[Arthroscopic matrix-associated bone marrow stimulation of ankle joint lesions].

OBJECTIVE

Arthroscopic matrix-associated bone marrow stimulation enables treatment of symptomatic osteochondral lesions of the ankle joint to alleviate pain and improve function.

INDICATIONS: Symptomatic osteochondral lesions caused by trauma, osteochondritis dissecans, or isolated degenerative cartilage damage. Unstable lesions with nonrefixable fragments.

CONTRAINDICATIONS: Acute infections, ubiquitous advanced osteoarthritis.

SURGICAL TECHNIQUE: Treatment of intra-articular pathologies and resection of hypertrophic synovia. Unstable cartilage tissue is debrided, and stable margins are created. The subchondral bone is microfractured to promote bleeding and cell migration. For deeper defects, a spongiosa graft can be performed. A tailored collagen matrix is introduced through a mini-arthrotomy and fixed with fibrin glue.

POSTOPERATIVE MANAGEMENT: Partial weightbearing of 10-20 kg, depending on the procedure performed. From week 7, load-bearing is gradually increased; full weight-bearing is possible after 12 weeks. Sports activities can be resumed after 6 months.

RESULTS

In a retrospective analysis of 10.611 inpatient procedures in Germany from 2006-2022, the numbers for arthroscopies and arthrotomies initially increased, whereby the number of arthrotomies peaked in 2020, followed by a decline. Arthroscopic procedures increased steadily, especially from 2014 onward, indicating a preference for the minimally invasive technique.