UNASSIGNED:距骨软骨损伤(OLT)的关节镜微骨折在短期和长期均显示出良好的功能结果。
UNASSIGNED:研究关节镜微骨折治疗OLT后5年的影像学和临床结果,以及包括富血小板血浆(PRP)和透明质酸(HA)在内的辅助治疗的有效性。
未经批准:队列研究;证据水平,2.
UNASSIGNED:我们前瞻性招募了432例患者,这些患者从2011年5月1日至2015年5月31日接受关节镜下微骨折治疗。初次手术后,每年进行磁共振成像(MRI)和负重X射线照片。采用MOCART(磁共振观察软骨修复组织)评分对MRI上修复软骨的结构进行评价,每年收集患者报告的结局(美国骨科足踝协会踝足-后足评分[AOFAS]和足踝结局评分)。主要结果指标为5年AOFAS评分。我们记录了基线特征,包括年龄,体重指数(BMI),和病变大小,和其他潜在相关因素,包括PRP/HA注射次数和BMI相对于基线的变化。
未经授权:包括355名患者,所有这些都有至少5年的随访数据。总的再手术率为9.0%(355个中的32个)。根据多变量分析,5年AOFAS评分与PRP注射次数相关(相关系数,3.12[95%CI,2.36至3.89];P<.001),基线时的BMI(相关系数,-0.222[95%CI,-0.363至-0.082];P=.002),和平均BMI从基线的变化(相关系数,-1.15[95%CI,-1.32至-0.98];P<.001)。比较PRP进样次数(0、1-2或≥3)时,我们发现,连续注射PRP的患者(注射间隔≥3次,两次注射间隔至少3个月)随着时间的推移功能和影像学恶化减少.
UNASSIGNED:关节镜下微骨折可改善OLT患者术后5年的患者报告和结构结局。连续注射PRP和从基线降低BMI能够减缓放射学和功能恶化。关于微骨折和PRP联合治疗OLT的未来试验应侧重于更长期的疗效,关节内,PRP的串行进样而不是单次进样。
UNASSIGNED: Arthroscopic microfracture for osteochondral lesion of the talus (OLT) has shown good functional outcomes in the short and long term.
UNASSIGNED: To investigate 5-year radiographic and clinical outcomes after arthroscopic microfracture in treatment of OLT and the effectiveness of adjunct therapies including platelet-rich plasma (PRP) and hyaluronic acid (HA).
UNASSIGNED: Cohort study; Level of evidence, 2.
UNASSIGNED: We prospectively enrolled 432 patients who underwent arthroscopic microfracture for OLT from May 1, 2011, to May 31, 2015. Magnetic resonance imaging (MRI) and weightbearing radiographs were performed annually after the initial surgery. The MOCART (magnetic resonance observation of cartilage repair tissue) score was used to evaluate the structure of the repaired cartilage on MRI, and patient-reported outcomes (American Orthopaedic Foot and Ankle Society ankle-hindfoot scale [AOFAS] and the Foot and Ankle Outcome Score) were collected annually. The primary outcome measure was 5-year AOFAS score. We recorded baseline characteristics including age, body mass index (BMI), and lesion size, and other potentially related factors including number of PRP/HA injection and change in BMI from baseline.
UNASSIGNED: Included were 355 patients, all with minimum 5-year follow-up data. The overall reoperation rate was 9.0% (32 of 355). According to multivariable analysis, 5-year AOFAS scores were associated with number of PRP injections (correlation coefficient, 3.12 [95% CI, 2.36 to 3.89]; P < .001), BMI at baseline (correlation coefficient, -0.222 [95% CI, -0.363 to -0.082]; P = .002), and mean BMI change from baseline (correlation coefficient, -1.15 [95% CI, -1.32 to -0.98]; P < .001). When comparing number of PRP injections (0, 1-2, or ≥3), we found that patients who had serial PRP injection (≥3 with at least a 3-month interval between injections) had diminished functional and radiographic deterioration over time.
UNASSIGNED: Arthroscopic microfracture improved patient-reported and structural outcomes for patients with OLT at 5 years after surgery. Serial PRP injections and reduction in BMI from baseline were able to slow radiographic and functional deterioration. Future trials regarding the combination of microfracture and PRP in treatment of OLT should focus on the efficacy of longer term, intra-articular, serial injections of PRP instead of single injections.