EFFECT OF WEIGHT-BEARING TIME ON MICRO-FRACTURE THERAPY FOR SMALL SIZED OSTEOCHONDRAL LESION OF TALUS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Shuyuan ^1,2 , WANG Junliang ¹

1Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;;
2Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University. Corresponding author: LIU Yujie, E-mail: liuyj301yy@yahoo.com.cn;

Corresponding author：

Keywords：

Osteochondral lesion of the talus; Micro-fracture therapy; Weight-bearing time; Joint function

DOI：

10.7507/1002-1892.20130146

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Objective To evaluate the effect of weight-bearing time on micro-fracture therapy for small sized osteochondral lesion of the talus (OLT) by comparing early weight-bearing and postponed weight-bearing. Methods Between March 2010 and September 2011, 43 patients with small sized OLT ( lt; 2 cm2) scheduled for arthroscopic micro-fracture therapy were randomly divided into early weight-bearing group (n=22) and postponed weight-bearing group (n=21). There was no significant difference in gender, age, body mass index, disease duration, disease cause, preoperative visual analogue scale (VAS) score, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score between 2 groups (P gt; 0.05). All patients of 2 groups received micro-fracture treatment under arthroscopy. Full weight bearing began under the protection of “8” figure shaped splint at immediately after operation in early weight-bearing group, and weight bearing began at 6 weeks after operation in postponed weight-bearing group. Results The size of cartilage injury was (1.24 ± 0.35) cm2 in early weight-bearing group and was (1.25 ± 0.42) cm2 in postponed weight-bearing group by arthroscopy measurement, showing no significant difference between 2 groups (t=0.09, P=0.93); and there was no significant difference in cartilage injury grading between 2 groups (Z= — 1.45, P=0.15). The follow-up time was 12-18 months (mean, 14.5 months) in 2 groups. VAS and AOFAS scores of each group at each time point after operation were all significantly improved when compared with preoperative scores (P lt; 0.05), but no significant difference was found between 2 groups at 3, 6, and 12 months after operation (P gt; 0.05). The time of returning to work in early weight-bearing group [(6.35 ± 1.93) months] was significantly shorter than that in postponed weight-bearing group [(8.75 ± 1.48) months] (t= — 4.10, P=0.00). Conclusion For patients with small sized OLT, early weight-bearing and postponed weight-bearing after micro-fracture therapy under arthroscopy have similar short-term results. But patients undergoing early weight-bearing can earlier return to work than patients undergoing postponed weight-bearing.

Citation： LI Shuyuan,WANG Junliang,QU Feng,LIU Chang,LIU Yujie,WANG Zhigang,WEI Min.. EFFECT OF WEIGHT-BEARING TIME ON MICRO-FRACTURE THERAPY FOR SMALL SIZED OSTEOCHONDRAL LESION OF TALUS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(6): 657-661. doi: 10.7507/1002-1892.20130146 Copy

1.	Orr JD, Dutton JR, Fowler JT. Anatomic location and morphology of symptomatic, operatively treated osteochondral lesions of the talus. Foot Ankle Int, 2012, 33(12): 1051-1057.
2.	Giannini S, Buda R, Battaglia M, et al. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med, 2013, 41(3): 511-518.
3.	Kim YS, Park EH, Kim YC, et al. Factors associated with the clinical outcomes of the osteochondral autograft transfer system inosteochondral lesions of the talus: second-look arthroscopic evaluation. Am J Sports Med, 2012, 40(12): 2709-2719.
4.	刘畅, 施新革, 刘玉杰, 等. 关节镜手术与非手术治疗踝关节退行性骨关节病的疗效比较. 中国修复重建外科杂志, 2012, 26(11): 1315-1318.
5.	Kok AC, Dunnen SD, Tuijthof GJ, et al. Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg, 2012, 51(6): 777-782.
6.	Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int, 2005, 26(8): 583-589.
7.	Ferkel RD, Zanotti RM, Komenda GA, et al. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med, 2008, 36(9): 1750-1762.
8.	Kuni B, Schmitt H, Chloridis D, et al. Clinical and MRI results after microfracture of osteochondral lesions of the talus. Arch Orthop Trauma Surg, 2012, 132(12): 1765-1771.
9.	Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy, 2006, 22(4): 367-374.
10.	Gobbi A, Francisco RA, Lubowitz JH, et al. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy, 2006, 22(10): 1085-1092.
11.	Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy, 2008, 24(1): 106-112.
12.	Lee DH, Lee KB, Jung ST, et al. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med, 2012, 40(9): 2023-2028.
13.	Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc, 2005, 13(3): 213-221.
14.	Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy, 2005, 21(2): 152-158.
15.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
16.	Cheng MS, Ferkel RD, Applegate GR. Osteochondral lesions of the talus: a radiologic and surgical comparison. Proceeding of Annual Meeting of the American Academy of Orthopedic Surgeons. New Orleans: [S.n], 1995.
17.	Backus JD, Viens NA, Nunley JA. Arthroscopic treatment of osteochondral lesions of the talus: microfracture and drilling versus debridement. J Surg Orthop Adv, 2012, 21(4): 218-222.
18.	Lee KB, Bai LB, Chung JY, et al. Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2): 247-253.
19.	Becher C, Driessen A, Hess T, et al. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 656-663.
20.	Mithoefer K, Williams RJ 3rd, Warren RF, et al. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med, 2006, 34(9): 1413-1418.
21.	Hensley CP, Sum J. Physical therapy intervention for a former power lifter after arthroscopic microfracture procedure for grade iv glenohumeral chondral defects. Int J Sports Phys Ther, 2011, 6(1): 10-26.

