The efficacy of microfracture combined with extracorporeal shock wave therapy and hyaluronic acid injections for treating osteochondral lesion of the talus and its impact on early rehabilitation: A retrospective case study.

Abstract

Arthroscopic microfracture is a conventional technique for treating osteochondral lesions of the talus (OLT) that are less than 1.5 cm² in area. Since the defects are filled with fibrocartilage after repair, some patients experience local pain postoperatively, subsequently affecting early rehabilitation. This study evaluates efficacy of combining microfracture with extracorporeal shock wave therapy (ESWT) and intra-articular hyaluronic acid (HA) injections for treating OLT and its impact on early rehabilitation. Patients were divided into Group A with patients experiencing walking pain at full weight-bearing 4-6 weeks after surgery, Group B with those experiencing pain 6-8 weeks after surgery. ESWT targeted the cartilage injury area and other pressure pain points, delivered weekly for five sessions. After each session, a 2.0-2.5 mL intra-articular injection of HA was administered to the ankle joint. Assessments were made before ESWT began, six weeks after the final treatment, and at the final follow-up. The primary outcome was the Visual Analogue Scale (VAS) pain score, and the secondary outcome was the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score. Forty-two patients were included, with a pre-treatment VAS score of 7.16 ± 1.54 decreasing to 2.11 ± 1.09 at the final follow-up, and the AOFAS score increasing from 67.78 ± 13.87 to 93.54 ± 4.10, showing significant differences (p < 0.05). Group A and B showed no significant differences in VAS and AOFAS scores across each time points (p > 0.05). ESWT synergizes with HA injections to significantly reduce post-microfracture weight-bearing pain and promote early joint function recovery.