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Introducrion Repair of the affected articular surface still remains an unsolved problem. The purpose of this study was to assess the efficacy of a biodegradable polycaprolactone implant coated with hydroxyapatite on the healing of an osteochondral defect of the femoral condyle in rats. Materials and methods An osteochondral defect of the medial femoral condyle was modeled in 76 Wistar rats divided into 2 groups. In the experimental group, the defect was replaced with a biodegradable polycaprolactone membrane coated with hydroxyapatite. In the control group, the defect remained untreated. The results were assessed within a year. Results In the experimental group, the animals had a significantly better range of motion at all stages of the experiment than the control animals. The implant ensured the integrity and congruence of the articular surface. On day 180, a newly formed area of the articular surface of the organotypic structure was observed in the defect. Biomechanical properties of the repaied zone restored after 60 days while in the control one they remained lower by 27-29 %. Discussion Filling the defect with an elastic implant made of polyprolactone with hydroxyapatite provided early functional load on the joint. The structure of the implant, simulating the extracellular matrix, promoted the growth, proliferation and directed differentiation of cells in the area of the osteochondral defect. The moderate rate of biodegradability of the material provided gradual replacement of the implant with organ-specific tissues. Conclusion A biodegradable polycaprolactone implant impregnated with hydroxyapatite particles might be effective for experimental osteochondral defect repair.

Background. The question of choosing a treatment strategy for full-thickness osteochondral defects of the tarsal bone remains relevant. When choosing a treatment strategy, two key points should be considered: restoring the architecture of the tarsal bone and achieving long-term restoration of cartilage-like coverage in the area of the osteochondral defect. Case report. A 34-year-old physically active patient sustained an ankle injury in 2011 and was treated conservatively. In 2020, he complained of pain and reduced activity. Initial assessment scores were: VAS (Visual Analog Scale) — 6 points, AOFAS-AHS (American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score) — 49 points, FAAM (Foot and Ankle Ability Measure) — 55 points. An MRI revealed an osteochondral defect in the medial part of the tarsal bone dome, measuring 16.4×9.4 mm and with a depth of 20.8 mm. The patient underwent the replacement of the bone defect with an autograft taken from the heel bone, using autologus matrix induced chondrogenesis (AMIC) procedure. After 6 months, a follow-up examination was performed, including ankle arthroscopy and removal of metal fixators. Arthroscopic findings showed that the chondroplasty area was almost identical to intact joint cartilage. One year after chondroplasty, the patient returned to his previous level of physical activity. Assessment scores were: VAS — 1 point, AOFAS-AHS — 94 points, FAAM — 83 points. Conclusion. The proposed method allows for the restoration of the architecture of the tarsal bone along with the cartilage surface. The use of a bone autograft helps to fill the tarsal bone defect, and covering the autograft with a collagen membrane contributes to the formation of hyaline-like cartilage tissue in the defect area.

Background. The relevance of the talar dome osteochondral lesions problem is assosiated with the difficulties of diagnosis, the lack of unified treatment algorythm and the great number of unsatisfactory clinical and functional results. In the last decade, there has been increasing interest in this topic in the literature, which is demonstrated by a great number of publications with series of observations or clinical cases. However, attempts to create the universal algorithm for this group of patients treatment are limited by the low level of existing studies evidence, high frequency of the new data publications, as well as the impossibility of using a number of surgical methods in different countries for legislative or other reasons. The aim is to determine the current state of the problem of the talar dome osteochondral lesions surgical treatment and to identify types of surgical interventions in patients with the studied pathology. Material and methods. 120 international articles published from 2000 to 2021, as well as 18 domestic publications for the period from 2007 to 2021 were selected for the literature analysis. The search for publications was carried out in the PubMed/MedLine and eLibrary databases. Results. The most widespread are surgical interventions aimed at stimulation of the bone marrow, and plastic surgery using osteochondral auto - and allografts. Currently, there is no consensus on the indications for different types of surgical methods, and the previously used indications are being questioned. This determines the need to improve diagnostic and treatment concepts. Conclusion. The studied literature cannot fully answer a number of questions related to the methods of surgical treatment of patients with symptomatic osteochondral lesions of the talar dome and indications for them. A more detailed assessment of the medium- and long-term clinical outcomes of various surgical methods and the development of algorithms for this group of patients treatment, specific for different countries, are needed.