of talar dome lesions to improve postoperative results, specifically pain reduction. For the study, 37 patients were identified having an OCD lesion of the talus measuring no larger than 2 cm². All patients were treated surgically with an arthroscopic micro-fracture repair along with the addition of HHA. Modified ACFAS ankle scores were taken pre-operatively and at 3 months, 12 months, and at 24 months postoperatively. Visual analog scores were also taken preoperative and 24 months postoperatively. The size of the talar lesions documented with pre-operative MRI’s was compared with intra-operative measurements for each patient. Additional surgical repairs, comorbidities and any complications were also recorded and evaluated. All patients were treated with micro-fracture with HAA. Postoperative ACFAS scores for 3 months, 12 months and 24 months were significantly improved (p < 0.0001) compared with average preoperative scores. Additionally, VAS scores were also significantly improved when comparing the average pre-operative (4.9) and post-operative (1.1) pain scores (p < 0.0001). The size of the lesions documented by pre-operative MRI correlated to intra-operative measurements. There were no identified complications. The addition of HAA to arthroscopic micro-fracture repair of talar dome lesions measuring less than 2 cm² has shown to significantly improve both post-operative VAS scores, when compared to preoperative scores. This improvement in ACFAS and VAS scores speaks to the potential use of HAA in the treatment of OCD.

Keywords

Bone Lesions, Human Amniotic Allograft, Ankle Arthroscopy, Talus Fractures, Cartilage Restoration, Stem Cells

