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Medial Talus Osteokondral Lezyonlarında Mikrofraktür ve Mozaikoplastinin Karşılaştırmalı Klinik ve Fonksiyonel Sonuçları

Yıl 2024, Cilt: 14 Sayı: 3, 306 - 314, 30.09.2024
https://doi.org/10.31832/smj.1519991

Öz

Amaç: Bu çalışma, medial talus osteokondral lezyonlarının (OCL'ler) tedavisinde iki cerrahi müdahale, mikrofraktür ve mozaikoplastinin erken klinik ve fonksiyonel sonuçlarını karşılaştırmayı amaçlamaktadır.

Yöntem ve Gereçler: Bu retrospektif çalışma, Ocak 2016'dan Ocak 2022'ye kadar XXX Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı'nda tedavi edilen hastaları içermektedir. Hastalar, mikrofraktür uygulananlar (Grup 1, n=20) ve mozaikoplasti uygulananlar (Grup 2, n=17) olarak iki gruba ayrılmıştır. Preoperatif ve postoperatif takip verileri başlangıçta, 6. ayda ve 12. ayda görsel analog skala (VAS) ve Amerikan Ortopedik Ayak ve Ayak Bileği Derneği (AOFAS) skorlarını içermektedir. İstatistiksel analiz NCSS yazılımı kullanılarak yapılmış olup, anlamlılık seviyesi p<0,05 olarak belirlenmiştir.

Bulgular: Mikrofraktür grubunun ortalama yaşı 37,9±12,5 yıl, mozaikoplasti grubunun ise 38±12,46 yıl idi (p=0,981). Her iki grup da başlangıçtan 6. ve 12. aylara kadar VAS skorlarında anlamlı iyileşme göstermiş olup, mozaikoplasti grubu ağrı azalmasında daha üstün bulunmuştur (p<0,001). AOFAS skorları da her iki grupta anlamlı olarak iyileşmiş olup, mozaikoplasti grubunun 12. ayda daha iyi fonksiyonel sonuçlar gösterdiği tespit edilmiştir (p=0,069).

Sonuç: Mikrofraktür ve mozaikoplasti, medial talus OCL'lerin tedavisinde erken dönemde ağrının azaltılmasında ve klinik durumda etkilidir.

