Surgeon, Sydney Orthopaedic Foot and Ankle Research Institute, North Sydney Orthopaedic & Sports Medicine Centre, Wollstonecraft, Australia.
Surgeon, Sydney Orthopaedic Foot and Ankle Research Institute, North Sydney Orthopaedic & Sports Medicine Centre, Wollstonecraft, Australia.
J Foot Ankle Surg. 2020 Jul-Aug;59(4):792-794. doi: 10.1053/j.jfas.2020.03.006. Epub 2020 Apr 16.
Osteochondral lesions (OCLs) are a diverse group of articular cartilage lesions with or without a subchondral component. They often result from ankle injuries in the young population. Lateral talar dome lesions are encountered more frequently in trauma. Bone marrow stimulation with microfracture is an established form of treatment for symptomatic OCL in the literature; however, reparative fibrocartilaginous tissue has inferior wear characteristics to hyaline cartilage, and clinical symptoms have been found to recur in 2 years. Recalcitrant OCL already treated with microfracture presents a considerable challenge to clinicians. Results of microfracture combined with chitosan-based biomaterial have been reported favorably in hip and knee. Chitosan glycerol phosphate has cationic properties that enhance clot adhesiveness within the space of an OCL and prevent blood clot retraction. Greater volume and better quality of reparative tissue using chitosan have been demonstrated in randomized controlled trials and in vivo studies. We prospectively report chitosan blood implant with microfracture results in patients with recalcitrant talar OCLs who were previously treated with microfracture alone in a single-surgeon study. We found a statistically significant improvement in Foot and Ankle outcome score (FAOS) and EQ-5D, with an average follow-up of >2 years.
骨软骨病变（OCLs）是一组不同类型的关节软骨病变，伴有或不伴有软骨下成分。它们通常发生在年轻人的踝关节损伤中。外侧距骨穹隆病变在创伤中更为常见。在文献中，骨髓刺激的微骨折术是治疗有症状的 OCL 的一种成熟方法；然而，修复性纤维软骨组织的磨损特性不如透明软骨，临床症状在 2 年内复发。已经接受微骨折术治疗的顽固性 OCL 对临床医生来说是一个相当大的挑战。在髋关节和膝关节中，已经报道了微骨折术联合壳聚糖基生物材料的结果是有利的。壳聚糖甘油磷酸具有正电荷特性，可增强 OCL 内血凝块的粘附性，并防止血凝块回缩。随机对照试验和体内研究表明，使用壳聚糖可获得更大体积和更好质量的修复组织。我们前瞻性地报告了在单独接受微骨折术治疗的顽固性距骨 OCL 患者中使用壳聚糖血液植入物联合微骨折术的结果，在一位外科医生的单中心研究中，我们发现 Foot and Ankle outcome score（FAOS）和 EQ-5D 有统计学意义的改善，平均随访时间>2 年。
