• 1.

    Ozenci AM & Aydin AT: Osteochondral lesions of the talus in adolescents. Acta Orthop Traumatol Turc 38: 138, 2004.

  • 2.

    Kumai T , Takakura Y & Higashiyama I et al.: Arthroscopic drilling for the treatment of osteochondral lesions of the talus. J Bone Joint Surg Am 81: 1229, 1999.

  • 3.

    Dragoni M , Bonasia DE & Amendola A: Osteochondral talar allograft for large osteochondral defects: technique tip. Foot Ankle Int 32: 910, 2011.

  • 4.

    Laffernetre O: Osteochondral lesions of the talus: current concept. Orthop Traumatol Surg Res 96: 554, 2010.

  • 5.

    Berndt AL & Harty M: Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 41: 988, 1959.

  • 6.

    Leontaritis N , Hinojosa L & Panchbhavi VK: Arthroscopically detected intra-articular lesions associated with acute ankle fractures. J Bone Joint Surg Am 91: 333, 2009.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Tokgöz MA , Atik & Esendağlı G et al.: Is it possible that the pathogenesis of osteoarthritis could start with subchondral trabecular bone loss like osteoporosis? Eklem Hastalik Cerrahisi 29: 152, 2018.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Sexton AT & Labib AS: Osteochondral lesions of the talus: current opinions on diagnosis and management. Curr Opin Orthop 18: 166, 2007.

  • 9.

    Chuckpaiwong B , Berkson EM & Theodore GH: Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy 24: 106, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Kajikawa Y , Morihara T & Sakamoto H et al.: Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing. J Cell Physiol 215: 837, 2008.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Smyth NA , Murawski CD & Haleem AM et al.: Establishing proof of concept: platelet-rich plasma and bone marrow aspirate concentrate may improve cartilage repair following surgical treatment for osteochondral lesions of the talus. World J Orthop 3: 101, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Dorotka R , Windberger U & Macfelda K et al.: Repair of articular cartilage defects treated by microfracture and a three-dimensional collagen matrix. Biomaterials 26: 3617, 2005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Hoemann CD , Sun J & McKee MD et al.: Chitosan-glycerol phosphate/blood implants elicit hyaline cartilage repair integrated with porous subchondral bone in microdrilled rabbit defects. Osteoarthritis Cartilage 15: 78, 2007.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Usuelli FG , D'Ambrosi R & Maccario C et al.: All-arthroscopic AMIC (AT-AMIC) technique with autologous bone graft for talar osteochondral defects: clinical and radiological results. Knee Surg Sports Traumatol Arthrosc 26: 875, 2018.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Cheng MS , Ferkel RD & Applegate GR: “Osteochondral lesions of the talus: a radiologic and surgical comparison,” in Arthroscopic Surgery: The Foot and the Ankle, Vol 1, edited by Ferkel, RD & Whipple, TL illustrated by SE Burst, p 152, Lippincott-Raven, Philadelphia, 1996.

    • Search Google Scholar
    • Export Citation
  • 16.

    Mintz DN , Tashjian GS & Connell DA et al.: Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy 19: 353, 2003.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Chew KTL , Tay E & Wong YS: Osteochondral lesions of the talus. Ann Acad Med Singapore 37: 63, 2008.

  • 18.

    Tosun HB & Yılmaz E: Our results of microfracture method in the treatment of osteochondral lesions of talus. Firat Med J 14: 175, 2009.

  • 19.

    Jung HG , Carag JA & Park JY et al.: Role of arthroscopic microfracture for cystic type osteochondral lesions of the talus with radiographic enhanced MRI support. Knee Surg Sports Traumatol Arthrosc 19: 858, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Eren TK , Ataoğlu MB & Eren A et al.: Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions. Eklem Hastalik Cerrahisi 30: 97, 2019.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Verhagen RA , Struijs PA & Bossuyt PM et al.: Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 8: 233, 2003.

  • 22.

    Elias I , Zoga AC & Morrison WB et al.: Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 28: 154, 2007.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Vanlauwe J , Saris DB & Victor J et al.: Five-year outcome of characterized chondrocyte implantation versus microfracture for symptomatic cartilage defects of the knee: early treatment matters. Am J Sports Med 39: 2566, 2011.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Gille J , Schuseil E & Wimmer J et al.: Mid-term results of autologous matrix-induced chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surg Sports Traumatol Arthrosc 18: 1456, 2010.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Siclari A , Mascaro G & Kaps C et al.: A 5-year follow-up after cartilage repair in the knee using a platelet-rich plasma-immersed polymer-based implant. Open Orthop J 8: 346, 2014.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Ferkel RD , Zanotti RM & Komenda GA et al.: Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med 36: 1750, 2008.

  • 27.

