Department of Orthopedics, Trauma Surgery and Spinal Cord Injury, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstr. 200a, 69118 Heidelberg, Germany.
Arch Orthop Trauma Surg. 2012 Dec;132(12):1765-71. doi: 10.1007/s00402-012-1595-3. Epub 2012 Aug 17.
Arthroscopic microfracture (AM) of osteochondral lesions of the talus is used to induce intrinsic refilling of the defect and reduce pain. The aim of this retrospective study was to investigate the clinical state after AM and the MRI outcome.
A total of 22 patients [10 women, 12 men, 31 years old (mean, 13-68 range)] treated for osteochondral lesions of the talus by AM were examined 2 years (median) postoperatively and pre- and postoperative MRI results compared. Swelling/effusion, articular constriction, joint pain, and range of motion restriction were documented. Clinical state was evaluated using the AOFAS hindfoot score. MRI was used to assess the size of the defect, presence of bone marrow edema, cysts and effusion, thickness of repair tissue, and integrity of the cartilage.
In all but six cases, the defect was located at the medial shoulder of the talus. The postoperative AOFAS score at follow-up was 87.5 points (median 36-100 points range). Seven patients were free of pain, 11 had "mild, occasional" pain, 1 "moderate daily", and 3 "severe, almost always present" pain (AOFAS). The defect volume was significantly reduced from 377 mm(3) preoperatively (median, interquartile distance: 417 mm(3)) to 249 mm(3) postoperatively (median, IQD: 336 mm(3), p = 0.019, Wilcoxon). In 7 cases, the defect was completely filled, in 11 partially and in 4 only slightly.
After AM of osteochondral lesions of the talus, 18 of 22 patients had no or mild, occasional pain at 2 years follow-up. On MRI, the lesion volume had been reduced and filling with repair tissue was found.
关节镜下微骨折术（AM）用于诱导软骨下骨缺损的内在填充并减轻疼痛。本回顾性研究的目的是调查 AM 后的临床状态和 MRI 结果。
共对 22 例（10 名女性，12 名男性，31 岁（平均，13-68 岁））因距骨软骨下骨病变接受 AM 治疗的患者进行了检查，术后 2 年（中位数）进行了比较，并比较了术前和术后 MRI 结果。记录肿胀/渗出、关节狭窄、关节疼痛和运动受限。使用 AOFAS 后足评分评估临床状态。MRI 用于评估缺损大小、骨髓水肿、囊肿和渗出、修复组织厚度以及软骨完整性。
除 6 例外，所有病例的缺损均位于距骨内侧肩。随访时的术后 AOFAS 评分为 87.5 分（中位数 36-100 分）。7 例患者无疼痛，11 例“轻度，偶尔”疼痛，1 例“中度日常”疼痛，3 例“重度，几乎总是存在”疼痛（AOFAS）。与术前相比，缺损体积从 377mm(3)（中位数，四分位距：417mm(3)）显著减少至术后 249mm(3)（中位数，IQR：336mm(3)，p=0.019，Wilcoxon）。在 7 例中，缺损完全填充，在 11 例中部分填充，在 4 例中仅轻微填充。
距骨软骨下骨病变 AM 治疗后，22 例患者中有 18 例在 2 年随访时无疼痛或轻度、偶发性疼痛。在 MRI 上，病变体积减少，修复组织填充。
