SLR - May 2014 - Tiffany K. Hoh
Reference: Guney A, Akar M, Karaman I, Oner M, Guney B. Clinical outcomes of platelet rich plasma (PRP) as an adjunct to microfracture surgery in osteochondral lesions of the talus. Knee Surg Sports Traumatol Arthrosc. 2013 Nov;167:1-6.
Scientific Literature Review
Reviewed By: Tiffany K. Hoh, DPM
Residency Program: MedStar Washington Hospital Center
Podiatric Relevance: Growth factors in platelets have been used in other medical specialties and for various conditions including tendon healing, diabetic wound healing, and repair of bony defects with varying results. Although platelet rich plasma (PRP) has been show to improve cartilage regeneration, there are no studies that assess its role in osteochondral lesions of the talus following surgical microfracture. This is a level II study on the functional outcomes of the effect of arthroscopic microfracture alone or in combination with PRP on osteochondral lesions of the talus. The authors of this study hypothesize that arthroscopic microfracture in combination with PRP would improve functional outcomes.
Methods: This study included a total of 35 patients who presented with ankle pain and were diagnosed with osteochondral lesions of the talus between June 2008 and July 2010. Those excluded were patients younger than 18 or older than 67 years of age, pregnant women, end stage ankle degenerative arthritis, lesions greater than 20 mm diameter, and septic arthritis sequelae. A detailed history and physical exam was performed, complete series of ankle x-rays were obtained, and CT and/or MRI study was performed for surgical planning. Patients were assigned an odd or even number at the initial visit to divide them into two groups. The control group was treated with arthroscopic microfracture alone while the combination group also received additional PRP administration in the ankle within 6-24 hours postoperatively. PRP was harvested in the first postoperative day consisting of a mean 1,335,500 ± 276,500 platelets/µl with a pH between 7.35 and 7.55. Patients were followed for an average 16.2 months (range 12-24 months). AAFAO, VAS, and FAAM scores were obtained preoperatively and postoperatively at least 12 months following surgery.
Results: There were 16 patients in the control group and 19 patients in the combination group. The groups did not differ in age, gender distribution, symptom duration, etiology, lesion localization, BMI, or disease state. AAFAO scores and FAAM scores in three domains (overall pain, 15-minute walking, and running function) were similar between the groups at baseline. The combination group had significantly higher VAS scores at baseline. At postoperative follow up, there was significant improvement in AOFAS and VAS scores between the groups. Improvement in VAS score was more pronounced in the combination group despite a higher pain score at baseline. Both groups showed improvements in all three domains of FAAM, however only the 15-minute walking domain was statistically significant. Postoperative neuropraxis complication occurred in one patient which resolved spontaneously.
Conclusions: Currently, surgical treatment recommendations for osteochondral lesions of the talus include arthroscopic excision with debridement and microfracture, and there is no standard method for harvesting PRP. This study suggests that PRP offers improved functional recovery when used in combination with arthroscopic microfracture of osteochondral lesions of the talus, however long-term studies are necessary to determine its efficacy.