关节镜下微骨折手术联合富血小板血浆注射对股骨内侧髁骨软骨损伤的临床疗效OA

Objective To investigate the clinical efficacy and safety of arthroscopic microfracture(AMF)combined with intra-articular injection of platelet-rich plasma(PRP)in the treatment of osteochondral lesions of the medial femoral condyle(OLMFC).Methods This prospective randomized controlled trial included 84 patients with unilateral OLMFC were consecutively admitted to Bozhou people's Hospital from August 2023 to August 2024.Using a block randomization method,patients were divided into a study group[microfracture(MF)+PRP,n=42]and divided them into the study group(MF+PRP,n=42)and the control group(MF only,n=42).Both groups underwent standardized arthroscopic MF,and the study group received intra-articular PRP injections at 1-4 weeks post operatively(2 ml per session,with a platelet concentration 5.2 times that of peripheral blood).Preoperative and postoperative assessments were conducted at 3,6,and 12 months,comparing visual analog scale(VAS)scores,Lysholm knee function scale(Lysholm score),International Knee Documentation Committee(IKDC)subjective knee evaluation form,magnetic resonance observation of cartilage repair tissue(MOCART)2.0 score,Tegner activity scale(TAS),bone marrow edema volume(BME-vol),and incidence of adverse events.Serum levels of tumor necrosis factor-alpha(TNF-α),interleukin-1 beta(IL-1β),and interleukin-6(IL-6)were measured preoperatively and at 48 h,4 weeks,and 12 weeks postoperatively.Results The total effective rate in the study group was significantly higher than that in the control group(95.12%vs.80.00%,P=0.039).The postoperative pain gradually decreased,with the VAS score at 12 months in the study group was significantly lower than that in the control group(1.51±0.51 vs.1.85±0.62,P<0.05).Both groups showed significant improvements in Lysholm score and IKDC score postoperatively,and the study group had significantly higher scores than the control group for Lysholm(89.62±3.47 vs.81.37±4.05,P<0.001)and IKDC(88.52±4.61 vs.79.83±5.74,P<0.001).Additionally,at 12 months post-surgery,the study group had a significantly lower BME-vol compared to the control group[(0.37±0.11)cm3 vs.(0.58±0.14)cm3,P<0.001],the MOCART 2.0 score was significantly higher than that of the control group[(87.25±10.93)vs.(81.32±8.07),P<0.05],and the TAS was also significantly higher than that of the control group[(89.65±3.41)vs.(81.37±4.14),P<0.001].Serum inflammation markers(TNF-α,IL-1β,IL-6)in the study group were significantly lower than those in the control group at all postoperative time points(all P<0.001).There were no statistically significant differences in the incidence of adverse events between the two groups(P>0.05).Conclusions AMF combined with sequential PRP intra-articular injection significantly alleviates pain and improves joint function in patients with OLMFC,promotes the absorption of subchondral bone marrow edema,enhances clinical satisfaction rates,and exhibits a favorable safety profile.