Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka 814-0180, Japan.
Am J Sports Med. 2013 Mar;41(3):528-34. doi: 10.1177/0363546512472979. Epub 2013 Jan 24.
The defect size of an osteochondral lesion of the talus is one of the most important prognostic factors for deciding clinical outcomes. However, the prognostic factors for small osteochondral lesions of the talus are unknown.
To investigate the significant prognostic factors for small osteochondral lesions of the talus using arthroscopic bone marrow stimulation techniques.
Case series; Level of evidence, 4.
Fifty ankles in 50 patients treated with arthroscopic bone marrow stimulation techniques for an osteochondral lesion of the talus (<150 mm(2)) were evaluated for prognostic factors. The patients were 22 men and 28 women (mean age, 35.0 years). Outcomes were measured using the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, Berndt and Harty scale, and Saxena criteria.
The mean lesion size was 62 mm(2) (range, 7-119 mm(2)). The mean AOFAS score improved from 74 (range, 18-90) preoperatively to 90 (range, 67-100) postoperatively. The Saxena criteria results were excellent, good, fair, and poor in 36 (72%), 8 (16%), 5 (10%), and 1 (2%) patients, respectively. The Berndt and Harty scale results were good in 34 (68%), fair in 6 (12%), and poor in 10 (20%) patients. Linear regression analyses showed prognostic significance for lesion depth and outcome. Medial lesions had a significantly higher incidence of poor outcomes than lateral lesions (P < .05). Among the medial lesions, lesions uncovered with the medial malleolus had inferior outcomes compared with covered lesions (P < .0001). There was no association between clinical outcome and lesion size or body mass index. In older patients (≥40 years), there was a significant trend toward inferior clinical outcomes (P < .05).
Arthroscopic bone marrow stimulation techniques provided satisfactory clinical outcomes. However, older patients, deep lesions, and medial lesions uncovered with the medial malleolus were associated with inferior clinical outcomes.
距骨骨软骨损伤的缺损大小是决定临床结果的最重要的预后因素之一。然而，对于小的距骨骨软骨损伤的预后因素尚不清楚。
使用关节镜下骨髓刺激技术探讨小的距骨骨软骨损伤的显著预后因素。
病例系列；证据等级，4 级。
50 例患者（50 足）接受关节镜下骨髓刺激技术治疗距骨骨软骨损伤（<150mm²），评估预后因素。患者为 22 名男性和 28 名女性（平均年龄，35.0 岁）。采用美国矫形足踝协会（AOFAS）踝-后足量表、Berndt 和 Harty 量表和 Saxena 标准评估结果。
平均病变大小为 62mm²（范围，7-119mm²）。AOFAS 评分从术前的 74 分（范围，18-90 分）改善至术后的 90 分（范围，67-100 分）。Saxena 标准的结果分别为优 36 例（72%）、良 8 例（16%）、可 5 例（10%）和差 1 例（2%）。Berndt 和 Harty 量表的结果分别为优 34 例（68%）、可 6 例（12%）和差 10 例（20%）。线性回归分析显示病变深度和结果具有预后意义。内侧病变的不良结局发生率显著高于外侧病变（P<.05）。在内侧病变中，未被内踝覆盖的病变结局较差，与被覆盖的病变相比（P<.0001）。临床结果与病变大小或体重指数无关。在年龄较大的患者（≥40 岁）中，临床结果有显著的下降趋势（P<.05）。
关节镜下骨髓刺激技术提供了满意的临床结果。然而，年龄较大、病变较深以及未被内踝覆盖的内侧病变与临床结果较差相关。
