To publish, you need a team: passionate, young people eager to improve themselves and to identify with the progress of their work and profession.
Thank you Camilla, Claudia, Cristian, Laura, Luigi, Miriam, Riccardo! Today, thanks to you, we talk about our publication in KSSTA 1: “All-arthroscopic AMIC(®) (AT-AMIC(®)) technique with autologous bone graft for talar osteochondral defects: clinical and radiological results.”
Cartilage and Clinical Research
Cartilage is a precious tissue that covers our bones at the joints, allowing smooth and painless movement and gliding between the joint surfaces.
It is a very important but delicate tissue: even a simple ankle sprain can be enough to cause significant damage.
Cartilage is so specific and specialized that it varies from joint to joint. These are small differences in terms of water content, proteins, and cells, but enough to determine the success of certain treatments in some joints and not in others.
Therefore, it is important to discuss treatment outcomes critically and scientifically. Such communications serve two main purposes.
The first is to promote scientific progress. In fact, only by communicating and publishing treatment results can the future path of research be identified.
The other purpose, often less considered, is patient safety! Today, orthobiology is advancing very quickly and frequently introduces new treatments. It is important for patients to know that their caregivers care about their health by collecting data and studying the results of their work. This is a sign of safety and attention primarily toward the patient.
The Scientific Journal
For our study, we chose KSSTA, the most important European journal focused on knee and ankle pathologies related to sports.
It is truly significant to highlight the journal that accepted our study for publication because it adds authority to our data.
Is it enough just to say that your research results were published?
Is it really important to talk about the number of publications a group has without specifying which journals they appeared in? What their “impact factor” is and where they are indexed?
The answer is no!
These might seem like details only relevant to professionals—doctors, biologists, engineers involved in research—but these aspects must be clearly communicated and explained, especially to patients.
Today, there are many scientific journals, but not all have the same requirements for their authors.
An important characteristic of a journal is, first of all, that it is indexed in a scientific research portal. The best known and most widely used by the scientific community is “PubMed.” The prerequisite to consider a journal authoritative in its field is to find it listed on PubMed!
Of course, this alone does not determine the importance of the published data. Journals are also “weighted” by an impact factor. This is the scientific community’s attempt to measure how influential a journal—and therefore the studies it publishes—are on research and medical practice. Essentially, it helps distinguish useful and authoritative publications.
The impact factor is based on various parameters and can certainly be debated, but its purpose is to highlight studies where patients were treated after approval by an ethics committee, with data collected rigorously. In short, it values milestone studies that are highly likely to be cited by others as a foundation for further research.
When we talk about a journal with a high Impact Factor, we refer to articles of a few pages that condense years of work by multiple professionals.
Basic scientists and physicians who took the care to write a protocol for ethics committee approval before starting the study. This approval is the “condicio sine qua non” for many journals and is a guarantee of quality for patients: it means a dedicated committee approved not only the treatment methodology but also the patient recruitment process and the data acquisition methods.
Following this comes data collection, which often means: seeing patients, assessing who are ideal candidates for successful treatment, treating patients, operating if necessary, and continuing to follow patients to help them and analyze the treatment’s effectiveness. Clearly, one professional alone cannot handle visiting, operating, and continuously acquiring data over time. Research requires a dedicated team of doctors.
Finally, a statistician is essential to study and analyze the data. Although a doctor may have statistical skills, an external observer will get the most from the data, and importantly, in an unbiased way.
Once the data is gathered and analyzed, the article must be written. This requires specific skills and knowledge of scientific journals.
Elsewhere in the world, in research-focused environments, significant budgets are dedicated to this process, with people employed full-time for this activity.
In Italy, unfortunately, this rarely happens.
That is why publishing requires a team: passionate, young people eager to improve themselves and to identify with the progress of their work and profession. Research means coming together to dedicate your time to a project that goes beyond publication—it is the satisfaction of contributing to the advancement of science in your own small field!
Our Procedure for Cartilage Repair 3
In cases of cartilage injury, we have proposed and published a fully arthroscopic treatment aimed at cartilage regeneration.
