The efficacy of microfracture combined with extracorporeal shock wave therapy and hyaluronic acid injections for treating osteochondral lesion of the talus and its impact on early rehabilitation: A retrospective case study.

IF 1.3 4区 医学 Q2 Medicine
Jia Zheng, Changgui Zhang, Liu Yang, Xin Chen, Xiaojun Duan
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Abstract

Arthroscopic microfracture is a conventional technique for treating osteochondral lesions of the talus (OLT) that are less than 1.5 cm2 in area. Since the defects are filled with fibrocartilage after repair, some patients experience local pain postoperatively, subsequently affecting early rehabilitation. This study evaluates efficacy of combining microfracture with extracorporeal shock wave therapy (ESWT) and intra-articular hyaluronic acid (HA) injections for treating OLT and its impact on early rehabilitation. Patients were divided into Group A with patients experiencing walking pain at full weight-bearing 4-6 weeks after surgery, Group B with those experiencing pain 6-8 weeks after surgery. ESWT targeted the cartilage injury area and other pressure pain points, delivered weekly for five sessions. After each session, a 2.0-2.5 mL intra-articular injection of HA was administered to the ankle joint. Assessments were made before ESWT began, six weeks after the final treatment, and at the final follow-up. The primary outcome was the Visual Analogue Scale (VAS) pain score, and the secondary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Forty-two patients were included, with a pre-treatment VAS score of 7.16 ± 1.54 decreasing to 2.11 ± 1.09 at the final follow-up, and the AOFAS score increasing from 67.78 ± 13.87 to 93.54 ± 4.10, showing significant differences (p < 0.05). Group A and B showed no significant differences in VAS and AOFAS scores across each time points (p > 0.05). ESWT synergizes with HA injections to significantly reduce post-microfracture weight-bearing pain and promote early joint function recovery.

微骨折联合体外冲击波治疗和透明质酸注射治疗距骨软骨病变的疗效及对早期康复的影响:回顾性病例研究。
关节镜下微骨折是治疗距骨软骨病变(OLT)面积小于1.5 cm²的常规技术。由于修复后缺损被纤维软骨填充,部分患者术后出现局部疼痛,影响早期康复。本研究评估微骨折联合体外冲击波治疗(ESWT)和关节内透明质酸(HA)注射治疗OLT的疗效及其对早期康复的影响。将术后4-6周出现完全负重行走疼痛的患者分为A组,术后6-8周出现疼痛的患者分为B组。ESWT针对软骨损伤区域和其他压力痛点,每周进行五次。每次疗程结束后,踝关节关节内注射2.0-2.5 mL HA。评估分别在ESWT开始前、最终治疗后6周和最终随访时进行。主要观察指标为视觉模拟评分(VAS)疼痛评分,次要观察指标为美国骨科足踝协会(AOFAS)踝关节-后足评分。纳入42例患者,治疗前VAS评分为7.16±1.54,最终随访时VAS评分为2.11±1.09,AOFAS评分由67.78±13.87上升至93.54±4.10,差异均有统计学意义(p < 0.05)。A、B组VAS、AOFAS评分各时间点差异无统计学意义(p < 0.05)。ESWT与HA注射协同作用,显著减轻微骨折后负重疼痛,促进早期关节功能恢复。临床证据等级:4级。
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来源期刊
Journal of Foot & Ankle Surgery
Journal of Foot & Ankle Surgery ORTHOPEDICS-SURGERY
CiteScore
2.30
自引率
7.70%
发文量
234
审稿时长
29.8 weeks
期刊介绍: The Journal of Foot & Ankle Surgery is the leading source for original, clinically-focused articles on the surgical and medical management of the foot and ankle. Each bi-monthly, peer-reviewed issue addresses relevant topics to the profession, such as: adult reconstruction of the forefoot; adult reconstruction of the hindfoot and ankle; diabetes; medicine/rheumatology; pediatrics; research; sports medicine; trauma; and tumors.
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