脱水异体微化软骨与单纯微骨折治疗内侧距骨骨软骨病变的短期疗效比较。
Short-term outcomes following dehydrated micronized allogenic cartilage versus isolated microfracture for treatment of medial talar osteochondral lesions.
机构信息
University of California, San Francisco, Department of Orthopaedic Surgery, San Francisco, CA, USA.
Stanford University, Department of Orthopaedic Surgery, Palo Alto, CA, USA.
出版信息
Foot Ankle Surg. 2022 Jul;28(5):642-649. doi: 10.1016/j.fas.2021.07.012. Epub 2021 Jul 21.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
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.
LEVEL OF EVIDENCE
IV.
背景
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。
方法
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。
结果
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）。
结论
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。
证据等级
IV。
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