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:
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 (plasmarich 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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