Comparative clinical and functional results of arthroscopic microfracture, nanofracture and antegrade drilling in Talus osteochondral lesions

Objective: The treatment of talus osteochondral lesions is controversial and the search for the most appropriate treatment option continues. Although the validity of arthroscopic treatment has been proven, it is not clear which surgical treatment modality will be used. In this study, we aimed to evaluate the comparative clinical and functional results of nanofracture, microfracture and antegrade drilling and bone marrow stimulation in patients who underwent ankle arthroscopy and to reveal the appropriate treatment. Materials and Methods: Between October 2016 and June 2022, we retrospectively evaluated patients who were admitted to the Orthopedics and Traumatology outpatient clinic of Düzce University Faculty of Medicine with the complaint of ankle pain and were diagnosed with talus osteochondral lesion radiologically and underwent isolated microfracture (group 1), nanofracture (group 2) and antegrade drilling (group 3) in surgical treatment. In this study, patients between the ages of 18 and 55 with stage 2-3 osteochondral lesion on MRI, symptoms lasting more than 6 months, cartilage lesions smaller than 2 cm, and lesions in one extremity were included, while patients who had previous ankle surgery, those with ankle fractures, those with cartilage lesions larger than 2 cm, patients with previous ankle cartilage injections, and patients who did not want to participate in the study were excluded. All patients were informed about the study, and an informed consent form and ethical approval were obtained. As demographic data of the patients; age, gender, affected side, dominant extremity, duration of symptoms, body mass index, MRI and CT classification, and follow-up period were evaluated. Clinical and functional scores of patients; AOFAS (American Orthopedic Foot‐Ankle Association Hind Foot Score) and VAS Score measured before treatment, 6 and 12 months after treatment. Results: As a result of our study, an improvement was observed in the AOFAS and VAS scores of arthroscopic microfracture, nanofracture and drilling in medial and small-sized pathologies in talus osteochondral lesions in the short term. There was no statistically significant difference between them. Conclusions: Arthroscopic bone marrow stimulation has a positive effect on clinical and functional scores in talus osteochondral lesions. All three of nanofractures, microfractures and drilling can be alternative treatments by evaluating their advantages and disadvantages well. Keywords: microfracture, nanofracture, drilling, talus, arthroscopy