Comparison of arthroscopic microfracture and autologous bone filling and fixation in treatment of talar cartilage defects

Objective To evaluate the clinical efficacy of arthroscopic autogenous bone filling and arthroscopic microfracture in the treatment of talus cartilage defects. Methods The patients who underwent arthroscopic surgery at the General Hospital of Jizhong Fengfeng Energy Group from January 2012 to June 2016 due to talus cartilage defects were enrolled according to the inclusion-exclusion criteria. Inclusion criteria: age at 18-70 years, the defect greater than 10 mm in diameter which can be surgical repaired. Exclusion criteria: history of rheumatoid arthritis and ankle joint diseases. A total of 26 patients were enrolled and divided into the observation group (n=11) and the control group (n=15) by the random number method. Arthroscopic autogenous bone filling and arthroscopic microfracture were performed respectively. Chi-square test and t-test were used to analyze and compare the American Orthopaedic Foot and Ankle Association (AOFAS) score and numerical rating scale (NRS), as well as the imaging evaluation. Results There was no significant difference in preoperative data between the two groups (P > 0.05). Both groups completed follow-up and CT review one year after surgery, and partially completed MRI review. There was no significant difference in AOFAS scores and NRS scores between the observation group and the control group (P>0.05). Compared to pre-operation, NRS scores of both groups were significantly improved(the observation group t =14.65, 7.99; the control group t =18.59, 5.57; all P <0.01). MRI results showed a significant difference in the smooth level of the subchondral bone between the two groups (χ2=7.23, P <0.01). After arthroscopic microfracture, 12 patients showed uneven cartilage surface, three patients showed cartilage surface flattening, three patients under autologous bone filling under arthroscopy showed cartilage surface unevenness, and eight patients showed cartilage surface smoothing. Conclusion Both groups of surgical methods can obtain satisfactory clinical results, and are suitable for further clinical promotion. Key words: Arthroscopy; Cartilage; Autografts