A comparison between arthroscopic drilling and microfracturing technique in treatment of osteochondral lesions of the talus

Abstract

Objective To compare the outcomes of bone marrow stimulation techniques -- drilling by a Kirschner needle versus microfracturing technique in the treatment of small osteochondral lesions of the talus. Methods From February 2014 to June 2017, 57 patients were treated at Department of Orthopaedics, Sun Yat-sen Memorial Hospital for small osteochondral lesions of the talus. Of them, 26 were treated by arthroscopic drilling with a Kirschner needle. They were 15 males and 11 females, aged from 20 to 57 years. The areas of osteochondral lesion ranged from 0.6 to 1.4 cm2. By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films, there were 9 cases of stage Ⅰ, 8 cases of stage Ⅱ, 6 cases of stage Ⅲ and 3 cases of stage Ⅳ. The other 31 patients of them were treated by arthroscopic microfracturing technique. They were 17 males and 14 females, aged from 24 to 55 years. The areas of osteochondral lesion ranged from 0.5 to 1.5 cm2. By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films, there were 10 cases of stage Ⅰ, 11 cases of stage Ⅱ, 8 cases of stage Ⅲ and 2 cases of stage Ⅳ. The 2 groups were compared in terms of visual analogue scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, the ankle activity score (AAS) and the Berndt & Harty staging of osteochondral lesions based on ankle X-ray films at the final follow-up. Results All the 57 patients were followed up for 13 to 27 months. The VAS, AOFAS and AAS scores and Berndt & Harty stages at the final follow-up were significantly improved in all the patients compared with their preoperative values (P 0.05). There was no significant difference between the 2 groups either in the excellent and good rate by the AOFAS ankle-hindfoot scoring [88.5% (23/26) versus 90.3% (28/31)] at the final follow-up (χ2=0.052, P=0.820). Conclusion In the treatment of small osteochondral lesions of the talus, both arthroscopic drilling with a Kirschner needle and microfracturing technique can achieve satisfactory short-term curative effects, but the long-term effects need to be further studied. Key words: Ankle joint; Cartilage; Wounds and injuries; Arthroscopy, subchondral