Hospital for Special Surgery, New York, NY, USA.
Geisel School of Medicine, Hanover, NH, USA.
Foot Ankle Int. 2021 Jun;42(6):689-698. doi: 10.1177/1071100720980020. Epub 2021 Feb 9.
Historically, microfracture has been used to treat small talar osteochondral lesions with good results, whereas osteochondral autologous transplantation (OAT) has proven effective for the treatment of larger lesions. It is not clear which method is more effective for medium-sized lesions around the critical size of 150 mm, above which microfracture outcomes tend to be poor. The purpose of this study was to determine the potential advantages of OAT augmented with a combination of extracellular matrix and bone marrow aspirate concentrate (ECM-BMAC) compared to debridement with ECM-BMAC (DEB) in the treatment of medium-sized osteochondral lesions of the talus (OLTs).
Clinical and radiographic data were collected retrospectively for patients treated by a single fellowship-trained foot and ankle surgeon. Magnetic resonance images (MRIs) were scored using the Magnetic Resonance Observation of Cartilage Tissue (MOCART) system and were evaluated for the presence of cysts and edema. Fifty-two patients met inclusion criteria, with 25 who received an OAT procedure. Age, body mass index, lesion size, lesion location, and follow-up time were similar between groups. Average MRI follow-up times were 16.7 months for the OAT group and 20.3 months for the DEB group ( = .38).
Patients treated with OAT had significantly higher average total MOCART scores (69 vs 55, = .04) and significantly lower rates of cyst (14% vs 55%, < .01), edema (59% vs 90%, = .04), revision surgery (0% vs 19%, = .05), and therapeutic injection for pain (4% vs 30%, = .02) compared to patients treated with DEB. No significant differences were detected in patient-reported outcome scores between groups.
The native hyaline cartilage introduced by OAT appears to result in higher-quality repair tissue when compared to DEB, as evidenced by OAT patients' higher MOCART scores and lower rates of cyst and edema. There was no difference in clinical outcome scores, though OAT patients did not require revision surgery or therapeutic injection for pain as frequently as DEB patients.
Level III, retrospective comparative study.
从历史上看，微骨折术已被用于治疗小型距骨骨软骨病变，疗效良好，而骨软骨自体移植（OAT）已被证明对治疗较大病变有效。对于大小在临界值 150mm 左右的中等大小病变，哪种方法更有效尚不清楚，因为微骨折术的结果往往较差。本研究旨在确定 OAT 联合细胞外基质和骨髓抽吸浓缩物（ECM-BMAC）治疗距骨骨软骨病变（OLTs）的潜在优势，与 ECM-BMAC 清创术（DEB）相比。
回顾性收集了一位经 fellowship培训的足踝外科医生治疗的患者的临床和放射学数据。使用磁共振成像观察软骨组织（MOCART）系统对磁共振成像（MRI）进行评分，并评估有无囊肿和水肿。52 名患者符合纳入标准，其中 25 名患者接受 OAT 手术。两组的年龄、体重指数、病变大小、病变位置和随访时间相似。OAT 组的平均 MRI 随访时间为 16.7 个月，DEB 组为 20.3 个月（ =.38）。
接受 OAT 治疗的患者平均总 MOCART 评分明显更高（69 比 55， =.04），囊肿发生率明显更低（14%比 55%， <.01），水肿发生率明显更低（59%比 90%， =.04），翻修手术率明显更低（0%比 19%， =.05），止痛治疗性注射率明显更低（4%比 30%， =.02），与接受 DEB 治疗的患者相比。两组患者的患者报告结果评分无显著差异。
与 DEB 相比，OAT 引入的天然透明软骨似乎产生了更高质量的修复组织，这可以从 OAT 患者更高的 MOCART 评分以及更低的囊肿和水肿发生率得到证明。虽然 OAT 患者不需要翻修手术或止痛治疗性注射的频率与 DEB 患者一样低，但两组患者的临床结果评分没有差异。
三级，回顾性比较研究。
