Gorgun Baris, Gamlı Alper, Duran Mehmet Emin, Bayram Berhan, Ulku Tekin Kerem, Kocaoglu Baris
Ortopediatri Istanbul, Istanbul, Turkey.
Department of Orthopedic Surgery, Faculty of Medicine, Acibadem University, Istanbul, Turkey.
Orthop J Sports Med. 2023 Jan 25;11(1):23259671221145733. doi: 10.1177/23259671221145733. eCollection 2023 Jan.
Single-step all-arthroscopic techniques have gained popularity recently in the treatment of osteochondral lesions of the talus (OLT). Concomitant subchondral bone defects led surgeons to add autologous bone grafting to the surgical procedures. Collagen scaffolds have been used widely for stabilization of the reconstruction and regeneration of the articular surface.
To compare single-step all-arthroscopic treatment of OLT consisting of debridement, microfracture, autologous bone grafting, and application of fibrin sealant in 2 patient groups: with versus without collagen scaffold.
Cohort study; Level of evidence, 3.
Included were 94 patients who underwent single-step all-arthroscopic treatment for OLT. Autologous bone grafting was applied to 48 patients (BG group), while autologous bone grafting plus collagen scaffold was applied to 46 patients (BG+S group). A fibrin sealant was applied to both groups. Clinical outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) score and the visual analog scale (VAS) for pain. Radiological outcomes were evaluated with the magnetic resonance observation of cartilage repair tissue score. The mean follow-up time was 69.3 ± 20.7 months.
Patients in both groups showed statistically significant improvement in pre- to postoperative AOFAS and VAS scores ( < .001 for all), with no difference between groups in AOFAS and VAS score improvement. Complete healing with or without hypertrophy was achieved in 42 patients in the BG group (87.5%) and 38 patients in the BG+S group (82.6%).
The treatment of bone lesions in OLT may be the ultimate goal to obtain successful outcomes, in which case using a collagen scaffold besides grafting may not affect clinical and radiological outcomes.
单步全关节镜技术最近在距骨骨软骨损伤（OLT）的治疗中受到欢迎。伴随的软骨下骨缺损促使外科医生在手术过程中增加自体骨移植。胶原支架已被广泛用于关节面重建和再生的稳定。
比较两组患者单步全关节镜治疗OLT的效果，治疗包括清创、微骨折、自体骨移植和应用纤维蛋白密封剂，一组使用胶原支架，另一组不使用。
队列研究；证据等级，3级。
纳入94例行单步全关节镜治疗OLT的患者。48例患者接受自体骨移植（BG组），46例患者接受自体骨移植加胶原支架（BG+S组）。两组均应用纤维蛋白密封剂。采用美国矫形足踝协会（AOFAS）评分和视觉模拟量表（VAS）评估疼痛情况，以评估临床疗效。通过磁共振观察软骨修复组织评分评估影像学疗效。平均随访时间为69.3±20.7个月。
两组患者术前至术后AOFAS和VAS评分均有统计学意义的改善（均P<0.001），两组间AOFAS和VAS评分改善无差异。BG组42例患者（87.5%）和BG+S组38例患者（82.6%）实现了有或无肥大的完全愈合。
OLT骨损伤的治疗可能是获得成功结果的最终目标，在这种情况下，除移植外使用胶原支架可能不会影响临床和影像学结果。
