Department of Orthopaedic Surgery, Kantonsspital Liestal, Liestal, Switzerland.
J Bone Joint Surg Am. 2010 Feb;92(2):279-86. doi: 10.2106/JBJS.H.01635.
The role of the location and severity of the initial cartilage lesions associated with an ankle fracture in the development of posttraumatic osteoarthritis has not been established, to our knowledge.
We performed a long-term follow-up study of a consecutive, prospectively included cohort of 288 ankle fractures that were treated operatively between June 1993 and November 1997. Arthroscopy had been performed in all cases in order to classify the extent and location of cartilage damage. One hundred and nine patients (47%) were available for follow-up after a mean of 12.9 years. The main outcome parameters were the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score for clinical evaluation and a modified Kannus osteoarthritis score for radiographic assessment of the development of posttraumatic osteoarthritis.
Cartilage damage anywhere in the ankle joint was associated with a suboptimal clinical outcome (odds ratio, 5.0 [95% confidence interval = 1.3 to 20.1]; p = 0.02) and with a suboptimal radiographic outcome (odds ratio = 3.4 [95% confidence interval = 1.0 to 11.2]; p = 0.04). An association was also found between the development of clinical signs of osteoarthritis and a deep lesion (>50% of the cartilage thickness) on the anterior aspect of the talus (odds ratio = 12.3 [95% confidence interval = 1.4 to 108.0]; p = 0.02) and a deep lesion on the lateral aspect of the talus (odds ratio = 5.4 [95% confidence interval = 1.2 to 23.5]; p = 0.02). A deep lesion on the medial malleolus was associated with the development of clinical signs of osteoarthritis (odds ratio = 5.2 [95% confidence interval = 1.9 to 14.6]; p < 0.01) and radiographic signs of osteoarthritis (odds ratio = 2.9 [95% confidence interval = 1.1 to 7.9]; p = 0.03) of osteoarthritis. There was no significant correlation between cartilage lesions on the fibula and the long-term outcome.
Our findings show that initial cartilage damage seen arthroscopically following an ankle fracture is an independent predictor of the development of posttraumatic osteoarthritis. Specifically, lesions on the anterior and lateral aspects of the talus and on the medial malleolus correlate with an unfavorable clinical outcome.
据我们所知，踝关节骨折初始软骨损伤的位置和严重程度与创伤后骨关节炎的发展之间的关系尚未确定。
我们对 1993 年 6 月至 1997 年 11 月期间连续前瞻性纳入的 288 例踝关节骨折患者进行了长期随访研究。所有病例均行关节镜检查以分类软骨损伤的范围和位置。平均随访 12.9 年后，109 例（47%）患者可获得随访。主要观察指标为美国矫形足踝协会（AOFAS）后足评分（临床评估）和改良 Kannus 骨关节炎评分（影像学评估）。
踝关节任何部位的软骨损伤均与临床结果不理想（比值比，5.0[95%置信区间，1.3 至 20.1]；p=0.02）和影像学结果不理想（比值比=3.4[95%置信区间，1.0 至 11.2]；p=0.04）相关。踝关节前部（距骨）深溃疡（>50%软骨厚度）（比值比=12.3[95%置信区间，1.4 至 108.0]；p=0.02）和外侧距骨深溃疡（比值比=5.4[95%置信区间，1.2 至 23.5]；p=0.02）与临床骨关节炎表现的发展也存在相关性。内踝深溃疡与骨关节炎的临床和影像学表现（比值比=5.2[95%置信区间，1.9 至 14.6]；p<0.01）和影像学表现（比值比=2.9[95%置信区间，1.1 至 7.9]；p=0.03）相关。腓骨软骨病变与长期结果之间无显著相关性。
我们的研究结果表明，踝关节骨折关节镜下可见的初始软骨损伤是创伤后骨关节炎发展的独立预测因子。具体而言，距骨前侧和外侧以及内踝的病变与不良的临床结局相关。
