Walsh Stewart J, Twaddle Bruce C, Rosenfeldt Michael P, Boyle Matthew J
Unisports Sports Medicine, Auckland, New Zealand.
Unisports Sports Medicine, Auckland, New Zealand Sports Medicine Center at Husky Stadium, Seattle, Washington, USA.
Am J Sports Med. 2014 Nov;42(11):2722-6. doi: 10.1177/0363546514550976. Epub 2014 Sep 26.
Midterm outcomes after arthroscopic debridement in patients with anterior ankle impingement without osteoarthritis are currently unclear.
To assess the functional and radiological outcomes after arthroscopic treatment of anterior ankle impingement with a minimum 5-year follow-up in patients without osteoarthritis.
Case series; Level of evidence, 4.
From September 1999 to March 2006, a consecutive series of eligible patients without ankle osteoarthritis and with anterior ankle impingement, who had persistent ankle pain and activity restrictions despite at least 6 months of nonoperative management, underwent standardized arthroscopic debridement and followed uniform postoperative management. Patients were assessed preoperatively and at 6 weeks, 6 months, and 12 months and then at 1-year intervals after surgery until a minimum of 5 years' follow-up had been achieved, with weightbearing ankle dorsiflexion, Foot Functional Index (FFI), and plain radiography including Scranton and McDermott classification (SMC) grade and tibial osteophyte size.
A total of 46 patients (42 male, 4 female) were prospectively assessed, with a mean age at surgery of 29 years (range, 16-44 years) and a mean follow-up duration of 5.1 years (range, 5.0-7.5 years). Preoperative ankle radiographs demonstrated a median SMC grade of 2 and a mean tibial osteophyte size of 5.1 mm. At a minimum of 5 years postoperatively, patients demonstrated limited improvement in ankle dorsiflexion (mean, 24.7° [preoperatively] vs 27.0° [final follow-up]; P = .049); however, they demonstrated substantial improvement in the FFI (mean, 20.5 [preoperatively] vs 2.7 [final follow-up]; P < .001). Postoperatively, 84% of patients showed a recurrence of radiological osteophytes, with plain radiographs at final follow-up demonstrating no significant difference in the SMC grade (P = .107) or tibial osteophyte size (P = .212) compared with preoperative imaging. There was no significant effect of patient age, sex, body mass index, or SMC grade at the time of surgery on any of the postoperative outcome measures.
In this prospective outcome study of 46 patients without osteoarthritis managed arthroscopically for anterior ankle impingement, the functional outcome scores had significantly improved at 5 years postoperatively despite a recurrence of radiographic osteophytes.
目前，无骨关节炎的前踝撞击症患者在关节镜清创术后的中期疗效尚不清楚。
评估无骨关节炎的前踝撞击症患者在关节镜治疗后至少5年随访期的功能和影像学结果。
病例系列；证据等级，4级。
从1999年9月至2006年3月，连续纳入一系列符合条件的无踝骨关节炎且患有前踝撞击症的患者，这些患者尽管经过至少6个月的非手术治疗仍存在持续的踝关节疼痛和活动受限，接受了标准化的关节镜清创术并遵循统一的术后管理。在术前、术后6周、6个月和12个月进行评估，然后在术后每年进行评估，直至至少随访5年，评估指标包括负重位踝关节背屈、足部功能指数（FFI）以及包括斯克兰顿和麦克德莫特分类（SMC）等级和胫骨骨赘大小的X线平片。
共前瞻性评估了46例患者（男42例，女4例），手术时的平均年龄为29岁（范围16 - 44岁），平均随访时间为5.1年（范围5.0 - 7.5年）。术前踝关节X线片显示SMC等级中位数为2级，胫骨骨赘平均大小为5.1毫米。术后至少5年时，患者踝关节背屈改善有限（平均，术前24.7° vs最终随访27.0°；P = 0.049）；然而，他们在FFI方面有显著改善（平均，术前20.5 vs最终随访2.7；P < 0.001）。术后，84%的患者出现影像学骨赘复发，最终随访时的X线平片显示与术前影像学相比，SMC等级（P = 0.107）或胫骨骨赘大小（P = 0.212）无显著差异。患者年龄、性别、体重指数或手术时的SMC等级对任何术后结果指标均无显著影响。
在这项对46例无骨关节炎的前踝撞击症患者进行关节镜治疗的前瞻性结果研究中，尽管影像学骨赘复发，但术后5年功能结果评分仍有显著改善。
