PURPOSE Microfracture is an established method to treat osteochondral defects of the talus. The value of the addition of an acellular matrix is still under debate. This study compared the results of arthroscopic microfracture vs. arthroscopic autologous matrix-induced chondrogenesis using a collagen I/III matrix (AMIC) in the management of articular cartilage defects of the talus. METHODS Patients with a minimum follow-up of 5 years after arthroscopic management for an articular cartilage defect of the talus with either microfracture alone or an additional acellular matrix were matched according to age, sex and BMI. The Hannover Scoring System for the ankle (HSS) and a Visual analog scale (VAS) for pain, function and satisfaction were used to evaluate the clinical outcome. Postoperative MRI was used to assess cartilage repair tissue based on the degree of defect repair and filling of the defect, integration to border zone, surface of the repair tissue, structure of the repair tissue, and subchondral bone alterations. RESULTS Thirty-two patients (16 microfracture, 16 AMIC) were included. No significant between-group differences were observed in demographic data and preoperative score values. Both groups showed statistically significant improvement when comparing the pre- and postoperative score values. No statistically significant differences were identified between the median values of the groups with the HSS (microfracture: 82 (range 71-96) points; AMIC 88 (range 40-98) points). Accordingly, no significant differences were observed for the VAS pain (microfracture: 0.95 (range 0-3.8); AMIC: 1.0 (range 0-8.5)), VAS function (microfracture: 8.4 (range 3.5-10); AMIC: 9.0 (range 1.5-10)) and VAS satisfaction (microfracture: 8.9 (range 2.8-10); AMIC: 9.45 (range 1.5-10)). MRI showed regeneration of tissue in the treated area without differences between the two groups. CONCLUSION Good clinical results were observed for arthroscopic microfracture with or without an additional acellular collagen I/III matrix in the treatment for articular cartilage defects of the talus. It appears that for defects as treated in this study, it is not worthwhile adding the collagen I/III matrix to the microfractures. LEVEL OF EVIDENCE III.

中文翻译：

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关节镜显微骨折与关节镜自体基质诱导的软骨形成治疗距骨的关节软骨缺损。

目的微骨折是一种治疗距骨骨软骨缺损的成熟方法。脱细胞基质的添加价值仍在争论中。这项研究比较了关节镜微骨折与关节镜自体基质诱导的软骨形成（使用胶原I / III基质（AMIC））处理距骨关节软骨缺损的结果。方法对关节镜治疗距骨关节软骨缺损至少进行5年随访的患者，单独进行微骨折或附加脱细胞基质，根据年龄，性别和BMI进行匹配。汉诺威踝关节评分系统（HSS）和疼痛，功能和满意度的视觉模拟评分表（VAS）用于评估临床疗效。术后MRI用于根据缺损的修复程度和缺损的程度，与边界区的整合，修复组织的表面，修复组织的结构以及软骨下骨的改变来评估软骨修复组织。结果包括32例患者（16例微骨折，16例AMIC）。在人口统计学数据和术前评分值上未观察到明显的组间差异。比较手术前后的评分值，两组均显示统计学上的显着改善。在具有HSS的组的中位值之间没有发现统计学上的显着差异（微断裂：82（范围71-96）点； AMIC 88（范围40-98）点）。因此，VAS疼痛未观察到明显差异（微骨折：0.95（范围0-3.8）； AMIC：1.0（范围0-8.5）），VAS功能（微断裂：8.4（范围3.5-10）； AMIC：9.0（范围1.5-10））和VAS满意度（微断裂：8.9（范围2.8-10）； AMIC：9.45（范围1.5-10））。MRI显示治疗区域的组织再生，两组之间没有差异。结论在有或无额外的脱细胞胶原I / III基质的关节镜显微骨折治疗距骨关节软骨缺损中观察到良好的临床效果。似乎对于本研究中治疗的缺陷，不值得在微裂缝中添加胶原蛋白I / III基质。证据级别III。MRI显示治疗区域的组织再生，两组之间没有差异。结论在有或无额外的脱细胞胶原I / III基质的关节镜显微骨折治疗距骨关节软骨缺损中观察到良好的临床效果。似乎对于本研究中治疗的缺陷，不值得在微裂缝中添加胶原蛋白I / III基质。证据级别III。MRI显示治疗区域的组织再生，两组之间没有差异。结论在有或无额外的脱细胞胶原I / III基质的关节镜微骨折治疗距骨关节软骨缺损中观察到良好的临床效果。似乎对于本研究中治疗的缺陷，不值得在微裂缝中添加胶原蛋白I / III基质。证据级别III。