Abstract
Introduction: Osteochondral lesions of talus are rarely seen. The aim of our study is to report the early functional results of the treatment of the talus osteochondral lesions with Arthroscopic microfracture technique and of the intraarticular hyaluronan injection postoperatively.
Material and Methods: 15 patients (8 men, 7 women) are included in this is a prospective, randomized clinical study between the years January 2003 and February 2006. The mean age is 39 +/−11 SD. The patients had chronic ankle pain. 7 patient had right, 8 patient had left ankle pain. Their MRI revealed osteochondral lesion on the medial and central part of the talus. All the patients are treated with arthroscopic debridement and microfracture. The patients are mobilized non-weight bearing on postoperative first day and full-weight bearing on postoperative third week. As a second part of the study, 6 patients randomized by envelope are selected to apply intraarticular Hyaluronan (Adant) injection. The injection is performed half dose by starting from postoperative third week, weekly, for 3 weeks. The foot and ankle function index is used for the functional evaluation and the pain category of the Freiburg index is used for the pain evaluation of the patients. The surveys are filled by all the patients preoperatively and ninth week postoperatively. The follow-up period is 6 months.
Findings: 10 patients have previous history of ankle trauma. For the biostatistics evaluation of the data, paired t-test is used. The increase in the Freiburg pain index is observed in the evaluation preoperative and postoperative data (p< 0.05). The effect of intraarticular Hyaluronan injection is found insignificant statistically (p> 0.05). The Foot and Ankle Index scores revealed a significant clinical improvement only in the categories; walking 4 blocks and walking fast (p< 0.05). In the injection group, the only significant improvement is observed in the category of walking 4 blocks (p< 0.05).
Results and Discussion: There are different developing modalities in the treatment of talus osteochondral lesions. As a result of our study, arthroscopic debridement and microfracture is found to decrease the pain and to increase the functional performance. The effect of intraarticular Hyaluronan injection is found to be insignificant compared with the non-injection group. Our patient number is small and follow-up period is short. Multi-centered, prospective and randomized studies are needed for further evaluations.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
