University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA.
Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA.
Foot Ankle Surg. 2022 Jul;28(5):642-649. doi: 10.1016/j.fas.2021.07.012. Epub 2021 Jul 21.
Osteochondral lesions of the talus (OLTs) have been traditionally treated with bone marrow stimulation techniques such as microfracture. However, conventional microfracture results in a biomechanically weaker repair tissue of predominantly type I collagen. Acellular micronized cartilage matrix (MCM) serves as a bioactive scaffold to restore hyaline cartilage. The purpose was to compare short-term outcomes after microfracture with and without augmentation with MCM for medial-sided OLTs.
A retrospective review was performed between 2010-2019 for medial-sided OLTs undergoing treatment with either microfracture augmented with MCM or isolated microfracture. The MCM was hydrated with either bone marrow aspirate concentrate (BMAC) or platelet-rich plasma (PRP). Outcomes included visual analogue scale (VAS) pain scores, Foot and Ankle Activity Measure (FAAM) scores, return-to-daily activities, and return-to-sport.
48 patients (14 MCM with PRP, 6 MCM with BMAC; 28 isolated microfracture) with average age 35.5 years (range: 13.8-67.2 years) and mean follow-up 4.0 ± 3.4 years (range,.13-10.7) were included. There was no difference in average lesion size between MCM and microfracture groups (64.0 ± 49.4 mm versus 57.3 ± 44.2 mm, P = .63) and a trend toward larger lesion size for BMAC compared to PRP (106.5 ± 59.2 versus 45.9 ± 32.1 mm, P = .056). There was no difference in time to return-to-activity (83.5 ± 18.8 versus 87.3 ± 49.1 days) or return-to-sports (151.9 ± 62.2 versus 165 ± 99.2 days) with MCM versus isolated microfracture. However, the MCM group had a significantly greater improvement in VAS pain score at final follow-up (4.9 ± 2.2 versus 2.7 ± 2.6, P = .0032) and significantly higher post-operative FAAM-Activities of Daily Living subscale scores (97.2 ± 8.2 versus 79.7 ± 32.8, P = .033).
Augmenting microfracture with MCM hydrated with PRP or BMAC may result in beneficial changes in pain scores and activities of daily living, but similar return-to-activities and return-to-sport times compared to microfracture alone in management of medial OLT.
IV.
距骨骨软骨病变（OLTs）传统上采用骨髓刺激技术治疗，如微骨折。然而，传统的微骨折导致主要为 I 型胶原的生物力学较弱的修复组织。脱细胞微化软骨基质（MCM）可作为生物活性支架，以恢复透明软骨。目的是比较内侧 OLTS 行微骨折联合与不联合 MCM 增强后的短期结果。
对 2010 年至 2019 年间接受微骨折联合 MCM 增强或单纯微骨折治疗的内侧 OLTS 进行回顾性分析。MCM 与骨髓抽吸浓缩物（BMAC）或富含血小板的血浆（PRP）混合水化。结果包括视觉模拟量表（VAS）疼痛评分、足踝活动测量（FAAM）评分、恢复日常活动和恢复运动。
纳入 48 例患者（14 例 MCM+PRP，6 例 MCM+BMAC；28 例单纯微骨折），平均年龄 35.5 岁（范围：13.8-67.2 岁），平均随访时间 4.0±3.4 年（范围，0.13-10.7 年）。MCM 组和微骨折组的平均病变大小无差异（64.0±49.4mm 与 57.3±44.2mm，P=0.63），BMAC 组的病变大小较 PRP 组有增大趋势（106.5±59.2mm 与 45.9±32.1mm，P=0.056）。MCM 组与单纯微骨折组在恢复活动时间（83.5±18.8 天与 87.3±49.1 天）或恢复运动时间（151.9±62.2 天与 165±99.2 天）方面无差异。然而，MCM 组的 VAS 疼痛评分在末次随访时显著改善（4.9±2.2 与 2.7±2.6，P=0.0032），术后 FAAM-日常生活活动子量表评分显著升高（97.2±8.2 与 79.7±32.8，P=0.033）。
用 PRP 或 BMAC 水化 MCM 增强微骨折可能会导致疼痛评分和日常生活活动的有益变化，但与单纯微骨折相比，在管理内侧 OLT 时，恢复活动和恢复运动的时间相似。
IV。
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