Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus
Long-term Outcomes of Microfracture for Treatment of Osteochondral Lesions of the Talus
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DOI：
10.1177/1071100721995427
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发表时间：
2021-07-01
影响因子：
2.7
通讯作者：
Raikin, Steven
中科院分区：
文献类型：
--
作者：
Corr, Daniel;Raikin, Jared;Raikin, Steven
背景：微骨折是距骨软骨病最常见的修复手术。虽然在短期至中期结果中显示出有效性，但微骨折产生的纤维软骨在生物力学和生物学上均劣于天然透明软骨，并且在修复后随着时间的推移容易发生退化。随着骨科生物制剂被提出来加强修复，在微骨折的长期临床结果研究中存在明显的空白，以确定这种额外的费用是否必要。研究方法：对2007年至2009年接受奥尔特微骨折的患者进行回顾性分析，这些患者由一名经过研究员培训的骨科医生进行。联系符合入选标准的患者，以完成足踝能力测量（FAAM）日常生活活动（ADL）和运动子量表以及疼痛视觉模拟量表（VAS），并使用5分Likert量表调查他们对手术结局的满意度以及向有相同问题的朋友推荐手术的可能性。对患者人口统计学资料进行了审查，并纳入统计分析。结果如下：在45名受访者中，3名患者因骨软骨缺损需要额外的踝关节手术，10年生存率为93.3%。在存活病例中，90.4%（38/42）报告对手术结果“非常满意”或“满意”。随访时VAS评分平均为14/100（范围，0-75），而FAAM-ADL和FAAM-Sports评分分别平均为90.29/100和82/100。36名患者（85.7%）表示，他们的踝关节并没有阻止他们参加自己选择的运动。结论：目前的研究代表了对接受孤立性关节镜下微骨折治疗距骨骨软骨缺损的患者至少10年的随访，存活率为93.3%，恢复运动的患者为85.7%。虽然生物佐剂可能在改善微骨折手术的长期结局方面发挥作用，但在常规使用成本合理之前，需要对使用矫形生物制剂的手术进行更大规模和更长期的随访研究。
Background: Microfracture is the most common reparative surgery for osteochondral lesions of the talus (OLTs). While shown to be effective in short- to midterm outcomes, the fibrocartilage that microfracture produces is both biomechanically and biologically inferior to that of native hyaline cartilage and is susceptible to possible deterioration over time following repair. With orthobiologics being proposed to augment repair, there exists a clear gap in the study of long-term clinical outcomes of microfracture to determine if this added expense is necessary. Methods: A retrospective review of patients undergoing microfracture of an OLT with a single fellowship-trained orthopedic surgeon from 2007 to 2009 was performed. Patients meeting the inclusion criteria were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and visual analog scale (VAS) for pain, as well as surveyed regarding their satisfaction with the outcome of the procedure and their likelihood to recommend the procedure to a friend with the same problem using 5-point Likert scales. Patient demographics were reviewed and included for statistical analysis. Results: Of 45 respondents, 3 patients required additional surgery on their ankle for the osteochondral defect, yielding a 10-year survival rate of 93.3%. Of surviving cases, 90.4% (38/42) reported being "extremely satisfied" or "satisfied" with the outcome of the procedure. The VAS score at follow-up averaged 14 out of 100 (range, 0-75), while the FAAM-ADL and FAAM-Sports scores averaged 90.29 out of 100 and 82 out of 100, respectively. Thirty-six patients (85.7%) stated that their ankle did not prevent them from participating in the sports of their choice. Conclusion: The current study represents a minimum 10-year follow-up of patients undergoing isolated arthroscopic microfracture for talar osteochondral defects, with a 93.3% survival rate and 85.7% return to sport. While biological adjuvants may play a role in improving the long-term outcomes of microfracture procedures, larger and longer-term follow-up studies are required for procedures using orthobiologics before their cost can be justified for routine use.