İzole Medial Talar Osteokondral Lezyonlarda Artroskopik Mikrokırık Sonrası Tek Doz Yüksek Moleküler Ağırlıklı Hyaluronik Asit Enjeksiyonun Klinik Sonuçlara Pozitif Etkisi

Year 2019, Volume: 11 Issue: 3, 460 - 467, 23.10.2019

Mehmet Arıcan Erdem Değirmenci

Abstract

Amaç: Artroskopik mikrokırık
sonrası talusun izole medial osteokondral lezyonlarının (OCL) tedavisinde tek
doz eklem içi yüksek moleküler ağırlıklı hyaluronik asit (HMW-HA)
enjeksiyonunun etkinliğinin araştırılması amaçlanmıştır.

Gereç
ve Yöntem: Çalışmaya, 2014-2017 yılları arasında
talusun medial OCLs'leri tanısıyla tedavi edilen toplam 39 hasta dahil edildi.
Hastalar, mikro kırık sonrası  4 ml
HMW-HA (22 mg / ml) enjeksiyonu uygulanan 18 hasta (grup 1) ve  mikro kırık uygulanmış, ancak enjeksiyon
yapılmayan 21 hasta (grup 2) olmak üzere iki gruba ayrıldı. Klinik ve
fonksiyonel sonuçlar tedaviden hemen önce, tedavinin 6. ayında ve son kontrolde
Görsel Analog Skalası (VAS) ve Amerikan Ortopedik Ayak ve Ayak Bileği
Skorlaması (AOFAS)  ile
değerlendirildi. 

 Bulgular: Ortalama AOFAS
skoru 1. ve 2. gruplarda sırasıyla 45.61 ± 14.71'den 95.11 ± 5.02 (p = 0.0001)
ve 41.81 ± 13.83'ten 90.29 ± 7.43'e (p = 0.0001) yükseldi. Benzer şekilde,
ortalama VAS skoru 1. ve 2. gruplarda sırasıyla 8.72 ± 1.23'ten 2.11 ± 1.45'e
(p = 0.0001) ve 9.05 ± 0.80'den 3.67 ± 2.22'ye (p = 0.0001) düşmüştür. Ek olarak,
grup 1'deki ortalama AOFAS skoru, son kontrolde grup 2'den (p = 0.025) daha
yüksekti ve grup 1'deki ortalama VAS skoru ameliyat sonrası 6. ayda ve son
kontrolde grup 2'den  daha düşüktü(p =
0.0001, p = 0.015, sırasıyla).

Sonuç: Her iki tedavi protokolünün
de ağrı ve fonksiyon kaybında azalmaya katkısı olmasına rağmen, artroskopik
mikrokırık sonrası tek doz HMW-HA enjeksiyonu önemli ölçüde daha etkili
olmuştur.

Keywords

Ayak Bileği Yaralanmaları, Kıkırdak, Artroskopi, Hyaluronik Asit

Improved Clinical Outcomes After Arthroscopic Microfracture in Isolated Medial Talar Osteochondral Lesions with a Single Injection of High Molecular Weight Hyaluronic Acid

Abstract

Objective: To investigate the efficacy of a single intra-articular injection of
high molecular weight hyaluronic acid (HMW-HA) for treating isolated medial
osteochondral lesions (OCLs) of the talus following arthroscopic microfracture.

Methods:
A total of 39
patients, treated between 2014–2017 for medial OCLs of the talus, were enrolled in the study. Patients were split
into two groups: group 1, consisting of 18 patients who received a single of 4
ml of HMW-HA (22 mg/ml) injection following microfracture; and group 2,
consisting of 21 patients who underwent microfracture but did not receive an
injection. Functional and clinical outcomes were assessed at baseline, 6
months, and at a final follow-up using a visual analogue scale (VAS) and the American Orthopaedic Foot and
Ankle Society Ankle-Hindfoot Scale (AOFAS).

Results: The mean AOFAS score increased in groups 1 and 2, from 45.61±14.71 to 95.11±5.02 (p=0.0001) and 41.81±13.83 to 90.29±7.43 (p=0.0001),
respectively. Similarly, the mean VAS score decreased in groups 1 and 2 from 8.72±1.23 to 2.11±1.45 (p=0.0001) and 9.05±0.80 to 3.67±2.22 (p=0.0001),
respectively. In addition, the mean AOFAS score in group 1 was higher than in
group 2 (p=0.025) at the final follow-up, and the mean VAS score in group 1 was
lower than that of group 2 (p=0.0001, p=0.015, respectively) at 6 months
postoperatively and the final follow-up.

Conclusions: Although both treatments for isolated medial OCL of the talus were
associated with a decrease in pain and less loss of function, single-dose HMW-HA injection following arthroscopic microfracture was significantly
more effective.

Keywords

Ankle Injuries, Cartilage, Arthroscopy, Hyaluronic Acid

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