Platelet-rich
plasma or hyaluronate in the management of osteochondral lesions of the talus.
Source
Department
of Orthopedic Surgery, Meir University Hospital, 59 Tchernichovsky Street,
Kfar-Saba, Israel. omer@extremegate.com
Abstract
BACKGROUND:
Nonoperative
options for osteochondral lesions (OCLs) of the talar dome are limited, and
currently, there is a lack of scientific evidence to guide management.
PURPOSE:
To evaluate
the short-term efficacy and safety of platelet-rich plasma (PRP) compared with
hyaluronic acid (HA) in reducing pain and disability caused by OCLs of the
ankle.
STUDY
DESIGN:
Randomized
controlled trial; Level of evidence, 2.
METHODS:
Thirty-two patients
aged 18 to 60 years were allocated to a treatment by intra-articular injections
of either HA (group 1) or PRP (plasma rich in growth factors [PRGF] technique,
group 2) for OCLs of the talus. Thirty OCLs, 15 per arm, received 3 consecutive
intra-articular therapeutic injections and were followed for 28 weeks. The
efficacy of the injections in reducing pain and improving function was assessed
at each visit using the American Orthopaedic Foot and Ankle Society (AOFAS)
Ankle-Hindfoot Scale (AHFS); a visual analog scale (VAS) for pain, stiffness,
and function; and the subjective global function score.
RESULTS:
The
majority of patients were men (n = 23; 79%). The AHFS score improved from 66
and 68 to 78 and 92 in groups 1 and 2, respectively, from baseline to week 28
(P < .0001), favoring PRP (P < .05). Mean VAS scores (1 = asymptomatic,
10 = severe symptoms) decreased for pain (group 1: 5.6 to 3.1; group 2: 4.1 to
0.9), stiffness (group 1: 5.1 to 2.9; group 2: 5.0 to 0.8), and function (group
1: 5.8 to 3.5; group 2: 4.7 to 0.8) from baseline to week 28 (P < .0001),
favoring PRP (P < .05 for stiffness, P < .01 for function, P > .05 for
pain). Subjective global function scores, reported on a scale from 0 to 100
(with 100 representing healthy, preinjury function) improved from 56 and 58 at
baseline to 73 and 91 by week 28 for groups 1 and 2, respectively (P < .01
in favor of PRP).
CONCLUSION:
Osteochondral
lesions of the ankle treated with intra-articular injections of PRP and HA
resulted in a decrease in pain scores and an increase in function for at least
6 months, with minimal adverse events. Platelet-rich plasma treatment led to a
significantly better outcome than HA.
Source:
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