Comparative Analysis of Short-term Efficacy between Robot- assisted Retrograde Drilling and Arthroscopic Microfracture for Osteochondral Lesions of the Talus

Abstract

Background Osteochondral lesions of the talus (OCLT) are lesions involving the articular cartilage and subchondral bone of the talus, most of which are associated with chronic micro-injuries following ankle trauma.micro-fractures, cartilage or bone transplantation assisted by ankle arthroscopy and the use of surgical robots has emerged for the treatment of OCLT is the pursuit of doctors and patients. A novel surgical procedure is introduced from the perspective of surgical robots involved in the minimally-invasive treatment of early OCLT to reach the persuit. Objective To investigate the short-term clinical efficacy of robot-assisted retrograde drilling and arthroscopic microfracture for osteochondral lesions of the talus (OCLT). Methods A total of 6 OCLT patients who were treated with robot navigation-assisted retrograde drilling and 10 OCLT patients who were treated with arthroscopic microfracture between October 2020 and October 2021 were analyzed. There were 11 males and five females, with a mean age of 36 years. The patients were followed up for 6 to 12 months to compare the changes in the OCLT lesion area by magnetic resonance imaging (MRI), visual analogue scale/score (VAS) and American Orthopedic Foot and Ankle Society score (AOFAS) before and after surgery. Results All 16 patients were followed up for an average of 8 months, and no complications occurred.Only one patient suffered discomfort involving transient postoperative pain in the operative area, but did not experience long-term numbness or chronic pain. Postoperative MRI revealed that none of the patients had severe signs of osteonecrosis, osteolysis or cystic changes of the talus, with lesion areas smaller than those before surgery. The difference was statistically significant (P < 0.01). The patients in the experimental group showed a more significant improvement in the last 3 months than in the first 3 months of the follow-up period. At the last follow-up, the VAS score was 3 points in the experimental group and 2.2 points in the control group, and the AOFAS score was 88.6 points in the experimental group and 88 points in the control group, all of which were significantly higher than those before operation, and the differences were statistically significant, but there was no statistically significant difference between the groups. Conclusion Both robot navigation-assisted retrograde drilling and arthroscopic microfracture for bone marrow stimulation (BMS) to treat OCLT in all patients obtained a satisfied result. In addition, the the experimental group can significantly reduced the operative time and showed fewer complications. Consequently, robot navigation-assisted retrograde drilling for BMS was a safe and effective procedure for the treatment of OCLT.