    Zaslav K , Cole B & Brewster R et al.: A prospective study of autologous chondrocyte implantation in patients with failed prior treatment for articular cartilage defect of the knee: results of the Study of the Treatment of Articular Repair (STAR) clinical trial. Am J Sports Med 37: 42, 2009.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Zengerink M , Struijs PA & Tol JL et al.: Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18: 238, 2010.

  • 29.

    Lee KB , Bai LB & Chung JY et al.: Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18: 247, 2010.

  • 30.

    Apprich S , Trattnig S & Welsch GH et al.: Assessment of articular cartilage repair tissue after matrix-associated autologous chondrocyte transplantation or the microfracture technique in the ankle joint using diffusion-weighted imaging at 3 Tesla. Knee Surg Sports Traumatol Arthrosc 23: 2384, 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Mei-Dan O , Carmont MR & Laver L et al.: Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med 40: 534, 2012.

  • 32.

    Guney A , Akar M & Karaman I et al.: Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 23: 2384, 2015.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Magnan B , Samaila E & Bondi M et al.: Three-dimensional matrix-induced autologous chondrocytes implantation for osteochondral lesions of the talus: midterm results. Adv Orthop 2012: 9, 2012.

    • Search Google Scholar
    • Export Citation
  • 34.

    Shimozono Y , Yasui Y & Ross AW et al.: Scaffolds based therapy for osteochondral lesions of the talus: a systematic review. World J Orthop 8: 798, 2017.

  • 35.

    Siclari A , Mascaro G & Gentili C et al.: A cell-free scaffold-based cartilage repair provides improved function hyaline-like repair at one year. Clin Orthop Relat Res 470: 910, 2012.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Comparison of Arthroscopic Treatment Methods in Talar Osteochondral Lesions: A Multicenter, Prospective, Randomized Clinical Trial

Fatih Doğar
Search for other papers by Fatih Doğar in
Current site
Google Scholar
PubMed
Close
 MD
,
Erdal Uzun
Search for other papers by Erdal Uzun in
Current site
Google Scholar
PubMed
Close
 MD
,
Kaan Gürbüz
Search for other papers by Kaan Gürbüz in
Current site
Google Scholar
PubMed
Close
 MD
,
Duran Topak
Search for other papers by Duran Topak in
Current site
Google Scholar
PubMed
Close
 MD
,
Mustafa Akar
Search for other papers by Mustafa Akar in
Current site
Google Scholar
PubMed
Close
 MD
,
Ökkeş Bilal
Search for other papers by Ökkeş Bilal in
Current site
Google Scholar
PubMed
Close
 MD
, and
Ahmet Güney
Search for other papers by Ahmet Güney in
Current site
Google Scholar
PubMed
Close
 MD

Background

The aim of the present study was to contribute new and updated information to the literature by comparing the clinical and radiologic results of arthroscopic microfracture, platelet-rich plasma (PRP) after arthroscopic microfracture, and BST-Cargel scaffold application after arthroscopic microfracture in the treatment of talar osteochondral lesions.

Methods

Sixty-two talar osteochondral lesion patients (31 women and 31 men) who underwent ankle arthroscopy in two different centers were randomized into three groups. The first group consisted of patients who underwent only arthroscopic microfracture (MF) (n = 22); the second group consisted of patients who underwent the PRP procedure after arthroscopic MF (PRP; n = 19); and the third group consisted of patients who underwent the BST-Cargel procedure after arthroscopic MF was (BST-Cargel; n = 21). The talar osteochondral lesions in the three groups were classified according to magnetic resonance and arthroscopic images. American Orthopedic Foot and Ankle Society, Foot and Ankle Ability Measurement (overall pain, 15-minute walking, running function), and visual analog scale scores were evaluated preoperatively and postoperatively, and postoperative return time to sports activities was performed.

Results

Compared to the preoperative score, postoperative American Orthopedic Foot and Ankle Society score increased 48.80 ± 9.60 in the BST-Cargel group, whereas there was an increase of 46.68 ± 3.65 in the PRP group and 29.63 ± 3.69 in the MF group, which were statistically significant (P < .05).There was a statistically significant postoperative change in the visual analog scale scores of the patients in all three groups compared to the preoperative scores (P < .05). At the end of the follow-up, the Foot and Ankle Ability Measurement overall pain, 15-minute walking, and running function results of all three groups increased significantly postoperatively compared to the preoperative values (P < .005).

Conclusions

BST-Cargel application with microfracture is a method that can be applied easily and safely with arthroscopy to lesions larger than 1.5 cm2 regardless of the size of the cartilage defect, and it has been found to be superior to the other two methods in terms of pain, functional score, radiologic recovery, and return to sports activities.

Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey.

Erciyes University Medical Faculty, Kayseri, Turkey.

Kayseri City Education and Research Hospital, Kayseri, Turkey.

Kapadokya Hospital, Nevsehir, Turkey.

Corresponding author: Fatih Doğar, MD, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras 46040, Turkey. (E-mail: drfatihdogar@hotmail.com)