Diz Osteokondritis Dissekans Lezyonlarında Mozakplasti Sonrası Hyaluronik Asit Enjeksiyonunun Tedavi Sonuçları
Abstract
Amaç: Mosaikplasti dizde osteokondritis dissekans (OCD) lezyonu olan hastaların tedavisinde yaygın olarak uygulanan cerrahi bir tekniktir. Mozaikplastiden sonra eklem içi hyaluronik asit (HA) enjeksiyonunu öneren birçok çalışma olmasına rağmen, literatürde fikir birliği yoktur. Bu çalışmadaki amacımız diz osteokondral lezyonlarında uygulanan mozaikoplasti sonrası HA enjeksiyonu yapılan hastaların diz fonksiyonel sonuçlarını araştırmayı amaçladık.
Gereç ve Yöntem: Diz MR (Mağnetik Rezonans) görüntülerine göre OCD lezyonu 1 cm2 den büyük ve mozaikplasti yapılan 41 hasta (32 erkek ve 9 kadın) çalışmaya dahil edildi. Hastalar HA enjeksiyonu yapılan ve kontrol grubu olmak üzere rastgele 2 gruba ayrıldı. HA uygulanan guruba ameliyattan 2 hafta sonra diz eklemi içine 2 ml HA enjeksiyonu uygulanırken kontrol grubuna ek bir tedavi uygulanmadı. Her iki gurubun ameliyattan sonra 6. ve 12. ay daki fonksiyonel sonuçları Lysholm diz skorlama sistemi, diz ağrı seviyeleri için de Visual Analog Scale (VAS) kullanılarak karşılaştırıldı.
Bulgular: HA gurup 22 (%53.7), kontrol gurubu ise 19 (%46,3) hastadan oluşuyordu. HA gurubun yaş ortalaması 31,5 yaş ve kontrol gurubun yaş ortalaması 31,47 yaş idi. Ameliyat sonrası 6.ve 12. aydaki Lysholm skorları ve VAS değerleri HA uygulanan gurupta kontrol gurubuna göre daha yüksek olup bu fark istatistiksel olarak anlamlı idi (p<0.01).
Sonuç: Mozaikplasti sonrası diz eklemine HA uygulanması daha az ağrı olmasını ve daha iyi fonksiyonel sonuçlar elde etmemizi sağlar.
Amaç: Mosaikplasti dizde osteokondritis dissekans
(OCD) lezyonu olan hastaların tedavisinde yaygın olarak uygulanan cerrahi bir tekniktir. Mozaikplastiden sonra
eklem içi hyaluronik asit (HA) enjeksiyonunu öneren birçok çalışma olmasına
rağmen, literatürde fikir birliği yoktur. Bu çalışmadaki amacımız diz
osteokondral lezyonlarında uygulanan mozaikoplasti sonrası HA enjeksiyonu yapılan hastaların diz
fonksiyonel sonuçlarını araştırmayı amaçladık.
Gereç
ve Yöntem: Diz MR (Mağnetik Rezonans) görüntülerine
göre OCD lezyonu 1 cm2 den büyük ve mozaikplasti yapılan
41 hasta (32 erkek ve 9 kadın) çalışmaya dahil edildi. Hastalar HA
enjeksiyonu yapılan ve kontrol grubu olmak üzere rastgele 2 gruba ayrıldı. HA
uygulanan guruba ameliyattan 2 hafta sonra
diz eklemi içine 2 ml HA enjeksiyonu uygulanırken kontrol grubuna ek bir
tedavi uygulanmadı. Her iki gurubun ameliyattan sonra 6. ve 12. ay daki fonksiyonel sonuçları Lysholm diz skorlama
sistemi, diz ağrı seviyeleri için de
Visual Analog Scale (VAS) kullanılarak karşılaştırıldı.
Bulgular:
HA gurup 22 (%53.7), kontrol gurubu ise 19 (%46,3) hastadan oluşuyordu. HA
gurubun yaş ortalaması 31,5 yaş ve kontrol gurubun yaş ortalaması 31,47 yaş
idi. Ameliyat sonrası 6.ve 12. aydaki
Lysholm skorları ve VAS değerleri
HA uygulanan gurupta kontrol
gurubuna göre daha yüksek olup bu fark
istatistiksel olarak anlamlı idi (p<0.01).
Sonuç:
Mozaikplasti sonrası diz eklemine HA
uygulanması daha az ağrı olmasını ve
daha iyi fonksiyonel sonuçlar elde etmemizi sağlar.