1. Orr JD, Dutton JR, Fowler JT. Anatomic location and morphology of symptomatic, operatively treated osteochondral lesions of the talus. Foot Ankle Int, 2012, 33(12): 1051-1057.
2. Giannini S, Buda R, Battaglia M, et al. One-step repair in talar osteochondral lesions: 4-year clinical results and t2-mapping capability in outcome prediction. Am J Sports Med, 2013, 41(3): 511-518.
3. Kim YS, Park EH, Kim YC, et al. Factors associated with the clinical outcomes of the osteochondral autograft transfer system inosteochondral lesions of the talus: second-look arthroscopic evaluation. Am J Sports Med, 2012, 40(12): 2709-2719.
4. 刘畅, 施新革, 刘玉杰, 等. 关节镜手术与非手术治疗踝关节退行性骨关节病的疗效比较. 中国修复重建外科杂志, 2012, 26(11): 1315-1318.
5. Kok AC, Dunnen SD, Tuijthof GJ, et al. Is technique performance a prognostic factor in bone marrow stimulation of the talus? J Foot Ankle Surg, 2012, 51(6): 777-782.
6. Becher C, Thermann H. Results of microfracture in the treatment of articular cartilage defects of the talus. Foot Ankle Int, 2005, 26(8): 583-589.
7. Ferkel RD, Zanotti RM, Komenda GA, et al. Arthroscopic treatment of chronic osteochondral lesions of the talus: long-term results. Am J Sports Med, 2008, 36(9): 1750-1762.
8. Kuni B, Schmitt H, Chloridis D, et al. Clinical and MRI results after microfracture of osteochondral lesions of the talus. Arch Orthop Trauma Surg, 2012, 132(12): 1765-1771.
9. Bae DK, Yoon KH, Song SJ. Cartilage healing after microfracture in osteoarthritic knees. Arthroscopy, 2006, 22(4): 367-374.
10. Gobbi A, Francisco RA, Lubowitz JH, et al. Osteochondral lesions of the talus: randomized controlled trial comparing chondroplasty, microfracture, and osteochondral autograft transplantation. Arthroscopy, 2006, 22(10): 1085-1092.
11. Chuckpaiwong B, Berkson EM, Theodore GH. Microfracture for osteochondral lesions of the ankle: outcome analysis and outcome predictors of 105 cases. Arthroscopy, 2008, 24(1): 106-112.
12. Lee DH, Lee KB, Jung ST, et al. Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus. Am J Sports Med, 2012, 40(9): 2023-2028.
13. Gobbi A, Nunag P, Malinowski K. Treatment of full thickness chondral lesions of the knee with microfracture in a group of athletes. Knee Surg Sports Traumatol Arthrosc, 2005, 13(3): 213-221.
14. Marder RA, Hopkins G Jr, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy, 2005, 21(2): 152-158.
15. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
16. Cheng MS, Ferkel RD, Applegate GR. Osteochondral lesions of the talus: a radiologic and surgical comparison. Proceeding of Annual Meeting of the American Academy of Orthopedic Surgeons. New Orleans: [S.n], 1995.
17. Backus JD, Viens NA, Nunley JA. Arthroscopic treatment of osteochondral lesions of the talus: microfracture and drilling versus debridement. J Surg Orthop Adv, 2012, 21(4): 218-222.
18. Lee KB, Bai LB, Chung JY, et al. Arthroscopic microfracture for osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc, 2010, 18(2): 247-253.
19. Becher C, Driessen A, Hess T, et al. Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up. Knee Surg Sports Traumatol Arthrosc, 2010, 18(5): 656-663.
20. Mithoefer K, Williams RJ 3rd, Warren RF, et al. High-impact athletics after knee articular cartilage repair: a prospective evaluation of the microfracture technique. Am J Sports Med, 2006, 34(9): 1413-1418.
21. Hensley CP, Sum J. Physical therapy intervention for a former power lifter after arthroscopic microfracture procedure for grade iv glenohumeral chondral defects. Int J Sports Phys Ther, 2011, 6(1): 10-26.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF WEIGHT-BEARING TIME ON MICRO-FRACTURE THERAPY FOR SMALL SIZED OSTEOCHONDRAL LESION OF TALUS

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