关节镜下微骨折术治疗胫骨远端关节面骨软骨损伤后的功能及磁共振成像结果
Functional and MRI outcomes after arthroscopic microfracture for treatment of osteochondral lesions of the distal tibial plafond.
作者信息
Ross Keir A, Hannon Charles P, Deyer Timothy W, Smyth Niall A, Hogan MaCalus, Do Huong T, Kennedy John G
机构信息
Department of Orthopaedic Surgery, Foot and Ankle Service, Hospital for Special Surgery, 523 East 72nd Street, East River Professional Building, 5th Floor, Room 507, New York, NY 10021. E-mail address for K. Ross:
East River Medical Imaging, Department of Radiology, 523 East 72nd Street, New York, NY 10021.
出版信息
J Bone Joint Surg Am. 2014 Oct 15;96(20):1708-15. doi: 10.2106/JBJS.M.01370.
BACKGROUND
Osteochondral lesions of the distal tibial plafond are uncommon compared with talar lesions. The objective of this study was to assess functional and magnetic resonance imaging (MRI) outcomes following microfracture for tibial osteochondral lesions.
METHODS
Thirty-one tibial osteochondral lesions in thirty-one ankles underwent arthroscopic microfracture. The Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) general health questionnaire were used to obtain patient-reported functional outcome scores preoperatively and postoperatively. MRI scans were assessed postoperatively with use of the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score for twenty-three ankles.
RESULTS
The average age was thirty-seven years (range, fifteen to sixty-eight years), and the average lesion area was 38 mm(2) (range, 7.1 to 113 mm(2)). Twelve ankles had a kissing lesion on the opposing surface of the talus, and two ankles had a concomitant osteochondral lesion elsewhere on the talus. FAOS and SF-12 scores were significantly improved (p < 0.01) at the time of follow-up, at an average of forty-four months. The average postoperative MOCART score was 69.4 (range, 10 to 95), with a lower score in the ankles with kissing lesions (62.8) than in the ankles with an isolated lesion (73.6). Increasing age negatively impacted improvement in SF-12 (p < 0.01) and MOCART (p = 0.04) scores. Increasing lesion area was negatively correlated with MOCART scores (p = 0.04) but was not associated with FAOS or SF-12 scores. Lesion location and the presence of kissing lesions showed no association with functional or MRI outcomes.
CONCLUSIONS
Arthroscopic microfracture provided functional improvements, but the optimal treatment strategy for tibial osteochondral lesions remains unclear. The repair tissue assessed on MRI was inferior to normal hyaline cartilage. The MRI outcomes appeared to deteriorate with increasing lesion area, and both functional and MRI outcomes appeared to deteriorate with increasing age.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
与距骨病变相比，胫骨远端关节面的骨软骨损伤并不常见。本研究的目的是评估微骨折术治疗胫骨骨软骨损伤后的功能及磁共振成像（MRI）结果。
方法
对31例踝关节的31处胫骨骨软骨损伤进行关节镜下微骨折术。采用足踝结局评分（FAOS）和简明健康调查问卷12项（SF-12）在术前和术后获取患者报告的功能结局评分。术后对23例踝关节的MRI扫描采用软骨修复组织磁共振观察（MOCART）评分进行评估。
结果
平均年龄为37岁（范围15至68岁），平均损伤面积为38平方毫米（范围7.1至113平方毫米）。12例踝关节在距骨相对表面有对吻损伤，2例踝关节在距骨其他部位有合并的骨软骨损伤。随访时平均44个月，FAOS和SF-12评分显著改善（p < 0.01）。术后平均MOCART评分为69.4（范围10至95），有对吻损伤的踝关节评分（62.8）低于孤立损伤的踝关节（73.6）。年龄增加对SF-12（p < 0.01）和MOCART（p = 0.04）评分的改善有负面影响。损伤面积增加与MOCART评分呈负相关（p = 0.04），但与FAOS或SF-12评分无关。损伤部位和对吻损伤的存在与功能或MRI结果无关。
结论
关节镜下微骨折术可改善功能，但胫骨骨软骨损伤的最佳治疗策略仍不明确。MRI评估的修复组织不如正常透明软骨。MRI结果似乎随损伤面积增加而恶化，功能和MRI结果似乎均随年龄增加而恶化。
证据水平
治疗性IV级。有关证据水平的完整描述，请参见作者须知。
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