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Clinical and MRI outcomes of HA injection following arthroscopic microfracture for osteochondral lesions of the talus

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to compare the clinical and magnetic resonance imaging (MRI) outcomes of arthroscopic microfracture surgery alone or in combination with hyaluronic acid (HA) injection in the treatment of osteochondral lesions of the talus.

Methods

Thirty-five patients with osteochondral lesions of the talus who underwent arthroscopic microfracture were included and followed up for at least 9 months post-operatively. The patients were randomly divided into non-injection group (n = 17) who received treatment with microfracture surgery alone and injection group (n = 18) who also accepted intra-articular injection of HA post-operatively. Quantitative MRI was used to evaluate the cartilage repair after surgery. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Scale scores and Visual Analogue Scale (VAS) scores were used to evaluate clinical outcomes.

Results

After operation, the MRI outcomes showed that the thickness index was higher (0.8 ± 0.1 vs. 0.7 ± 0.1) and the T2 index was lower (1.2 ± 0.1 vs. 1.4 ± 0.1) in the injection group than in the non-injection group (P < 0.01). As for the volumes of subchondral bone marrow oedema, there are no significant differences between groups (n.s.). Compared with the non-injection group, the AOFAS score and the VAS score yielded a higher level of improvement in injection group at final follow-up post-operatively (P < 0.05).

Conclusions

Arthroscopic microfracture is a safe and effective procedure for osteochondral lesions of the talus. Intra-articular HA injection as an adjunct to arthroscopic microfracture might offer better functional recovery than microfracture alone.

Level of evidence

II.

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References

  1. Apprich S, Trattnig S, Welsch GH, Noebauer-Huhmann IM, Sokolowski M, Hirschfeld C, Stelzeneder D, Domayer S (2012) 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. Osteoarthritis Cartilage 20:703–711

    Article  CAS  PubMed  Google Scholar 

  2. Becher C, Thermann H (2005) Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int 26:583–589

    PubMed  Google Scholar 

  3. Becher C, Driessen A, Hess T, Longo UG, Maffulli N, Thermann H (2010) Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc 18:656–663

    Article  PubMed  Google Scholar 

  4. Becher C, Zühlke D, Plaas C, Ewig M, Calliess T, Stukenborg-Colsman C, Thermann H (2014) T2-map** at 3 T after microfracture in the treatment of osteochondral defects of the talus at an average follow-up of 8 years. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2913-9

    Google Scholar 

  5. Bining HJ, Santos R, Andrews G, Forster BB (2009) Can T2 relaxation values and color maps be used to detect chondral damage utilizing subchondral bone marrow edema as a marker? Skeletal Radiol 38:459–465

    Article  PubMed  Google Scholar 

  6. Brem MH, Schlechtweg PM, Bhagwat J, Genovese M, Dillingham MF, Yoshioka H, Lang P (2008) Longitudinal evaluation of the occurrence of MRI-detectable bone marrow edema in osteoarthritis of the knee. Acta Radiol 49:1031–1037

    Article  CAS  PubMed  Google Scholar 

  7. Carpenter B, Motley T (2008) The role of viscosupplementation in the ankle using hylan G-F 20. J Foot Ankle Surg 47:377–384

    Article  PubMed  Google Scholar 

  8. Domayer SE, Apprich S, Stelzeneder D, Hirschfeld C, Sokolowski M, Kronnerwetter C, Chiari C, Windhager R, Trattnig S (2012) Cartilage repair of the ankle: first results of T2 map** at 7.0 T after microfracture and matrix associated autologous cartilage transplantation. Osteoarthritis Cartilage 20:829–836

    Article  CAS  PubMed  Google Scholar 

  9. Doral MN, Bilge O, Batmaz G, Donmez G, Turhan E, Demirel M, Atay OA, Uzumcugil A, Atesok K, Kaya D (2012) Treatment of osteochondral lesions of the talus with microfracture technique and postoperative hyaluronan injection. Knee Surg Sports Traumatol Arthrosc 20:1398–1403

    Article  CAS  PubMed  Google Scholar 

  10. Giannini S, Buda R, Faldini C, Vannini F, Bevoni R, Grandi G, Grigolo B, Berti L (2005) Surgical treatment of osteochondral lesions of the talus in young active patients. J Bone Joint Surg Am 87:28–41

    Article  PubMed  Google Scholar 

  11. Gobbi A, Francisco RA, Lubowitz JH, Allegra F, Canata G (2006) Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy 22:1085–1092

    Article  PubMed  Google Scholar 

  12. Hannon CP, Smyth NA, Murawski CD, Savage-Elliott I, Deyer TW, Calder JD, Kennedy JG (2014) Osteochondral lesions of the talus: aspects of current management. Bone Joint J 96:164–171

    Article  PubMed  Google Scholar 

  13. Karatosun V, Unver B, Ozden A, Ozay Z, Gunal I (2008) Intra-articular hyaluronic acid compared to exercise therapy in osteoarthritis of the ankle. A prospective randomized trial with long-term follow-up. Clin Exp Rheumatol 26:288–294

    CAS  PubMed  Google Scholar 

  14. Kijowski R, Stanton P, Fine J, De Smet A (2006) Subchondral bone marrow edema in patients with degeneration of the articular cartilage of the knee joint. Radiology 238:943–949

