Lee Moses, Kwon Ji Won, Choi Woo Jin, Lee Jin Woo
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
Foot Ankle Int. 2015 Sep;36(9):1050-7. doi: 10.1177/1071100715581477. Epub 2015 Apr 13.
Previous reports suggest that prolonged instability of the ankle may contribute to development of osteochondral lesions and eventually lead to osteoarthritis. However, no studies have directly compared osteochondral lesions in ankles with chronic lateral ankle instability (CLAI) to those without instability. This study was performed to determine characteristics and resulting clinical outcomes associated with osteochondral lesions of the talus (OLT) in patients with and without instability.
Of 420 patients who underwent primary arthroscopic marrow stimulation for OLT, 74 patients were identified as having concomitant CLAI. After considering age, sex, body mass index, and initial trauma history for the propensity score (1:2 ratio), a total of 148 patients without CLAI were matched from the remainder of the cohort. Demographics and lesion characteristics were compared using preoperative magnetic resonance imaging (MRI) and arthroscopy. Clinical outcomes were compared using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle score, and the Foot and Ankle Outcome Score (FAOS).
The OLT group with CLAI presented a significantly increased proportion of lateral-side OLT, large OLT (150 mm(2) or larger), and chondral lesions at the tip of the medial malleolus (P = .018, P = .024, and P < .001, respectively). VAS and AOFAS scores were comparable at the last follow-up. However, the OLT with CLAI group also exhibited a significantly increased proportion of failure (AOFAS score less than 80) and inferior outcomes in the FAOS for the sport and recreation subscale (P = .034 and P = .005, respectively).
Compared with osteochondral lesions in ankles without CLAI, osteochondral lesions in an unstable ankle had an increased proportion of larger lesions (150 mm(2) or larger) and additional chondral lesions at the tip of the medial malleolus and the tibia plafond. This group also displayed increased clinical failure (AOFAS score less than 80). Inferior performance in sport and recreational activities may be more likely in patients with both OLT and CLAI.
Level III, retrospective cohort study.
既往报告提示，踝关节长期不稳定可能促使骨软骨损伤的发生，并最终导致骨关节炎。然而，尚无研究直接比较慢性外侧踝关节不稳定（CLAI）患者与无踝关节不稳定患者的骨软骨损伤情况。本研究旨在确定伴有和不伴有踝关节不稳定的距骨骨软骨损伤（OLT）的特征及相关临床结局。
在420例行初次关节镜下骨髓刺激治疗OLT的患者中，74例被确定为伴有CLAI。在考虑年龄、性别、体重指数及初始创伤史的倾向评分（1:2比例）后，从其余队列中匹配出148例无CLAI的患者。使用术前磁共振成像（MRI）和关节镜检查比较人口统计学和损伤特征。使用视觉模拟量表（VAS）、美国矫形足踝协会（AOFAS）踝关节评分和足踝结局评分（FAOS）比较临床结局。
伴有CLAI的OLT组中外侧OLT、大的OLT（150平方毫米或更大）以及内踝尖部软骨损伤的比例显著增加（分别为P = 0.018、P = 0.024和P < 0.001）。末次随访时VAS和AOFAS评分相当。然而，伴有CLAI的OLT组失败比例（AOFAS评分低于80）也显著增加，且在运动和娱乐亚量表的FAOS中结局较差（分别为P = 0.034和P = 0.005）。
与无CLAI的踝关节骨软骨损伤相比，不稳定踝关节的骨软骨损伤中较大损伤（150平方毫米或更大）以及内踝尖部和胫骨平台额外软骨损伤的比例增加。该组临床失败情况（AOFAS评分低于80）也增加。OLT和CLAI并存的患者在运动和娱乐活动中的表现可能更差。
III级，回顾性队列研究。