Kaynakça

  • Kekeç AF, Yıldırım A. Mid-term results of autologous matrix- induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study. Jt Dis Relat Surg. 2023;34(3):613-619. doi:10.52312/jdrs.2023.1197
  • Butler J, Hartman H, Dhillon R, et al. Outcomes Following the Use of Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review. Cureus. 2024;16(6). doi:10.7759/ cureus.62044
  • Altomare D, Di Matteo B, Kon E. Conservative Treatment for Ankle Cartilage: Cellular and Acellular Therapies: A Systematic Review. Foot Ankle Clin. 2024;29(2):253-263. doi:10.1016/j.fcl.2023.07.003
  • van Diepen PR, Smithuis FF, Hollander JJ, et al. Reporting of Morphology, Location, and Size in the Treatment of Osteochondral Lesions of the Talus in 11,785 Patients: A Systematic Review and Meta- Analysis. Cartilage. 2024:19476035241229026. doi:10.1177/19476035241229026
  • Yasui Y, Miyamoto W, Shimozono Y, Tsukada K, Kawano H, Takao M. Evidence-Based Update on the Surgical Technique and Clinical Outcomes of Retrograde Drilling: A Systematic Review. Cartilage. 2024:19476035241239303. doi:10.1177/19476035241239303
  • Zhang J, Zheng K, Cai W, Huang X, Li Q. Influence of Subchondral Cysts on the Outcomes of Surgical Treatment for Osteochondral Lesions of the Talus: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2024;12(2):23259671241226719. doi:10.1177/23259671241226719
  • Chen XQ, Liu J, Wang T, et al. Comparative analysis of short-term efficacy between robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus. Front Surg. 2024;11:1404513. doi:10.3389/fsurg.2024.1404513
  • Walther M, Gottschalk O, Aurich M. Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group ‘clinical tissue regeneration’ of the German Society of Orthopedics and Traumatology (DGOU). EFORT Open Rev. 2024;9(3):217- 234. doi:10.1530/eor-23-0075
  • Merritt G, Epstein J, Roland D, Bell D. Fresh osteochondral allograft transplantation (FOCAT) for definitive management of a 198 square millimeter osteochondral lesion of the talus (OLT): A case report. Foot (Edinb). 2021;46:101639. doi:10.1016/j.foot.2019.09.001
  • Solheim E, Hegna J, Inderhaug E. Long-Term Survival after Microfracture and Mosaicplasty for Knee Articular Cartilage Repair: A Comparative Study Between Two Treatments Cohorts. Cartilage. 2020;11(1):71-76. doi:10.1177/1947603518783482
  • Kılınçcıoğlu N, Sr., Kalacı A. The Comparison of the Results of Microfracture and Mosaicplasty in Talus Osteochondral Lesions. Cureus. 2024;16(5). doi:10.7759/ cureus.61217
  • Amouyel T, Barbier O, De L’Escalopier N, et al. Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: A prospective multicentric study. Knee Surg Sports Traumatol Arthrosc. 2023;31(8):3044-3050. doi:10.1007/s00167-022-06876-w
  • Zhang L, Luo Y, Zhou X, Fu S, Wang G. Outcomes from Osteochondral Autograft Transplant or Mosaicplasty in 26 Patients with Type V Osteochondral Lesions of the Talus. Med Sci Monit. 2021;27. doi:10.12659/msm.930527
  • Matthews JR, Sonnier JH, Paul RW, et al. A systematic review of cartilage procedures for unstable osteochondritis dissecans. Phys Sportsmed. 2023;51(6):497-505. doi:10. 1080/00913847.2022.2082262
  • Lopes R, Amouyel T, Benoist J, et al. Return to sport after surgery for osteochondral lesions of the talar dome. Results of a multicenter prospective study on 58 patients. Orthop Traumatol Surg Res. 2023;109(8s):103675. doi:10.1016/j.otsr.2023.103675
  • de l’Escalopier N, Amouyel T, Mainard D, et al. Long-term outcome for repair of osteochondral lesions of the talus by osteochondral autograft: A series of 56 Mosaicplasties ®. Orthop Traumatol Surg Res. 2021;107(8s):103075. doi:10.1016/j.otsr.2021.103075
  • Guney A, Yurdakul E, Karaman I, Bilal O, Kafadar IH, Oner M. Medium-term outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet- rich plasma in the treatment of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1293-8. doi:10.1007/s00167-015-3834-y
  • Anders S, Götz J, Grifka J, Baier C. [Ankle cartilage repair: Therapeutic options, results and technical aspects]. Orthopade. 2017;46(11):938-946. Knorpelreparative Eingriffe am oberen Sprunggelenk: Therapieoptionen, Ergebnisse und technische Aspekte. doi:10.1007/ s00132-017-3470-y
  • Mukai S, Nakagawa Y, Nishitani K, Sakai S, Nakamura R, Takahashi M. Mosaicplasty With High Tibial Osteotomy for Knee Subchondral Insufficiency Fracture Had Better Magnetic Resonance Observation of Cartilage Repair Tissue Scores With Less Bone Marrow Edema and Better Plug Union and Less Plug Necrosis Compared With Mosaicplasty Alone. Arthroscopy. 2023;39(2):337-346. doi:10.1016/j.arthro.2022.07.020
  • Pallamar M, Eder T, Ganger R, Farr S. Surgical treatment of atraumatic osteochondrosis dissecans of the immature talus-Clinical results and prevalence of radiographic joint degeneration after a median follow-up of 72.5 months. Foot Ankle Surg. 2022;28(5):557-563. doi:10.1016/j. fas.2021.05.007
  • Kim TY, Song SH, Baek JH, Hwang YG, Jeong BO. Analysis of the Changes in the Clinical Outcomes According to Time After Arthroscopic Microfracture of Osteochondral Lesions of the Talus. Foot Ankle Int. 2019;40(1):74-79. doi:10.1177/1071100718794944
  • Rikken QGH, Dahmen J, Stufkens SAS, Kerkhoffs G. Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2021;29(11):3525- 3533. doi:10.1007/s00167-021-06630-8

Comparative Clinical and Functional Results of Microfracture and Mosaicoplasty in Medial Talus Osteochondral Lesions

Yıl 2024, Cilt: 14 Sayı: 3, 306 - 314, 30.09.2024
https://doi.org/10.31832/smj.1519991