Keywords
Supporting Institution
yok
References
- 1. Gill TJ, McCulloch PC, Glasson SS, Blanchet T, Morris EA. Chondral defect repair after the microfracture procedure: a nonhuman primate model. Am J Sports Med. 2005;33:680-685 2. Marder RA, Hopkins GJ, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy. 2005;21:152-158. 3. Prado MP, Kennedy JG, Raduan F, Nery C. Diagnosis and treatment of osteochondral lesions of the ankle: current concepts. Rev Bras Ortop.2016;51(5):489–500. 4. Murawski CD, Kennedy JG. Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2013;95(11):1045–1054. 5.Mithoefer K, Williams RJ 3rd, Warren RF, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee: a prospective cohort study. J Bone Joint Surg Am. 2005;87: 1911-1920. 6. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;(391):362-369. 7.Buckwalter JA. Articular cartilage injuries. Clin Orthop Relat Res. 2002;402:21-37. 8.Frisbie DD, Trotter GW, Powers BE, et al. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg. 1999;28:242-255. 9.Tytherleigh-Strong G, Hurtig M, Miniaci A. Intra-articular hyaluronan following autogenous osteochondral grafting of the knee. Arthroscopy. 2005;21:999-1005. 10. Greenwald RA. Oxygen radicals, inflammation, and arthritis: pathophys- iological considerations and implications for treatment. Semin Arthritis Rheum. 1991;20:219-240. 11.Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res.1985;(198):43-49. 12.Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56. 13.Alparslan B, Özkan İ, Acar U, Çullu E, Şavk ŞÖ. Diz ekleminde tam kat kıkırdak lezyonlarının tedavisinde mikrokırık yöntemi. Acta Orthop Traumatol Turc. 2007;41 Suppl 2:62-6. 14.Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16(2):83-6. 15.Magnussen RA, Dunn WR, Carey JL, Spindler KP. Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res. 2008;466(4):952-7. 16.Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med.1994;331:889-895. 17. Haklar U, Tüzüner T, Kocaoğlu B, Güven O. Mosaicplasty technique in the treatment of osteochondral lesions of the knee. Acta Orthop Traumatol Turc. 2008;42(5):344-349. 18. Robert H. Chondral repair of the knee joint using mosaicplasty. Orthop Traumatol Surg Res. 2011;97(4):418-429. 19.Asari A, Miyauchi S, Matsuzaka S, et al. Molecular weight-dependent effects of hyaluronate on the arthritic synovium. Arch Histol Cytol.1998;61:125-135. 20.Kelly MA, Kurzweil PR, Moskowitz RW. Intra-articular hyaluronans in knee osteoarthritis: rationale and practical considerations. Am J Orthop.2004;33:15-22. 21.Gerald NS, Stephen LM, Kenneth DB, Elizabeth AM. Effect of intraarticular hyaluronan injection in experimental canine osteoarthritis. Arthritis and Rheumatism. 1998;41:976-984 22. Peyron JG: Preliminary clinical assessment of Nahyaluronate injection into human arthritic joints. Pathol Biol (Paris).1974;22(8):731-736. 23. Puhl W: Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study. Osteoarthritis Cartilage.1993;1(4):233-41 24. Listrat V: Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthritis Cartilage. 1997;5(3):153-60. 25.Ozturk A, Ozdemir MR, Ozkan Y. Osteochondral autografting (mosaicplasty) in grade IV cartilage defects in the knee joint: 2- to 7-year results. Int Orthop. 2006;30:200-204. 26.Peyron JG. Intraarticular hyaluronan injections in the treatment of osteoarthritis: State-of-the-art review. J Rheumatol.1993;20:10-15. 27. Scale D, Wobig M, Wolbert W. Viscosupplementation of osteoarthritic knees with hylan: A treatment schedule study. Ther Res. 1994;55:220-232.
Treatment outcomes of mosaicplasty followed by postoperative hyaluronic acid injection in patients with osteochondritis dissecans (OCD) of the knee
Abstract
Aim: Mosaicplasty is a common surgical technique performed in patients with osteochondritis dissecans (OCD) of the knee. In the present study, we aimed to investigate the effectivity of mosaicplasty followed by intraarticular hyaluronic acid (HA) injection on the functional outcomes of the knee joint in patients with osteochondral lesions of the knee.
Methods: The retrospective study included 41 patients (32 men and 9 women) that underwent mosaicplasty due to the detection of an OCD lesion larger than 1 cm2 on magnetic resonance imaging (MRI). The patients were randomly divided into HA (n=22) and control (n=19) groups. The HA group received 2 ml of HA injection at two weeks after surgery and the control group received no additional treatment. At postoperative months 6 and 12, functional outcomes of the patients were graded using the Lysholm knee score and pain intensity was assessed using Visual Analog Scale (VAS) in both groups.
Results: The HA group included 22 (53.7%) and the control group included 19(46.3%) patients. The mean age was 31.5 in the HA group and 31.47 years in the control group. The Lysholm scores at postoperative months 6 and 12 were significantly higher in the HA group compared to the control group (p<0.01). Similarly, the VAS scores at postoperative months 6 and 12 were significantly higher in the HA group compared to the control group (p<0.01).
