Summary:
No studies have compared outcomes between arthroscopic subchondral drilling and microfracture. The purpose of this study was to compare the clinical outcomes of the two methods and to evaluate prognostic factors affecting the outcomes. The arthroscopic subchondral drilling and microfracture techniques of bone marrow stimulation showed similar good functional outcomes. Both techniques appear to be effective and reliable methods. The limitation is that this study presented results only on clinical outcomes, suggesting that the healing status of the lesion was not directly assessed through MRI or arthroscopy.
Introduction
Arthroscopic bone marrow stimulation is a frequently used to treat symptomatic osteochondral lesions of the talus. There are two common methods are used for bone marrow stimulation techniques such as subchondral drilling and microfracture. However, no studies have compared outcomes between these two methods. The purpose of this study was to compare the clinical outcomes of the two methods for osteochondral lesions of the talus and to evaluate prognostic factors affecting the outcomes.
Methods
Ninety patients (90 ankles) who underwent arthroscopic bone marrow stimulation for osteochondral lesions of the talus constituted the study cohort. The 90 ankles were divided into two groups: a drilling group (40 ankles) and a microfracture group (50 ankles). Each group was matched for age and gender. Both groups were comparable with regard to preoperative demographic data. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, a visual analog scale (VAS), and Ankle Activity Score (AAS) were used to compare clinical outcomes, during the mean follow-up period of 43 months.
Results
Mean AOFAS scores were 66.0 points in the drilling group and 66.2 points in the microfracture group preoperatively and these improved to 91.8 points and 92.2 points at the final follow-up visit, respectively. Mean VAS scores improved from 7.0points preoperatively to 2.3 points at the final follow-up in the drilling group, and from 7.4 points preoperatively to 1.9 points in the microfracture group. Mean AAS in the drilling and microfracture groups improved from 4.6 and 3.9 preoperatively to 6.2 and 6.2 at final follow-up, respectively. No significant differences were found between the two groups in terms of AOFAS scores, VAS, and AAS.
Conclusion
The arthroscopic subchondral drilling and microfracture techniques of bone marrow stimulation showed similar good functional outcomes. Both techniques appear to be effective and reliable methods for the treatment of osteochondral lesions of the talus.