Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands.
Am J Sports Med. 2012 Oct;40(10):2318-24. doi: 10.1177/0363546512455403. Epub 2012 Aug 8.
Anterior ankle arthroscopy is the preferred surgical approach for the treatment of osteochondral defects of the talus (OCDs). However, the ankle is a congruent joint with limited surgical access.
The dual purpose of this study was (1) to quantify the anterior arthroscopic reach (defined as the proportion of the talar dome articular surface located anterior to the anterior distal tibial rim) with the ankle in full plantar flexion and (2) to identify predictive factors of the arthroscopic reach.
Descriptive laboratory study.
Computed tomography scans were obtained of 59 ankles (57 patients aged 33 ± 11 years) in full plantar flexion in a nonmetallic 3-dimensional footplate. The arthroscopic reach of both the medial and lateral talar domes was assessed on sagittal reconstructions using a custom-made software routine. Intraobserver and interobserver reliability were calculated by intraclass correlation coefficients (ICCs). Various predictive factors of the arthroscopic reach were analyzed by multivariate linear regression analysis.
The arthroscopic reach was 48.2% ± 6.7% (range, 26.7%-60.7%) of the medial talar dome and 47.8% ± 6.5% (range, 31.2%-65.1%) of the lateral talar dome (P = .62). The intraobserver and interobserver reliability of both measurements were excellent (ICC, .99). The clinical plantarflexion angle was a statistically significant predictive factor of both the medial and lateral arthroscopic reaches (ie, increased plantar flexion corresponded to increased area of access), while joint laxity, gender, and age were not predictive.
Almost half of the talar dome is accessible anterior to the anterior distal tibial rim. The plantarflexion angle is an independent predictive factor of the arthroscopic reach both medially and laterally.
These results may facilitate preoperative planning of the surgical approach for OCDs.
踝关节镜检查是治疗距骨骨软骨缺损（OCDs）的首选手术方法。然而，踝关节是一个吻合关节，手术入路有限。
本研究的双重目的是（1）定量测量踝关节完全跖屈时的前关节镜可达范围（定义为距骨穹隆关节面位于前胫骨远端前缘之前的比例），（2）确定关节镜可达范围的预测因素。
描述性实验室研究。
对 59 例踝关节（57 例患者，年龄 33 ± 11 岁）进行非金属 3 维足板的完全跖屈位 CT 扫描。使用定制的软件程序在矢状重建图像上评估内侧和外侧距骨穹隆的关节镜可达范围。通过组内相关系数（ICCs）计算观察者内和观察者间的可靠性。通过多元线性回归分析评估关节镜可达范围的各种预测因素。
内侧距骨穹隆的关节镜可达范围为 48.2% ± 6.7%（范围，26.7%-60.7%），外侧距骨穹隆的关节镜可达范围为 47.8% ± 6.5%（范围，31.2%-65.1%）（P =.62）。两种测量方法的观察者内和观察者间可靠性均为优（ICC，.99）。临床跖屈角度是内侧和外侧关节镜可达范围的统计学显著预测因素（即，跖屈角度增加对应于可进入区域的增加），而关节松弛度、性别和年龄不是预测因素。
距骨穹隆的近一半可在前胫骨远端前缘前进行关节镜检查。跖屈角度是关节镜可达范围的独立预测因素，无论是内侧还是外侧。
这些结果可能有助于 OCDs 手术入路的术前规划。