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Kappis, M. (1922) Weitere Beitragezur Traumatisch-Mechanischen Entstehung der “Spontanen” Knorpelablosungen (Sogen. Osteochondritis Dissecans). Deutsche Zeitschrift für Chirurgie, 171, 13-29. http://dx.doi.org/10.1007/BF02812921
[2]	Rendu, A. (1932) Fracture Intra-articulaireparcellaire de la po?lieastraglienne. Lyon Médical, 150, 220.
[3]	Yvars, M.F. (1975) Osteochondral Fractures of the Dome of the Talus. Clinical Orthopaedics and Related Research, 114, 185-191.
[4]	Kelbérine, F. and Frank, A. (1998) Arthroscopic Treatment of Osteochondral Lesions of the Talar Dome: A Retrospective Study of 48 Cases. Arthroscopy: Journal of Arthroscopic & Related Surgery, 15, 77-84. http://dx.doi.org/10.1053/ar.1999.v15.0150071
[5]	Angermann, P. and Jensen, P. (1989) Osteochondritis Dissecans of the Talus: Long-Term Results of Surgical Treatment. Foot & Ankle, 10, 161-163. http://dx.doi.org/10.1177/107110078901000309
[6]	Hatch, E.L. (1999) Burns and Bravery. In: Hatch, E.L., Ed., Médico: My Life as a Country Doctor in Mexico, 193-195.
[7]	Gwei-Djen, L. and Needham, J. (1964) Medieval Preparations of Urinary Steroid Hormones. IntJ Hist Med., 8, 101-121. http://dx.doi.org/10.1017/S0025727300029355
[8]	Davis, S. (1910) Skin Transplantation: With a Review of 550 Cases at the Johns Hopkins Hospital. Johns Hopkins Hosp Rep Ba/t, 15, 307-396.
[9]	Sabella, N. (1913) Use of the Fetal Membranes in Skin Grafting. Medication Reconciliation NY, 83, 478-480.
[10]	Stern, M. (1913) The Grafting of Preserved Amniotic Membrane to Burned and Ulcerated Surfaces. Substituting Skin Grafts. JAMA, 60, 973-974. http://dx.doi.org/10.1001/jama.1913.04340130021008
[11]	Douglas, B. (1952) Homografts of Fetal Membranes as a Covering for Large Wounds—Especially Those from Burns: An Experimental and Clinical Study (Preliminary Report). Journal of the Tennessee Medical Association, 45, 230-235.
[12]	deRotth, A. (1940) Plastic Repair of Conjunctival Defects with Fetal Membranes. Archives of Ophthalmology, 23, 522-525.
[13]	Shimberg, M. (1938) The Use of Amniotic-Fluid Concentrates in Orthopaedic Conditions. Journal of Bone and Joint Surgery, 20, 167-177.
[14]	Volkov, M.V. (1973) Arthroplasty of Joints Using Amniotic Membrane. In: Chapchal, G., Ed., Arthroplasty of the Hip: 5th International Symposium 1972 in Nijmegen Netherlands, Georg Thieme, Stuttgart.
[15]	Trelford, J.D., Hanson, F.W., Anderson, D.C. and Mendel, V.E. (1975) Amnion Autografts, Permanent Structure. J Med, 6, 243-247.
[16]	Anderson, J.J. (2009) Bone Grafting and Orthobiologics for Reconstruction of the Diabetic Lower Extremity. In: Zgonis, T., Ed., Surgical Reconstruction of the Diabetic Foot and Ankle, Lippincott Williams & Wilkins, Philadelphia, 192-193.
[17]	Cornell, C.N. (1999) Osteoconductive Materials and Their Role as Substitutes for Autogenous Bone Grafts. Orthopedic Clinics of North America, 30, 591-598. http://dx.doi.org/10.1016/S0030-5898(05)70112-7
[18]	Weinraub, G.M. (2005) Orthobiologics: A Survey of Materials and Techniques. Clinics in Podiatric Medicine and Surgery, 22, 509-519. http://dx.doi.org/10.1016/j.cpm.2005.08.003
[19]	Lane, J.M. and Bromstrom, M.P.G. (1998) Bone Grafting and New Composite Biosynthestic Graft Materials. AAOS Instructional Course Lectures, 47, 525-534.
[20]	Martin, R.B., Chapman, M.W., Sharkey, N.A., et al. (1995) Bone in Growth and Mechanical Properties of Coralline Hydroxyapatite 1 Year from Implantation. Biomaterials, 14, 341-348. http://dx.doi.org/10.1016/0142-9612(93)90052-4
[21]	Anderson, J.J., Boone, J.J., Hansen, M., Brady, C., Gough, A. and Fowler, Z. (2013) Ankle Arthrodesis Fusion Rates for Mesenchymal Stem Cell Bone Allograft Verses Proximal Tibia Autograft. Journal of the American Podiatric Medical Association, Submitted June.
[22]	Anderson, J.J., Jeppesen, N.S., Hansen, M., Brady, C., Gough, A. and Fowler, Z. (2013) First Metatarsophalangeal Joint Arthrodesis: Comparison of Mesenchymal Stem Cell Allograft versus Autogenous Bone Graft Fusion Rates. Surgical Science, 4.
[23]	Sachs, B.P. and Stern, C.M. (1979) Activity and Characterization of a Low Molecular Fraction Present in Human Amniotic Fluid with Broad Spectrum Antibacterial Activity. British Journal of Obstetrics and Gynaecology, 86, 81-86. http://dx.doi.org/10.1111/j.1471-0528.1979.tb10572.x
[24]	Anderson, J.J., Gough, A.F., Hansen, M.H. and Swayzee, Z. (2014) Initial Experience with Tricortical Iliac Crest Bone Graft and Human Amniotic Allograft in Evans Calcaneal Osteotomy. Journal of the American Podiatric Medical Association.
[25]	Davitt, J.S., MacWilliams, B.A. and Armstrong, P.F. (2001) Plantar Pressure and Radiographic Changes after Distal Calcaneal Legthening in Children and Adolescents. Journal of Pediatric Orthopaedics, 21, 70-75. http://dx.doi.org/10.1097/01241398-200101000-00015
[26]	NuTech Medical (2012) NuCel: Multipotential Cellular Matrix (HCT/P). 1, 1-2.
[27]	NuTech Medical (2012) NuCel: Product Overview. 1, 1-2.
[28]	Sato, T.A., Keelan, J.A. and Mitchel, M.D. (2003) Critical Paracrine Interactions between TNF-α and IL-10 Regulate Lipopolysaccharide-Stimulated Human Choriodecidual Cytokine and Prostaglandin E2 Production. The Journal of Immunology, 170, 158-166. http://dx.doi.org/10.4049/jimmunol.170.1.158