Comparison of arthroscopic microfracture and cell-free scaffold implantation techniques in the treatment of talar osteochondral lesions
Toygun Kağan Eren1, Muhammet Baybars Ataoğlu1, Ali Eren1, Dilan Ece Geylan2, Ali Yusuf Öner2, Ulunay Kanatlı1
1Department of Orthopedics and Traumatology, Gazi University Faculty of Medicine, Ankara, Turkey
2Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
Keywords: Cartilage, magnetic resonance observation of cartilage repair tissue, microfracture, osteochondral lesion, scaffold, talus.
Objectives: This study aims to compare two single-step arthroscopic techniques, microfracture and cell-free scaffold implantation, in the treatment of talar osteochondral lesions (OCLs) clinically and radiologically.
Patients and methods: This retrospective study included 62 patients (35 males, 27 females; mean age 41±13 years; range, 15 to 65 years) diagnosed with talar OCLs between March 2007 and January 2015. Patients who were followed-up with a minimum of 24 months with lesions larger than 1 cm2 were included. Pre- and postoperative clinical evaluations were performed according to the American Orthopedic Foot and Ankle Society (AOFAS) anklehindfoot scale and radiological evaluations according to the magnetic resonance observation of cartilage repair tissue (MOCART) scale.
Results: Patients were divided into microfracture (n=22) and scaffold (n=40) groups. The mean follow-up duration was 36.1±14.9 months. The mean preoperative AOFAS score increased from 60.6±13.9 to 82.1±11.8 in the microfracture group (p<0.001) and from 53.8±13.6 to 89.4±9.9 in the scaffold group (p<0.001). The scaffold group had superior results than the microfracture group clinically (p=0.011). Clinical results were superior in younger patients (Conclusion: Both single-step arthroscopic techniques are effective and safe in the treatment of talar OCLs. The scaffold technique showed superior clinical results than the microfracture technique in short-term follow-up. Age, trauma history and gender significantly affected the treatment outcomes. The scaffold technique can be considered as a safe and good alternative particularly in the treatment of large lesions.