Citation Information :
Syed RF, Thati S, Rachha R. ChondroFiller Application for Osteochondral Lesions of the Talus: Case Series and Surgical Technique. J Foot Ankle Surg Asia-Pacific 2025; 12 (2):84-89.
Aim and background: A number of techniques and procedures are continuously evolving for the surgical management of osteochondral lesions of the talus (OLT). Our aim is to share our experience of ChondroFiller liquid application in the osteochondral lesions, describe the surgical technique of its application specific to the talar lesions, and present a review of the literature.
Methods: ChondroFiller liquid (Meidrix Biomedicals, Germany) is a cell-free chondro-conductive collagen matrix made of native type I collagen extracted from rat tail tendon. We used ChondroFiller for osteochondral defects in the knee and ankle and prospectively followed up the patients over a period of 18 months (December 2022–June 2023). In the knee, ChondroFiller was used for lesions up to 15 mm in size, and in the OLT, up to 12 mm. All of them were done by the dry arthroscopy method using carbon dioxide (CO2) at the time of ChondroFiller application.
Results: A significant improvement was noticed in the International Knee Documentation Committee Subjective knee evaluation form (IKDC) scores for the knee and the American Orthopedic Foot and Ankle Society (AOFAS) scores for the ankle in the short term. The mean follow-up for the knees was 6 months (range 3–17 months), and the average follow-up for the ankles was 7 months (4–11 months). This paper aims to describe the method of application and short-term outcomes with the use of ChondroFiller specific to osteochondral lesions of the talus.
Conclusion: ChondroFiller is very easy to use, and our short-term results are satisfactory. Short-term and medium-term clinical results are satisfactory in the literature. However, long-term outcome studies and randomized controlled studies are needed to establish its efficacy in managing osteochondral lesions of the talus.
Clinical significance: The current literature on the treatment of osteochondral lesions of the talus is diverse and has shown variable results. We provide an insight into the surgical technique of using ChondroFiller liquid, which is a novel and innovative approach in the treatment of OLT.
Fox AJS, Bedi A, Rodeo SA. The basic science of articular cartilage: structure, composition, and function. Sports Health 2009;1(6):461–468. DOI: 10.1177/1941738109350438
Lan T, McCarthy HS, Hulme CH, et al. The management of talar osteochondral lesions—current concepts. J Arthrosc Jt Surg 2021;8(3):231–237. DOI: 10.1016/j.jajs.2021.04.002
Kraeutler MJ, Kaenkumchorn T, Pascual-Garrido C, et al. Peculiarities in ankle cartilage. Cartilage 2017;8(1):12–18. DOI: 10.1177/1947603516642572
Kuettner KE, Cole AA. Cartilage degeneration in different human joints. Osteoarthritis Cartilage 2005;13(2):93–103. DOI: 10.1016/j.joca.2004.11.006
Nosewicz TL, Beerekamp MSH, De Muinck Keizer RJO, et al. Prospective computed tomographic analysis of osteochondral lesions of the ankle joint associated with ankle fractures. Foot Ankle Int 2016;37(8):829–834. DOI: 10.1177/1071100716644470
Martijn HA, Lambers KTA, Dahmen J, et al. High incidence of (osteo)chondral lesions in ankle fractures. Knee Surg Sports Traumatol Arthrosc 2021;29(5):1523–1534. DOI: 10.1007/s00167-020-06187-y
O'Loughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 2010;38(2):392–404. DOI: 10.1177/0363546509336336
Verhagen RAW, Maas M, Dijkgraaf MGW, et al. Prospective study on diagnostic strategies in osteochondral lesions of the talus. Is MRI superior to helical CT? J Bone Joint Surg Br 2005;87(1):41–46. DOI: 10.1302/0301-620X.87B1.14702
Steele JR, Dekker TJ, Federer AE, et al. Republication of “osteochondral lesions of the talus: current concepts in diagnosis and treatment.” Foot Ankle Orthop 2023;8(3):24730114231192961. DOI: 10.1177/24730114231192961
Gavenis K, Schmidt-Rohlfing B, Andereya S, et al. A cell-free collagen type I device for the treatment of focal cartilage defects. Artif Organs 2010;34(1):79–83. DOI: 10.1111/j.1525-1594.2009.00776.x
Schneider U, Schmidt-Rohlfing B, Gavenis K, et al. A comparative study of 3 different cartilage repair techniques. Knee Surg Sports Traumatol Arthrosc 2011;19(12):2145–2152. DOI: 10.1007/s00167-011-1460-x
Available from: https://meidrix.de/wp-content/uploads/2022/06/meidrix-Informationsflyer-ChondroFiller-EN-online.pdf.
