ABSTRACT
Objective:
To investigate the
efficacy of posterior
ankle arthroscopic
microfracture with
platelet-rich plasma (PRP)
injection for the
treatment of posterior osteochondral lesions of the
talus (OLT).
Methods:
A retrospective case series study was conducted on clinical data of 13
patients with posterior OLT admitted to Shanghai Sixth People′s
Hospital Affiliated to Shanghai Jiao Tong
University from September 2019 to October 2020. There were 10
males and 3
females,
aged 10-65 years [(38.2±15.9)years]. According to Hepple′s
classification, four
patients were with type II, three with type IV, and six with type V. According to Elias′ grid scheme, nine
patients were in zone 7 and four
patients in zone 9. The
disease duration was 13-51 months [(26.2±11.4)months]. All
patients underwent posterior
ankle arthroscopic
microfracture with PRP
injection. The operation
time was recorded. The visual analogue scale (VAS), American Orthopedic
Foot and
Ankle Society (AOFAS)
ankle-hindfoot score, and
ankle range of motion (ROM) were compared before operation and at 3 months and 1 year after operation. The
magnetic resonance observation of
cartilage repair
tissue (MOCART) score was used to evaluate the repair of
cartilage injury at 1 year after operation.
Complications were recorded.
Results:
All
patients were followed up for 12-25 months [(15.7±3.7)months]. The operation
time ranged from 50 to 90 minutes [(63.8±13.3)minutes]. The VAS improved from 3.0(3.0, 4.0)points before operation to 1.0(0, 2.0)points at 3 months after operation and 1.0(0,1.5)points at 1 year after operation; the AOFAS
ankle-hindfoot score was improved from (66.1±11.8)points before operation to (84.8±9.5)points at 3 months after operation and (92.9±8.6)points at 1 year after operation; the
ankle ROM was improved from (48.5±7.5)° before operation to (61.9±10.3)° at 3 months after operation and (65.4±11.8)° at 1 year after operation (all P<0.05). There was no significant difference in VAS at 3 months and 1 year after operation ( P>0.05). There were significant differences in AOFAS
ankle-hindfoot score and
ankle ROM at 3 months and 1 year after operation (all P<0.05). According to AOFAS
ankle-hindfoot score, the results were excellent in 11
patients, good in one, and fair in one, with the excellent and good rate of 92%. The MOCART score was 40-85 points [(70.4±14.2)points] at 1 year after operation. There was no postoperative
necrosis,
infection or neurovascular
injury. Two
patients had slight
transient pain during
rehabilitation training and were improved after non-surgical
treatment.
Conclusion:
For posterior OLT, posterior
ankle arthroscopic
microfracture with PRP
injection can effectively alleviate
pain, improve
ankle function and repair
cartilage damage, with satisfactory short-term
efficacy.