Öz

Introduction: This study aims to compare the early clinical and functional outcomes of two surgical interventions, microfracture and mosaicoplasty, in the treatment of medial talus osteochondral lesions (OCLs).
Materials and Methods: This retrospective study included patients treated in the Department of Orthopaedics and Traumatology, Faculty of Medicine, Düzce University from January 2016 to January 2022. Patients were divided into two groups as those who underwent arthroscopic microfracture (Group 1, n=20) and those who underwent mosaicoplasty (Group 2, n=17). Preoperative and postoperative follow-up data were evaluated with visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores at baseline, 6 months and 12 months.
Results: The mean age was 37.9±12.5 years in the microfracture group and 38±12.46 years in the mosaicoplasty group (p=0.981). Both groups showed significant improvement in VAS scores from baseline to the 6th and 12th months, and pain reduction was more significant in the mosaicoplasty group (p<0.001). AOFAS scores improved significantly in both groups and the mosaicoplasty group had better functional results at 12 months (p=0.069).
Conclusions: Microfracture and mosaicoplasty are effective in the treatment of medial talus OCLs to reduce pain and improve clinical status in the early period.

Kaynakça

  • Kekeç AF, Yıldırım A. Mid-term results of autologous matrix- induced chondrogenesis surgery with or without scaffolds for arthroscopic treatment of deep talus osteochondral lesions: A comparative study. Jt Dis Relat Surg. 2023;34(3):613-619. doi:10.52312/jdrs.2023.1197
  • Butler J, Hartman H, Dhillon R, et al. Outcomes Following the Use of Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review. Cureus. 2024;16(6). doi:10.7759/ cureus.62044
  • Altomare D, Di Matteo B, Kon E. Conservative Treatment for Ankle Cartilage: Cellular and Acellular Therapies: A Systematic Review. Foot Ankle Clin. 2024;29(2):253-263. doi:10.1016/j.fcl.2023.07.003
  • van Diepen PR, Smithuis FF, Hollander JJ, et al. Reporting of Morphology, Location, and Size in the Treatment of Osteochondral Lesions of the Talus in 11,785 Patients: A Systematic Review and Meta- Analysis. Cartilage. 2024:19476035241229026. doi:10.1177/19476035241229026
  • Yasui Y, Miyamoto W, Shimozono Y, Tsukada K, Kawano H, Takao M. Evidence-Based Update on the Surgical Technique and Clinical Outcomes of Retrograde Drilling: A Systematic Review. Cartilage. 2024:19476035241239303. doi:10.1177/19476035241239303
  • Zhang J, Zheng K, Cai W, Huang X, Li Q. Influence of Subchondral Cysts on the Outcomes of Surgical Treatment for Osteochondral Lesions of the Talus: A Systematic Review and Meta-analysis. Orthop J Sports Med. 2024;12(2):23259671241226719. doi:10.1177/23259671241226719
  • Chen XQ, Liu J, Wang T, et al. Comparative analysis of short-term efficacy between robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus. Front Surg. 2024;11:1404513. doi:10.3389/fsurg.2024.1404513
  • Walther M, Gottschalk O, Aurich M. Operative management of osteochondral lesions of the talus: 2024 recommendations of the working group ‘clinical tissue regeneration’ of the German Society of Orthopedics and Traumatology (DGOU). EFORT Open Rev. 2024;9(3):217- 234. doi:10.1530/eor-23-0075
  • Merritt G, Epstein J, Roland D, Bell D. Fresh osteochondral allograft transplantation (FOCAT) for definitive management of a 198 square millimeter osteochondral lesion of the talus (OLT): A case report. Foot (Edinb). 2021;46:101639. doi:10.1016/j.foot.2019.09.001
  • Solheim E, Hegna J, Inderhaug E. Long-Term Survival after Microfracture and Mosaicplasty for Knee Articular Cartilage Repair: A Comparative Study Between Two Treatments Cohorts. Cartilage. 2020;11(1):71-76. doi:10.1177/1947603518783482
  • Kılınçcıoğlu N, Sr., Kalacı A. The Comparison of the Results of Microfracture and Mosaicplasty in Talus Osteochondral Lesions. Cureus. 2024;16(5). doi:10.7759/ cureus.61217
