Novel treatment of 99Tc-MDP improves clinical and radiographic results for patients with osteochondral lesions of the talus.
BACKGROUND
Management of osteochondral lesions of talus (OLT) remains controversial. 99Tc-MDP, a decay product of 99mTc-MDP which is widely used for bone scan, is effective in the clinical treatment of rheumatoid arthritis. The purpose of the study is to investigate the effects of 99Tc-MDP treatment on OLT.


METHODS
In the clinical evaluation, 66 patients with a total of 83 lesions of OLT who failed appropriate non-operative treatment and surgery were retrospectively included and treated with intravenous injection of 99Tc-MDP and Chinese herbal fumigation (CHF). The effects of 99Tc-MDP and CHF on OLT were evaluated by the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), Visual Analog Scale (VAS), activities of daily living (Barthel Index), and MRI, 99mTc-MDP SPECT/CT and CT. Radiographic changes were also assessed by the transverse long diameter of the cyst on CT.


RESULTS
At the last follow-up, AOFAS, VAS and Barthel Index improved significantly from 68.66±9.76, 3.05±0.34 and 85±8.31 to 85.4±8.31, 1.85±0.36 and 94.7±4.99 (P<0.01), respectively after one course treatment in 66 patients with OLT. Thirty one (31/66) patients had a second treatment course. Their AOFAS, VAS and Barthel Index also improved significantly after the mean follow-up of 7±2 (6-15) months. And the average diameter of the cysts decreased from 8.01±3.35 mm to 4.74±2.83 mm (P<0.01) in the 31 patients.


CONCLUSIONS
The retrospective study indicates that a combination treatment of 99Tc-MDP and CHF is effective in pain relief and return of function in a short term of follow-up for patients with OLT. Our results suggest that the small cystic lesions with increased uptake of 99mTc-MDP on SPECT/CT can be well treated by 99Tc-MDP and CHF. This novel technique holds the potential to emerge as an effective conservative treatment for OLT without adverse effects. The level of evidence for 99Tc-MDP is medium for the number of patients and retrospective study.
Nuclear Medicine of Bone and Joint, Henan Luoyang Zhenggu Hospital and Henan Orthopedics Hospital, Luoyang, China.
Hongjuan
H
Liu
Nuclear Medicine of Bone and Joint, Henan Luoyang Zhenggu Hospital and Henan Orthopedics Hospital, Luoyang, China.
Huili
H
Guo
Nuclear Medicine of Bone and Joint, Henan Luoyang Zhenggu Hospital and Henan Orthopedics Hospital, Luoyang, China.
Shunong
S
Guo
Nuclear Medicine of Bone and Joint, Henan Luoyang Zhenggu Hospital and Henan Orthopedics Hospital, Luoyang, China.
Junhui
J
Wang
Nuclear Medicine of Bone and Joint, Henan Luoyang Zhenggu Hospital and Henan Orthopedics Hospital, Luoyang, China.
Yanju
Y
Ye
Department of Nuclear Medicine, Tenth People's Hospital of Tongji University, Shanghai, China - mc_7419@hotmail.com.
Chao
C
Ma
D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D013669:Technetium Tc 99m Medronate / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D013669:Technetium Tc 99m Medronate