    Article  PubMed  Google Scholar 

  15. Kuni B, Schmitt H, Chloridis D, Ludwig K (2012) Clinical and MRI results after microfracture of osteochondral lesions of the talus. Arch Orthop Trauma Surg 132:1765–1771

    Article  CAS  PubMed  Google Scholar 

  16. Lee DH, Lee KB, Jung ST, Seon JK, Kim MS, Sung IH (2012) Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med 40:2023–2028

    Article  PubMed  Google Scholar 

  17. Lee KB, Bai LB, Chung JY, Seon JK (2010) Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 18:247–253

    Article  PubMed  Google Scholar 

  18. Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M (2012) Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med 40:534–541

    Article  PubMed  Google Scholar 

  19. Oneto JM, Ellermann J, LaPrade RF (2010) Longitudinal evaluation of cartilage repair tissue after microfracture using T2-map**: a case report with arthroscopic and MRI correlation. Knee Surg Sports Traumatol Arthrosc 18:1545–1550

    Article  PubMed  Google Scholar 

  20. Raynauld JP, Martel-Pelletier J, Berthiaume MJ, Abram F, Choquette D, Haraoui B, Beary JF, Cline GA, Meyer JM, Pelletier JP (2008) Correlation between bone lesion changes and cartilage volume loss in patients with osteoarthritis of the knee as assessed by quantitative magnetic resonance imaging over a 24-month period. Ann Rheum Dis 67:683–688

    Article  PubMed  Google Scholar 

  21. Salk RS, Chang TJ, D’Costa WF, Soomekh DJ, Grogan KA (2006) Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg Am 88:295–302

    Article  PubMed  Google Scholar 

  22. Scher C, Craig J, Nelson F (2008) Bone marrow edema in the knee in osteoarthrosis and association with total knee arthroplasty within a three-year follow-up. Skeletal Radiol 37:609–617

    Article  PubMed  PubMed Central  Google Scholar 

  23. Sun SF, Chou YJ, Hsu CW, Hwang CW, Hsu PT, Wang JL, Hsu YW, Chou MC (2006) Efficacy of intra-articular hyaluronic acid in patients with osteoarthritis of the ankle: a prospective study. Osteoarthritis Cartilage 14:867–874

    Article  PubMed  Google Scholar 

  24. Tanamas SK, Wluka AE, Pelletier JP, Pelletier JM, Abram F, Berry PA, Wang Y, Jones G, Cicuttini FM (2010) Bone marrow lesions in people with knee osteoarthritis predict progression of disease and joint replacement: a longitudinal study. Rheumatology (Oxford) 49:2413–2419

    Article  Google Scholar 

  25. Tao H, Shang X, Lu R, Li H, Hua Y, Feng X, Chen S (2014) Quantitative magnetic resonance imaging (MRI) evaluation of cartilage repair after microfracture (MF) treatment for adult unstable osteochondritis dissecans (OCD) in the ankle: correlations with clinical outcome. Eur Radiol 24:1758–1767

    Article  PubMed  Google Scholar 

  26. Trattnig S, Mamisch TC, Welsch GH, Glaser C, Szomolanyi P, Gebetsroither S, Stastny O, Horger W, Millington S, Marlovits S (2007) Quantitative T2 map** of matrix-associated autologous chondrocyte transplantation at 3 Tesla: an in vivo cross-sectional study. Invest Radiol 42:442–448

    Article  PubMed  Google Scholar 

  27. Verhagen RA, Struijs PA, Bossuyt PM, van Dijk CN (2003) Systematic review of treatment strategies for osteochondral defects of the talar dome. Foot Ankle Clin 8:233–242

    Article  PubMed  Google Scholar 

  28. Waterman BR, Belmont PJ Jr, Cameron KL, Deberardino TM, Owens BD (2010) Epidemiology of ankle sprain at the United States Military Academy. Am J Sports Med 38:797–803

    Article  PubMed  Google Scholar 

  29. Welsch GH, Trattnig S, Domayer S, Marlovits S, White LM, Mamisch TC (2009) Multimodal approach in the use of clinical scoring, morphological MRI and biochemical T2-map** and diffusion-weighted imaging in their ability to assess differences between cartilage repair tissue after microfracture therapy and matrix-associated autologous chondrocyte transplantation: a pilot study. Osteoarthritis Cartilage 17:1219–1227

    Article  CAS  PubMed  Google Scholar 

  30. Zengerink M, Struijs PA, Tol JL, van Dijk CN (2010) Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 18:238–246

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China

      **-Liang Shang, Shi-Yi Chen, Yun-**a Li & Ying-Hui Hua

    2. Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China

      Hong-Yue Tao

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    1. **-Liang Shang
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    2. Hong-Yue Tao
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    Correspondence to Shi-Yi Chen or Ying-Hui Hua.

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    **-Liang Shang and Hong-Yue Tao have contributed equally to this work.

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    Shang, XL., Tao, HY., Chen, SY. et al. Clinical and MRI outcomes of HA injection following arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc 24, 1243–1249 (2016). https://doi.org/10.1007/s00167-015-3575-y

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