Abstract
BackgroundThis study aims to compare clinical outcomes of distraction arthroplasty alone versus combined with arthroscopic microfracture in treating post-traumatic ankle arthritis.MethodsThe study cohort consisted of 96 patients (96 ankles) who underwent distraction arthroplasty alone or combined with arthroscopic microfracture between May 2005 and April 2012. Patients were divided into the distraction group (n = 46) and the combined group (n = 50). The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analog scale (VAS), and ankle activity score (AAS) were used to compare the clinical outcomes between groups. Arthritis severity was assessed on the radiograph.ResultsAt the mean follow-up period of 30.8 ± 3.1 and 31.4 ± 3.6 months, respectively, no severe complications occurred and no further surgical interventions for symptomatic arthritis were required in both groups. The AOFAS scores improved significantly in the combined group than in the distraction group (59.0 ± 4.7 and 58.0 ± 4.9 preoperatively versus 85.0 ± 4.9 and 88.9 ± 5.4 at final visit, P < 0.001). The AAS scores were also significantly higher in the combined group (3.6 ± 1.1 and 3.3 ± 1.0 preoperatively versus 6.5 ± 1.1 and 7.1 ± 1.3 at final visit, P = 0.009). Pain was significantly alleviated in the combined group by the VAS scores (6.4 ± 0.9 and 6.7 ± 0.9 preoperatively versus 2.3 ± 0.8 and 2.0 ± 0.7 at final visit, P = 0.040). The combined group achieved better radiographic arthritis severity decrease than the distraction group (P = 0.012).ConclusionsCompared to distraction arthroplasty alone, distraction arthroplasty combined with arthroscopic microfracture can offer better functional recovery, pain relief, and ankle arthritis resolution for treating post-traumatic ankle arthritis.
Highlights
This study aims to compare clinical outcomes of distraction arthroplasty alone versus combined with arthroscopic microfracture in treating post-traumatic ankle arthritis
Baseline characteristics The distraction group consisted of 18 men and 26 women with a mean age of 43.6 ± 9.3 years and mean follow-up duration of 30.8 ± 3.1 months
The most important finding of the present study was that compared to distraction arthroplasty alone, distraction arthroplasty with arthroscopic microfracture would result in improved postoperative functional recovery, pain relief, and arthritis resolution, as determined by American Orthopaedic Foot and Ankle Society (AOFAS), visual analog scale (VAS), and ankle activity score (AAS) score as well as radiographic ankle arthritis grades
Summary
This study aims to compare clinical outcomes of distraction arthroplasty alone versus combined with arthroscopic microfracture in treating post-traumatic ankle arthritis. Post-traumatic arthritis is a clinically very common disease accounting for 65–80% of secondary ankle arthritis, which can cause severe pain and limited joint mobility. Post-traumatic arthritis is characterized by articular cartilage damage to varying degrees [3]. Bone marrow stimulation procedures, such as microfracture and multiple drilling, have the ability of recruiting potential mesenchymal stem cells to repair damaged articular cartilage, which is helpful for treatment of ankle arthritis [5]. Many previous studies demonstrated good-to-excellent clinical results of distraction arthroplasty on ankle arthritis, after which patients achieved good functional outcomes and pain relief [7, 8]. No studies have reported outcome comparison between distraction arthroplasty with microfracture and distraction arthroplasty alone on posttraumatic arthritis
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