Foot and Ankle Surgeon, Department of Orthopedic, The Second People's Hospital of Yunnan Province, the Affiliated Hospital of Yunnan University, Kunming, China.
Associate Professor, Department of Radiology, The Affiliated Hospital of Yunnan University, Kunming, China.
J Foot Ankle Surg. 2021 Nov-Dec;60(6):1270-1279. doi: 10.1053/j.jfas.2020.11.013. Epub 2021 Jun 30.
The aim of this meta-analysis was to compare the efficacy and safety between the microfracture (MFx) and augmented microfracture (MFx+) techniques for articular cartilage defects of the talus (OLTs). PubMed and EMBASE were searched from January 1950 to October 2020. Only randomized controlled trials, quasi-randomized controlled trials, and observational studies (retrospective and prospective) applying MFx and MFx+ techniques to treat talar cartilage defects were selected. Ten trials with 492 patients were included. There was significant difference in final American Orthopaedic Foot & Ankle Society score (AOFAS) (mean difference [MD] = 7.07; 95% confidence interval [CI], 3.70-10.44; p < .01), AOFAS change (MD = 7.97; 95% CI, 4.27-11.66; p < .01), visual analog scale (VAS) change score (MD = 0.44; 95% CI, 0.29-0.59; p < .01), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score (MD = 12.51; 95% CI, 7.16-17.86; p < .01), complication (RR = 0.33; 95% CI, 0.16-0.69; p < .01), and revision (Relative risk = 0.34; 95% CI, 0.15-0.77; p < .05), between the MFx and MFx+ groups. No significant difference was observed for final VAS pain score (MD = -0.53; 95% CI, -1.2 to 1.05; p = .13) and Tegner scale (MD = 0.31; 95% CI, -1.05 to 1.66; p = .66) in either group. Our results suggest that augmented microfracture is superior to microfracture alone in the treatment of talar OLTs based on the AOFAS, MOCART, VAS score, complication rate, and revision ratio. Therefore, microfracture with augmentation should be considered as a treatment for OLTs of talus. However, more randomized trials are still required to determine the long-term superiority of MFx+.
本荟萃分析的目的是比较微骨折术（MFx）和增强微骨折术（MFx+）治疗距骨骨软骨损伤（OLT）的疗效和安全性。从 1950 年 1 月到 2020 年 10 月，我们在 PubMed 和 EMBASE 上进行了检索。仅选择应用 MFx 和 MFx+技术治疗距骨软骨缺损的随机对照试验、准随机对照试验和观察性研究（回顾性和前瞻性）。共纳入 10 项试验，共 492 例患者。末次美国矫形足踝协会评分（AOFAS）（均数差 [MD] = 7.07；95%置信区间 [CI]，3.70-10.44；p <.01）、AOFAS 变化（MD = 7.97；95% CI，4.27-11.66；p <.01）、视觉模拟评分（VAS）变化评分（MD = 0.44；95% CI，0.29-0.59；p <.01）、磁共振软骨修复组织观察评分（MOCART）（MD = 12.51；95% CI，7.16-17.86；p <.01）、并发症（RR = 0.33；95% CI，0.16-0.69；p <.01）和翻修率（RR = 0.34；95% CI，0.15-0.77；p <.05），MFx 组与 MFx+组之间差异有统计学意义。两组间末次 VAS 疼痛评分（MD = -0.53；95% CI，-1.2 至 1.05；p =.13）和 Tegner 评分（MD = 0.31；95% CI，-1.05 至 1.66；p =.66）差异无统计学意义。我们的研究结果表明，基于 AOFAS、MOCART、VAS 评分、并发症发生率和翻修率，增强微骨折术在治疗距骨 OLT 方面优于单纯微骨折术。因此，对于距骨 OLT，应考虑采用微骨折术联合增强术。然而，仍需要更多的随机试验来确定 MFx+的长期优势。