Schneider U. Controlled, randomized multicenter study to compare compatibility and safety of ChondroFiller liquid (cell free 2-component collagen gel) with microfracturing of patients with focal cartilage defects of the knee joint. Video J Orthop Surg 2016;1:1–8. DOI: 10.5348/VNP05-2016-1-OA-1
Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959;41:988–1020. DOI: 10.2106/00004623-195941060-00002
Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 1999;20(12):789–793. DOI: 10.1177/107110079902001206
Cheng MS, Ferkel RD, Applegate GR. Osteochondral Lesions of the Talus: A Radiologic and Surgical Comparison. In: Annual Meeting of the American Academy of Orthopaedic Surgeons. New Orleans; 1995.
Brittberg M, Winalski CS. Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 2003;85(suppl_2):58–69. DOI: 10.2106/00004623-200300002-00008
Wang CC, Yang KC, Chen IH. Current treatment concepts for osteochondral lesions of the talus. Tzu Chi Med J 2020;33(3):243–249. DOI: 10.4103/tcmj.tcmj_106_20
De Smet AA, Ilahi OA, Graf BK. Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle. Skeletal Radiol 1996;25(2):159–163. DOI: 10.1007/s002560050054
Raikin SM, Elias I, Zoga AC, et al. Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 2007;28(2):154–161. DOI: 10.3113/FAI.2007.0154
Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 2018;24(1):106–112. DOI: 10.1016/j.arthro.2007.07.022
Ramponi L, Yasui Y, Murawski CD, et al. Lesion size is a predictor of clinical outcomes after bone marrow stimulation for osteochondral lesions of the talus: a systematic review. Am J Sports Med 2017;45(7):1698–1705. DOI: 10.1177/0363546516668292
Choi S-W, Lee G-W, Lee K-B. Arthroscopic microfracture for osteochondral lesions of the talus: functional outcomes at a mean of 6.7 years in 165 consecutive ankles. Am J Sports Med 2020;48(1):153–158. DOI: 10.1177/0363546519887957
Furukawa T, Eyre DR, Koide S, et al. Biochemical studies on repair cartilage resurfacing experimental defects in the rabbit knee. J Bone Joint Surg Am 1980;62(1):79–89. DOI: 10.2106/00004623-198062010-00012
O'Driscoll SW. The healing and regeneration of articular cartilage. J Bone Joint Surg Am 1998;80(12):1795–1812. DOI: 10.2106/00004623-199812000-00011
Malahias MA, Kostretzis L, Megaloikonomos PD, et al. Autologous matrix-induced chondrogenesis for the treatment of osteochondral lesions of the talus: a systematic review. Orthop Rev 2021;12:8872. DOI: 10.4081/or.2020.8872
Brittberg M, Lindahl A, Nilsson A, et al. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med 1994;331:889–895. DOI: 10.1056/NEJM199410063311401
Niemeyer P, Salzmann G, Schmal H, et al. Autologous chondrocyte implantation for the treatment of chondral and osteochondral defects of the talus: a meta-analysis of available evidence. Knee Surg Sports Traumatol Arthrosc 2012;20:1696–1703. DOI: 10.1007/s00167-011-1729-0
Walther M, Gottschalk O, Aurich M. Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group ‘clinical tissue regeneration’ of the German Society of Orthopedics and Traumatology (DGOU). EFORT Open Rev 2024;9(3):217–234. DOI: 10.1530/EOR-23-0075
Schüettler KF, Struewer J, Rominger MB, et al. Repair of a chondral defect using a cell free scaffold in a young patient—a case report of successful scaffold transformation and colonisation. BMC Surg 2013;13:11. DOI: 10.1186/1471-2482-13-11
Efe T, Theisen C, Fuchs-Winkelmann S, et al. Cell-free collagen type I matrix for repair of cartilage defects—clinical and magnetic resonance imaging results. Knee Surg Sports Traumatol Arthrosc 2012;20:1915–1922. DOI: 10.1007/s00167-011-1777-5
Syed RF, Rachha R, Thati S. Chondrofiller and treatment of cartilage defects in the knee. Acta Sci Orthop 2024;7:3–7. DOI: 10.31080/ASOR.2024.07.0986
Jerosch J, Joseph P. Midterm results after cell free collagen matrix (ChondroFiller LiquidTM). OUP 2020;9:109–115. DOI: 10.3238/oup.2019.0109-0115
Mazek J, Gnatowski M, Salas AP, et al. Arthroscopic utilization of ChondroFiller gel for the treatment of hip articular cartilage defects: a cohort study with 12- to 60-month follow-up. J Hip Preserv Surg 2021;8(1):22–27. DOI: 10.1093/jhps/hnab002
Perez-Carro L, Mendoza Alejo PR, Castanedo GG, et al. Hip chondral defects: arthroscopic treatment with the needle and curette technique and ChondroFiller. Arthrosc Tech 2021;10(7):e1669–e1675. DOI: 10.1016/j.eats.2021.03.011
Corain M, Zanotti F, Giardini M, et al. The use of an acellular collagen matrix ChondroFiller Liquid® for trapeziometacarpal osteoarthritis. J Arthritis 2023;12(1):1–5. DOI: 2684-124X.2023.12.(1).10001