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

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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