Department of Orthopedic Surgery, Meir University Hospital, 59 Tchernichovsky Street, Kfar-Saba, Israel.
Am J Sports Med. 2012 Mar;40(3):534-41. doi: 10.1177/0363546511431238. Epub 2012 Jan 17.
Nonoperative options for osteochondral lesions (OCLs) of the talar dome are limited, and currently, there is a lack of scientific evidence to guide management.
To evaluate the short-term efficacy and safety of platelet-rich plasma (PRP) compared with hyaluronic acid (HA) in reducing pain and disability caused by OCLs of the ankle.
Randomized controlled trial; Level of evidence, 2.
Thirty-two patients aged 18 to 60 years were allocated to a treatment by intra-articular injections of either HA (group 1) or PRP (plasma rich in growth factors [PRGF] technique, group 2) for OCLs of the talus. Thirty OCLs, 15 per arm, received 3 consecutive intra-articular therapeutic injections and were followed for 28 weeks. The efficacy of the injections in reducing pain and improving function was assessed at each visit using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale (AHFS); a visual analog scale (VAS) for pain, stiffness, and function; and the subjective global function score.
The majority of patients were men (n = 23; 79%). The AHFS score improved from 66 and 68 to 78 and 92 in groups 1 and 2, respectively, from baseline to week 28 (P < .0001), favoring PRP (P < .05). Mean VAS scores (1 = asymptomatic, 10 = severe symptoms) decreased for pain (group 1: 5.6 to 3.1; group 2: 4.1 to 0.9), stiffness (group 1: 5.1 to 2.9; group 2: 5.0 to 0.8), and function (group 1: 5.8 to 3.5; group 2: 4.7 to 0.8) from baseline to week 28 (P < .0001), favoring PRP (P < .05 for stiffness, P < .01 for function, P > .05 for pain). Subjective global function scores, reported on a scale from 0 to 100 (with 100 representing healthy, preinjury function) improved from 56 and 58 at baseline to 73 and 91 by week 28 for groups 1 and 2, respectively (P < .01 in favor of PRP).
Osteochondral lesions of the ankle treated with intra-articular injections of PRP and HA resulted in a decrease in pain scores and an increase in function for at least 6 months, with minimal adverse events. Platelet-rich plasma treatment led to a significantly better outcome than HA.
距骨穹隆处骨软骨病变（OCLs）的非手术治疗选择有限，目前缺乏指导管理的科学证据。
评估富含血小板的血浆（PRP）与透明质酸（HA）相比，在减轻 OCL 引起的踝关节疼痛和残疾方面的短期疗效和安全性。
随机对照试验；证据水平，2 级。
将 32 名 18 至 60 岁的患者按关节内注射 HA（组 1）或 PRP（富含生长因子的 PRGF 技术，组 2）的方式分配到治疗组，用于治疗距骨的 OCL。每组各有 15 个 OCL，共 30 个 OCL，接受 3 次连续关节内治疗性注射，并随访 28 周。使用美国矫形足踝协会（AOFAS）踝关节-后足量表（AHFS）；疼痛、僵硬和功能的视觉模拟量表（VAS）；以及主观整体功能评分，在每次就诊时评估注射对减轻疼痛和改善功能的效果。
大多数患者为男性（n=23；79%）。从基线到 28 周，组 1 和组 2 的 AHFS 评分分别从 66 和 68 提高到 78 和 92（P<0.0001），PRP 组更优（P<0.05）。平均 VAS 评分（1=无症状，10=严重症状）从基线到 28 周时疼痛（组 1：5.6 至 3.1；组 2：4.1 至 0.9）、僵硬（组 1：5.1 至 2.9；组 2：5.0 至 0.8）和功能（组 1：5.8 至 3.5；组 2：4.7 至 0.8）均有所下降（P<0.0001），PRP 组更优（僵硬方面 P<0.05，功能方面 P<0.01，疼痛方面 P>0.05）。主观整体功能评分（0 至 100 分，100 分代表健康、受伤前的功能）从基线时的 56 和 58 分别提高到组 1 和组 2 的第 28 周时的 73 和 91（P<0.01，PRP 组更优）。
距骨穹隆处 OCL 经关节内注射 PRP 和 HA 治疗后，疼痛评分降低，功能改善至少持续 6 个月，且不良反应最小。PRP 治疗的效果明显优于 HA。
