Foot & Ankle International - 2017 FAI Supplement - 47S

Naples, FL, USA) through a stab incision. The syringe
was centrifuged (10 minutes, 1,500 rotations per minute).
The supernatant was used to impregnate a collagen I/III
matrix (Chondro-Gide, Geistlich, Wollhusen, Switzerland)
that was cut to the size of the cartilage defect roughly
before and definitely after. The matrix with stem cells was
fixed into the chondral defect with fibrin glue (Tissucoll,
Deerfield, IL, USA).
Results: Sixty-six patients with 69 chondral defects were
included in the study. The age of the patients was 35 years
on average (range, 12-64 years). VAS FA before surgery
was 48.9 on average (range, 16.5-75.9). The defects were
located as follows, medial talar shoulder, n=28; lateral talar
shoulder, n=28 (medial and lateral talar shoulder, n=3),
tibia, n=3. The defect size was 1.4cm2 on average (range,
.6 - 6cm2). 60 patients (91%) completed 5-year-follow-up.
No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range,
60.8-100; p=.01).

used to identify PE particles. The presence of metal particles and giant cell reaction to PE particles were also scored.
Results: Macrophages, PE particles, metallosis, and foreign body giant cell reaction scores were significantly
higher in the osteolysis group compared with the control
group. In the osteolysis group, ORO staining was positive
in 93% (53/57), birefringent material was present in 96.5%
(55/57), and macrophage infiltrates were present in 96.5%
(55/57). Foreign body giant cell reaction with giant cells
surrounding PE particles was present in 49.1% (28/57) of
osteolytic specimens. The presence of foreign body giant
cell reaction was associated with significantly higher macrophage, ORO, and polarizable material scores. The average time to surgery for osteolysis from the index ankle
replacement was 6.0 (range, 0-15) years for the 57 patients
in the osteolysis group.

Conclusion: MAST led to improved and high validated
outcome scores at 5-year-followup. No method related
complications were registered. Even though a control
group is missing, we conclude that MAST is an effective
method mid-term for the treatment of chondral defects of
the ankle.

Conclusion: This study is the largest ankle arthroplasty
histological analysis to show that areas of osteolysis consist of abundant polyethylene wear particles, present both
intracellularly and extracellularly. Furthermore, these
areas were associated with a CD163+ macrophage infiltrate and frequently a foreign body reaction with giant
cells engulfing PE particles. It is likely that implant wear
particles play a significant role in osteolysis based on the
histopathology.

Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00044
©The Author(s) 2017

Foot & Ankle International, 38(S1)
DOI: 10.1177/1071100717S00045
©The Author(s) 2017

Histological Analysis of Early Osteolysis
in Total Ankle Arthroplasty

Subchondral Bone Degradation
Following Bone Marrow Stimulation:
An MRI Analysis

Oliver Schipper, MD, Steven Haddad, MD
Category: Ankle Arthritis
Keywords: ankle arthritis, ankle arthroplasty, ankle
replacement, osteolysis
Introduction/Purpose: The purpose of this study was to perform a histological comparative analysis of tibiotalar joint
samples taken from areas of osteolysis adjacent to total ankle
arthroplasties vs control synovial specimens to determine the
reaction to and presence of polyethylene (PE) particles.
Methods: A total of 57 pathology samples were identified
in the osteolysis group, while 11 were identified in the control group. For each sample, hematoxylin and eosin, Oil
Red O (ORO), and macrophage marker CD163-stained
slides were created. Polarized light and ORO stain were
AOFAS Annual Meeting 2017

Yoshiharu Shimozono, MD, Youichi Yasui,
MD, Robin Megill, MPH, John Kennedy, MD,
FRCS(Orth)
Category: Ankle
Keywords: osteochondral lesions, talus, subchondral bone,
bone marrow stimulation
Introduction/Purpose: Microfracture is the most common operative procedure for the treatment of osteochondral lesions of the talus (OLT). The role of the subchondral
bone (SCB)/plate (SCBP) is recognized as one of the most
significant factors providing joint-loading support to the
ankle. Greater attention has recently been paid to the
SCBP and its effects on overlying hyaline and fibrocartilage function. However, damage to the SCB and SCBP
47S

Table of Contents for the Digital Edition of Foot & Ankle International - 2017 FAI Supplement