  • Amouyel T, Barbier O, De L’Escalopier N, et al. Higher preoperative range of motion is predictive of good mid-term results in the surgical management of osteochondral lesions of the talus: A prospective multicentric study. Knee Surg Sports Traumatol Arthrosc. 2023;31(8):3044-3050. doi:10.1007/s00167-022-06876-w
  • Zhang L, Luo Y, Zhou X, Fu S, Wang G. Outcomes from Osteochondral Autograft Transplant or Mosaicplasty in 26 Patients with Type V Osteochondral Lesions of the Talus. Med Sci Monit. 2021;27. doi:10.12659/msm.930527
  • Matthews JR, Sonnier JH, Paul RW, et al. A systematic review of cartilage procedures for unstable osteochondritis dissecans. Phys Sportsmed. 2023;51(6):497-505. doi:10. 1080/00913847.2022.2082262
  • Lopes R, Amouyel T, Benoist J, et al. Return to sport after surgery for osteochondral lesions of the talar dome. Results of a multicenter prospective study on 58 patients. Orthop Traumatol Surg Res. 2023;109(8s):103675. doi:10.1016/j.otsr.2023.103675
  • de l’Escalopier N, Amouyel T, Mainard D, et al. Long-term outcome for repair of osteochondral lesions of the talus by osteochondral autograft: A series of 56 Mosaicplasties ®. Orthop Traumatol Surg Res. 2021;107(8s):103075. doi:10.1016/j.otsr.2021.103075
  • Guney A, Yurdakul E, Karaman I, Bilal O, Kafadar IH, Oner M. Medium-term outcomes of mosaicplasty versus arthroscopic microfracture with or without platelet- rich plasma in the treatment of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2016;24(4):1293-8. doi:10.1007/s00167-015-3834-y
  • Anders S, Götz J, Grifka J, Baier C. [Ankle cartilage repair: Therapeutic options, results and technical aspects]. Orthopade. 2017;46(11):938-946. Knorpelreparative Eingriffe am oberen Sprunggelenk: Therapieoptionen, Ergebnisse und technische Aspekte. doi:10.1007/ s00132-017-3470-y
  • Mukai S, Nakagawa Y, Nishitani K, Sakai S, Nakamura R, Takahashi M. Mosaicplasty With High Tibial Osteotomy for Knee Subchondral Insufficiency Fracture Had Better Magnetic Resonance Observation of Cartilage Repair Tissue Scores With Less Bone Marrow Edema and Better Plug Union and Less Plug Necrosis Compared With Mosaicplasty Alone. Arthroscopy. 2023;39(2):337-346. doi:10.1016/j.arthro.2022.07.020
  • Pallamar M, Eder T, Ganger R, Farr S. Surgical treatment of atraumatic osteochondrosis dissecans of the immature talus-Clinical results and prevalence of radiographic joint degeneration after a median follow-up of 72.5 months. Foot Ankle Surg. 2022;28(5):557-563. doi:10.1016/j. fas.2021.05.007
  • Kim TY, Song SH, Baek JH, Hwang YG, Jeong BO. Analysis of the Changes in the Clinical Outcomes According to Time After Arthroscopic Microfracture of Osteochondral Lesions of the Talus. Foot Ankle Int. 2019;40(1):74-79. doi:10.1177/1071100718794944
  • Rikken QGH, Dahmen J, Stufkens SAS, Kerkhoffs G. Satisfactory long-term clinical outcomes after bone marrow stimulation of osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2021;29(11):3525- 3533. doi:10.1007/s00167-021-06630-8
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm Araştırma Makalesi
Yazarlar

Sönmez Sağlam 0000-0003-2651-8003

Mehmet Arıcan 0000-0002-0649-2339

Zekeriya Okan Karaduman 0000-0002-6719-3666

Mücahid Osman Yücel 0000-0002-9405-2367

Raşit Emin Dalaslan 0000-0001-5068-8024

Erken Görünüm Tarihi 24 Eylül 2024
Yayımlanma Tarihi 30 Eylül 2024
Gönderilme Tarihi 21 Temmuz 2024
Kabul Tarihi 13 Ağustos 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 14 Sayı: 3

Kaynak Göster

AMA Sağlam S, Arıcan M, Karaduman ZO, Yücel MO, Dalaslan RE. Comparative Clinical and Functional Results of Microfracture and Mosaicoplasty in Medial Talus Osteochondral Lesions. Sakarya Tıp Dergisi. Eylül 2024;14(3):306-314. doi:10.31832/smj.1519991

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