First and foremost, this procedure emphasizes minimally invasive surgery: it is performed arthroscopically. Performing the surgery arthroscopically means using two small incisions—one for the camera to provide an intra-articular view, and the other for the surgical instruments. Not opening the joint is not just a technical gesture to showcase surgical skills, but a sign of care and respect for the joint itself and its intrinsic healing potential: patients treated arthroscopically recover more quickly and experience less post-operative swelling compared to those operated on using open techniques.
Secondly, our technique is truly biological—it harnesses the body’s own regenerative capabilities!
In fact, after a toilette (a cleaning of the damaged tissue), we perform micro-perforations or even nano-perforations (smaller than micro-perforations) in the bone with the goal of triggering the upward migration of bone marrow cells known as mesenchymal cells—cells with the extraordinary power to regenerate tissue.
Of course, on their own, these cells do not have the organizational ability to form healthy tissue. That’s why a collagen membrane is placed over the lesion, serving as a three-dimensional framework or scaffolding for these cells. Once given structure, the mesenchymal cells are, in most cases, capable of regenerating the original cartilage tissue.
The Goal of the Procedure
The ultimate goal of the procedure is, of course, to regenerate cartilage—but even more importantly, it is to ensure the well-being of our patient.
That’s why our treatment plan includes the regular administration of clinical scores. These are simple questions that correspond to a scoring system, providing an objective measure of the patient’s ankle health before the surgery, then again at 6 months, 1 year, 2 years, and 5 years after the procedure.
This is the reason why my team periodically contacts patients who have undergone cartilage reconstruction surgery. When a patient agrees to respond to questions about their health status, they are offering two invaluable contributions: data that allows us to publish and advance scientific knowledge, and data that helps the next patient by informing care based on previous experiences.
The patient's health status is essential and is the foundation of our reports. However, it is also necessary to understand visually and internally what happens to the ankle after the repair.
That’s why our patients are monitored over time as part of our standard care protocol, which includes: weight-bearing X-rays of the foot and ankle, MRI scans, and CT scans.
X-rays, which are the only imaging that can be performed while standing, give us an estimate of any deformities in the lower limb and the potential rebalancing of load distribution during the healing process.
MRI scans inform us about the health of the lesion, particularly through the presence of edema. In practical terms, they indicate whether a lesion is still active or has “cooled off,” helping to predict whether it will worsen in terms of symptoms or size.
CT scans, on the other hand, provide a more reliable measurement of the size of the lesion and can reveal whether it has decreased or even completely healed.
Why It’s Important to Treat Cartilage Lesions: The Risk Is Ankle Osteoarthritis
We often repeat it: the ankle is a congruent joint—its articular surfaces fit together perfectly.
A cartilage injury is, in fact, a disruption of this balance: the surfaces no longer match as precisely.
In the long term, an untreated cartilage lesion leads to degenerative osteoarthritis: patients who do not receive treatment are at risk of developing ankle osteoarthritis.
Thanks to insightful epidemiological studies, we now know that ankle osteoarthritis has a significant negative impact on patients' quality of life.
According to data from a Canadian study published by a colleague and friend (Alistair Younger), 20% of patients with ankle osteoarthritis lose their jobs due to severe disability.
It is clear that ankle osteoarthritis dramatically affects patients’ quality of life—on par with hip osteoarthritis and even more so than knee osteoarthritis.
Treating cartilage lesions not only often allows young athletes to return to their sport, but also prevents the future onset of ankle osteoarthritis—a serious and disabling condition.
Our Results Two Years After the Procedure
Our study has confirmed a significant clinical improvement in patients treated with our technique. The younger the patient undergoing the procedure, the easier the return to sport—this is a truly interesting finding, as the desire to resume previous activities is often the main motivation behind the decision to undergo surgery.
As mentioned, what fills us with both satisfaction and hope are also the results from imaging studies.
MRIs show a remarkable improvement of the lesion at 6 months post-op, but even more significantly, the healing process continues to evolve up to 2 years after surgery.
This is reassuring even for those patients whose recovery seems slower or initially less satisfying. It is not appropriate to plan a re-intervention too soon, as regenerative processes continue over time—and full satisfaction may still be achieved even beyond 6 months after the procedure.