Singh N, Pandey C R, Tamang B, Singh R
Department of Orthopaedics and Traumatology, Grande International Hospital, Kathmandu, Nepal.
Department of Physiotherapy and Rehabilitation, Grande International Hospital, Kathmandu, Nepal.
Malays Orthop J. 2020 Jul;14(2):64-71. doi: 10.5704/MOJ.2007.014.
The study was conducted to evaluate the efficacy of arthroscopic debridement, microfracture and plasma rich in growth factor (PRGF) injection in the management of type V (Scranton) osteochondral lesions of talus and its role in healing the subchondral cyst and cessation of progression of ankle osteoarthritis.
This is a prospective case series conducted on patients who were diagnosed with type V osteochondral lesions of talus. All the cases were treated with arthroscopic debridement, microfracture, and PRGF injections. The patients were evaluated for the healing of subchondral cysts and progression of osteoarthritis with radiography (plain radiographs and computerised tomography Scan). Also, the patients' outcome was evaluated with Quadruple Visual Analogue Scale, Ankle Range of Motion, Foot and Ankle Disability Index, Foot and Ankle Outcome Instrument and a Satisfaction Questionnaire.
Five male patients underwent arthroscopic debridement, microfracture and PRGF injection for type V osteochondral lesion of talus. The mean age of patients was 27.4 years (19-47 years). All the patients gave history of minor twisting injury. Subchondral cyst healing was achieved in all patients by six months post-surgery. However, four out of five patients had developed early osteoarthritic changes of the ankle by their last follow-up [mean follow-up 29 months (ranged 15-36 months)]. Despite arthritic changes, all the patients reported 'Good' to 'Excellent' results on satisfaction questionnaire and Foot and Ankle Disability Index and could perform their day to day activities including sports.
Arthroscopic debridement, microfracture, and PRGF causes healing of the subchondral cyst but does not cause cessation of progression to osteoarthritis of ankle in type V osteochondral defects of talus. However, despite progress to osteoarthritis, patient satisfaction post-procedure is good to excellent at short-term follow-up.
本研究旨在评估关节镜下清创、微骨折术及富血小板生长因子（PRGF）注射治疗V型（斯克兰顿分型）距骨骨软骨损伤的疗效，及其在治疗软骨下囊肿和阻止踝关节骨关节炎进展中的作用。
这是一项针对诊断为V型距骨骨软骨损伤患者的前瞻性病例系列研究。所有病例均接受关节镜下清创、微骨折术及PRGF注射治疗。通过影像学检查（X线平片和计算机断层扫描）评估患者软骨下囊肿的愈合情况及骨关节炎的进展情况。此外，采用四分量视觉模拟量表、踝关节活动范围、足踝残疾指数、足踝结局工具及满意度调查问卷对患者的治疗结果进行评估。
5例男性患者接受了关节镜下清创、微骨折术及PRGF注射治疗V型距骨骨软骨损伤。患者的平均年龄为27.4岁（19 - 47岁）。所有患者均有轻微扭伤史。术后6个月所有患者的软骨下囊肿均愈合。然而，在最后一次随访时[平均随访29个月（范围15 - 36个月）]，5例患者中有4例出现了踝关节早期骨关节炎改变。尽管出现了骨关节炎改变，但所有患者在满意度调查问卷和足踝残疾指数上均报告了“良好”至“优秀”的结果，并且能够进行包括运动在内的日常活动。
关节镜下清创、微骨折术及PRGF可使软骨下囊肿愈合，但不能阻止V型距骨骨软骨缺损患者踝关节骨关节炎的进展。然而，尽管进展为骨关节炎，但在短期随访中患者术后满意度良好至优秀。
