Combining arthroscopic microfracture, autologous bone grafting, and PRP injection for the treatment of Hepple IV-V stage osteochondral lesions of talus.

PURPOSE: The purpose of this study was to evaluate the clinical and radiological outcomes of arthroscopic autologous cancellous bone grafting combined with platelet-rich plasma (PRP) injection in patients with osteochondral lesions of talus (OLT).

METHODS

This retrospective study was conducted at Xuzhou Renci Hospital from January 2020 to June 2023, including patients was diagnosed with Hepple stage IV or V OLT by magnetic resonance imaging (MRI). All patients underwent arthroscopic debridement and microfracture, autologous cancellous bone grafting, and PRP injection. Preoperative and postoperative assessments were performed using the visual analogue scale (VAS) for pain, the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Kofoed score for ankle function. Radiological outcomes were evaluated by the magnetic resonance observation of cartilage repair tissue (MOCART). A paired sample t-test was used for statistical analysis to compare preoperative and postoperative data, with a P-value < 0.05 was considered statistically significant.

RESULTS

Of the 21 patients with single cystic OLT with a complete set of follow-up data, there were 13 males and 8 females, with a mean age of 49.76 ± 10.24 years, a mean follow-up time of 16.81 ± 2.46 months and a mean illness duration of 12.47 ± 5.51 months. The mean VAS had significant (P < 0.001 decreased from 6 (5, 6) preoperatively to 1 (1, 1.5) at the last follow-up. The mean AOFAS and Kofoed scores significantly (P < 0.001) improved from 63.24 ± 9.81 preoperatively to 89.33 ± 5.47 at the last follow-up and from 28.43 ± 8.77 to 89.14 ± 5.19, respectively. All patients underwent follow-up MRI with a mean MOCART score of 69.10 ± 10.36 at last follow-up. No complications occurred in all patients, and no adverse reactions were observed at the donor knee site.

CONCLUSION

Arthroscopic microfracture, autologous cancellous bone grafting and PRP injection is a promising technique for treating OLT, with favorable short-term pain relief, functional improvement and a high patient satisfaction rate for Hepple IV-V OLT. It is necessary to conduct large-scale, prospective, randomized controlled trials to further validate the long-term efficacy and safety of this procedure.Keywords Osteochondral lesions of talus (OLT), Arthroscopy, autologous cancellous bone grafting, platelet-rich plasma (PRP).