SLR - March 2023 - Matthew D Kennedy, DPM
Title: Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive AnklesReference: Fu S, Yang K, Li X, Chen C, Mei G, Su Y, Xue J, Zou J, Zhang J, Shi Z. Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive Ankles. Orthop J Sports Med. 2022 Oct 14;10
Level of Evidence: Cohort Study, Level 2
Scientific Literature Review
Reviewed By: Matthew D Kennedy, DPM
Residency Program: San Francisco Bay Area Foot and Ankle Residency Program
Podiatric Relevance: Arthroscopic microfracture is still an area of debate in foot and ankle surgery literature. There are several bodies of work with inconsistent evidence to promote or disprove efficacy of microfracture. There is also still an ongoing debate about adjunctive therapies used in combination with microfracture for osteochondral lesions of the talus (OLT).
Methods: Level 2 prospective cohort study of 355 patients from a single institution who underwent arthroscopic microfracture for OLT from May 2011 to May 2015. Primary outcome was 5-year AOFAS score. Patients received intraoperative platelet rich plasma (PRP) or hyaluronic acid (HA) as per surgeon preference. A small cohort of patients received one or several follow up PRP injections postoperatively, with a minimum of 3 months between injections.
Results: In the 355-patient cohort, 88 patients received intraoperative HA injections while 95 patients received intraoperative PRP injections. In the postoperative course, 148 patients received 1-2 PRP injections, while 51 patients received greater than 3 PRP injections. Five-year AOFAS scores were associated with number of PRP injections, BMI at baseline, and mean BMI change from baseline. The authors also note that the group with serial PRP injections had less decline in their magnetic resonance observation of cartilage repair tissue (MOCART) scores over the follow up period, however statistical analysis of MOCART was not included.
Conclusions: Overall this article provides a good overview of midrange term follow up for adjunctive therapies for microfracture for OLT. The authors do a good analysis of their own study methodology limitations and do admit to underpowered nature of their data. Of note, it is interesting that PRP vs No PRP group had no significance yet increasing number of PRP injections was significant. The serial PRP injection group was also the smallest subgroup in the study population, which could confound the results. Further research may be warranted into the efficacy of postoperative intraarticular injection courses for long term OLT management. This study acts as a pertinent reminder to clinicians of the power of weight loss in dealing with chronic ankle pain. Further partnership with our nutrition/endocrinology specialists to help provide outpatients a whole health approach.