Conclusion: The administration of mosaicplasty followed by instant intraarticular HA injection led to better clinical outcomes and less postoperative pain
Keywords
References
- 1. Gill TJ, McCulloch PC, Glasson SS, Blanchet T, Morris EA. Chondral defect repair after the microfracture procedure: a nonhuman primate model. Am J Sports Med. 2005;33:680-685 2. Marder RA, Hopkins GJ, Timmerman LA. Arthroscopic microfracture of chondral defects of the knee: a comparison of two postoperative treatments. Arthroscopy. 2005;21:152-158. 3. Prado MP, Kennedy JG, Raduan F, Nery C. Diagnosis and treatment of osteochondral lesions of the ankle: current concepts. Rev Bras Ortop.2016;51(5):489–500. 4. Murawski CD, Kennedy JG. Operative treatment of osteochondral lesions of the talus. J Bone Joint Surg Am. 2013;95(11):1045–1054. 5.Mithoefer K, Williams RJ 3rd, Warren RF, et al. The microfracture technique for the treatment of articular cartilage lesions in the knee: a prospective cohort study. J Bone Joint Surg Am. 2005;87: 1911-1920. 6. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;(391):362-369. 7.Buckwalter JA. Articular cartilage injuries. Clin Orthop Relat Res. 2002;402:21-37. 8.Frisbie DD, Trotter GW, Powers BE, et al. Arthroscopic subchondral bone plate microfracture technique augments healing of large chondral defects in the radial carpal bone and medial femoral condyle of horses. Vet Surg. 1999;28:242-255. 9.Tytherleigh-Strong G, Hurtig M, Miniaci A. Intra-articular hyaluronan following autogenous osteochondral grafting of the knee. Arthroscopy. 2005;21:999-1005. 10. Greenwald RA. Oxygen radicals, inflammation, and arthritis: pathophys- iological considerations and implications for treatment. Semin Arthritis Rheum. 1991;20:219-240. 11.Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res.1985;(198):43-49. 12.Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45-56. 13.Alparslan B, Özkan İ, Acar U, Çullu E, Şavk ŞÖ. Diz ekleminde tam kat kıkırdak lezyonlarının tedavisinde mikrokırık yöntemi. Acta Orthop Traumatol Turc. 2007;41 Suppl 2:62-6. 14.Steadman JR, Miller BS, Karas SG, Schlegel TF, Briggs KK, Hawkins RJ. The microfracture technique in the treatment of full-thickness chondral lesions of the knee in National Football League players. J Knee Surg. 2003;16(2):83-6. 15.Magnussen RA, Dunn WR, Carey JL, Spindler KP. Treatment of focal articular cartilage defects in the knee: a systematic review. Clin Orthop Relat Res. 2008;466(4):952-7. 16.Brittberg M, Lindahl A, Nilsson A, Ohlsson C, Isaksson O, Peterson L. Treatment of deep cartilage defects in the knee with autologous chondrocyte transplantation. N Engl J Med.1994;331:889-895. 17. Haklar U, Tüzüner T, Kocaoğlu B, Güven O. Mosaicplasty technique in the treatment of osteochondral lesions of the knee. Acta Orthop Traumatol Turc. 2008;42(5):344-349. 18. Robert H. Chondral repair of the knee joint using mosaicplasty. Orthop Traumatol Surg Res. 2011;97(4):418-429. 19.Asari A, Miyauchi S, Matsuzaka S, et al. Molecular weight-dependent effects of hyaluronate on the arthritic synovium. Arch Histol Cytol.1998;61:125-135. 20.Kelly MA, Kurzweil PR, Moskowitz RW. Intra-articular hyaluronans in knee osteoarthritis: rationale and practical considerations. Am J Orthop.2004;33:15-22. 21.Gerald NS, Stephen LM, Kenneth DB, Elizabeth AM. Effect of intraarticular hyaluronan injection in experimental canine osteoarthritis. Arthritis and Rheumatism. 1998;41:976-984 22. Peyron JG: Preliminary clinical assessment of Nahyaluronate injection into human arthritic joints. Pathol Biol (Paris).1974;22(8):731-736. 23. Puhl W: Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study. Osteoarthritis Cartilage.1993;1(4):233-41 24. Listrat V: Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthritis Cartilage. 1997;5(3):153-60. 25.Ozturk A, Ozdemir MR, Ozkan Y. Osteochondral autografting (mosaicplasty) in grade IV cartilage defects in the knee joint: 2- to 7-year results. Int Orthop. 2006;30:200-204. 26.Peyron JG. Intraarticular hyaluronan injections in the treatment of osteoarthritis: State-of-the-art review. J Rheumatol.1993;20:10-15. 27. Scale D, Wobig M, Wolbert W. Viscosupplementation of osteoarthritic knees with hylan: A treatment schedule study. Ther Res. 1994;55:220-232.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Publication Date | March 31, 2020 |
| Acceptance Date | March 8, 2020 |
| Published in Issue | Year 2020 Volume: 10 Issue: 1 |