Leumann André, Horisberger Monika, Buettner Olaf, Mueller-Gerbl Magdalena, Valderrabano Victor
Orthopaedic Department, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Department of Anatomy, University of Basel, Basel, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2016 Jul;24(7):2133-9. doi: 10.1007/s00167-015-3591-y. Epub 2015 Apr 9.
Osteochondral lesions of the talus are often located posteromedially requiring open surgery to facilitate solid and complete osteochondral reconstruction. The aim of the study was to identify the optimal anatomical site for medial malleolar osteotomy based on the criteria of minimal cartilage damage (Study I) and to report on the morbidity in patients receiving osteotomy performed at the previously identified site (Study II).
For Study I, cartilage coverage of the tibiofibular ankle joint facet was measured in 40 cadaveric ankles (20 cadaver specimens). In Study II, we assessed clinical (VAS pain score, AOFAS score, range of motion) and radiological outcome measures (SPECT-CT) in 17 patients (mean age, 36.8 ± 10.8 years) undergoing medial malleolar osteotomy.
The medial edge in the transition zone of the tibial plafond to the medial malleolus showed less than 75 % of cartilage coverage in 62.5 % of cadavers (Study I). Surgery resulted in lower pain levels (2.4 ± 2.6 compared with 6.3 ± 1.8 points; p < 0.001) and greater AOFAS scores (82.9 ± 14.1 compared with 43.5 ± 10.8 to points; p < 0.001) compared with baseline (Study II). No signs of intra-operative damage or mal- or non-union were found. Long-term morbidity was found in one patient. Implant removal was necessary in 12 of 17 patients (71 %).
Anatomically, there is an optimal location for the medial malleolar osteotomy at the medial ankle edge involving minimal cartilage damage. Clinical results using this location showed no short- or mid-term morbidity and little long-term morbidity. However, many patients required re-intervention for implant removal.
IV.
距骨骨软骨损伤常位于后内侧，需要进行开放手术以促进稳固且完整的骨软骨重建。本研究的目的是基于软骨损伤最小化标准确定内踝截骨的最佳解剖部位（研究I），并报告在先前确定部位进行截骨的患者的发病率（研究II）。
对于研究I，在40个尸体踝关节（20个尸体标本）中测量胫腓踝关节面的软骨覆盖情况。在研究II中，我们评估了17例接受内踝截骨的患者（平均年龄36.8±10.8岁）的临床（视觉模拟疼痛评分、美国足踝外科协会评分、活动范围）和放射学结局指标（单光子发射计算机断层扫描-计算机断层扫描）。
在62.5%的尸体中，胫骨平台至内踝过渡区的内侧边缘软骨覆盖不足75%（研究I）。与基线相比，手术导致疼痛水平降低（分别为2.4±2.6分和6.3±1.8分；p<0.001），美国足踝外科协会评分更高（分别为82.9±14.1分和43.5±10.8分；p<0.001）（研究II）。未发现术中损伤、畸形愈合或不愈合的迹象。1例患者出现长期并发症。17例患者中有12例（71%）需要取出植入物。
从解剖学角度来看，在内踝边缘进行内踝截骨存在一个最佳位置，软骨损伤最小。使用该位置的临床结果显示无短期或中期并发症，长期并发症也很少。然而，许多患者需要再次干预以取出植入物。
IV级。
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