RÉSUMÉ
Objective: To investigate the effectiveness of micro-fracture therapy combined with intra-articular injection of platelet-rich plasma (PRP) in the treatment of small sized osteochondral lesion of the talus (OLT). Methods: Between September 2014 and October 2017, 43 patients with small sized OLT met the inclusive criteria were admitted and randomly divided into micro-fracture group (21 cases) and combined group (22 cases). Patients in the micro-fracture group were treated with micro-fracture therapy, and patients in the combined group were treated with micro-fracture therapy combined with intra-articular injection of PRP. There was no significant difference in gender, age, disease duration, side of OLT, injured position, lesion area, Mintz classification, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analogue scale (VAS) score between the two groups ( P>0.05). After treatment, MRI, VAS score, and AOFAS ankle-hind foot score were used to evaluate the recovery of OLT and the ankle function. Results: All incisions healed by first intention, and no complications such as venous thrombosis and ankle joint infection occurred. All patients were followed up 12-18 months after operation, with an average of 15.6 months. The VAS scores and the AOFAS ankle-hind foot scores were significantly improved at 6 and 12 months after operation in the two groups ( P<0.05), and the scores at 12 months were significantly improved when compared with postoperative scores at 6 months ( P<0.05). Compared with the micro-fracture group, the VAS score and the AOFAS ankle-hind foot score were significantly improved in the combined group at 6 and 12 months after operation ( P<0.05). MRI showed that OLT was well filled in both groups at 12 months after operation. Conclusion: Compared with micro- fracture therapy, micro-fracture therapy combined with intra-articular injection of PRP can effectively reduce pain, improve ankle function, and has a good effectiveness in the treatment of small sized OLT.
RÉSUMÉ
Ankle injury is one of the most common injuries, and osteochondral lesions of the talus occur in up to 70% of acute ankle sprains or fractures. The number of sports injuries have increased due to the increase in leisure activities, and the development of diagnostic techniques to evaluate the cartilage status leads to a higher prevalence of osteochondral lesions of the talus. Although osteochondral lesions of the talus with no symptoms can be treated conservatively, adult patients are usually treated by surgery because they are more likely to fail after non-surgical management. Recovery to normal cartilage is important, but there has been no surgical treatment established for effective cartilage regeneration. Bone marrow stimulation, such as arthroscopic microfracture, is a commonly used surgical procedure and an effective treatment for lesions that are small or failed after non-operative treatment. In addition, there are treatments, such as osteochondral autograft transplantation, osteochondral allograft transplantation and autologous chondrocyte implantation. The selection of the methods depends on the size and location of the lesion, the presence of subchondral cysts, and the results of previous surgery. Many surgical procedures have shown good results in short and mid-term follow-up studies but the results of long-term follow-up have been unclear. Various treatment methods, such as hyaluronan, platelet-rich plasma, mesenchymal stem cells, and bone marrow aspirate concentrate, have been available recently due to the development of various biological agents.