Savage-Elliott Ian, Smyth Niall A, Deyer Timothy W, Murawski Christopher D, Ross Keir A, Hannon Charles P, Do Huong T, Kennedy John G
Hospital for Special Surgery, New York, New York, U.S.A.
Hospital for Special Surgery, New York, New York, U.S.A..
Arthroscopy. 2016 Sep;32(9):1846-54. doi: 10.1016/j.arthro.2016.04.018. Epub 2016 Jul 22.
To identify potential cysts using magnetic resonance imaging (MRI) after autologous osteochondral transplantation (AOT) for osteochondral lesions of the talus (OLTs) as well as to determine the effect of cysts on short-term clinical outcomes.
Eighty-nine MRI scans of 37 patients who had AOT for an OLT were evaluated. Radiographic variables examined included cyst presence, cyst location, bone edema, and cartilage integrity. Patient clinical variables recorded and examined for association with the presence of a cyst included gender, age, preoperative lesion size, size and number of osteochondral graft used, symptoms reported, and pre- and postoperative Foot and Ankle Outcome Score (FAOS) and Short Form-12 (SF-12) scores measured at final follow-up.
Twenty-four patients (64.8%) had MRI evidence of cystic change after AOT for an OLT at a mean MRI follow-up time of 15 months after surgery (range 2-54). Patients with presence of a cyst after surgery were older (mean age, 42.7 years) than those without cysts (mean age, 32.7 years) (P = .041), and among patients with a cyst, older patients more often had involvement of the subchondral plate (57.3 v 36.7 years) (P < .001). No other variables associated with cyst formation had statistical significance. Mean patient FAOS scores increased from 50 (±19) preoperatively to 87 (±8) postoperatively. Mean SF-12 scores increased from 52 (±18) preoperatively to 85 (±6) postoperatively. Patients not identified as having a cyst had lower SF-12 (P = .028) and FAOS (P = .032) preoperative scores and more improvement in SF-12 (P = .006) and FAOS (P = .016) scores than patients with cysts.
Postoperative cyst formation on MRI was found to be a common occurrence after AOT for OLT. Although increasing age was related to increased cyst prevalence, the clinical impact of cyst formation was not found to be significant at short-term follow-up. Continued long-term longitudinal follow-up of postoperative cysts is needed.
Level IV, prognostic case series.
利用磁共振成像（MRI）识别距骨骨软骨损伤（OLT）自体骨软骨移植（AOT）术后的潜在囊肿，并确定囊肿对短期临床疗效的影响。
对37例行OLT自体骨软骨移植患者的89次MRI扫描进行评估。检查的影像学变量包括囊肿的存在、囊肿位置、骨水肿和软骨完整性。记录并检查与囊肿存在相关的患者临床变量，包括性别、年龄、术前损伤大小、使用的骨软骨移植物的大小和数量、报告的症状，以及最终随访时测量的术前和术后足踝结局评分（FAOS）和简明健康调查量表12项（SF-12）评分。
24例患者（64.8%）在OLT自体骨软骨移植术后平均15个月（范围2 - 54个月）的MRI随访中有囊肿形成的证据。术后有囊肿的患者（平均年龄42.7岁）比无囊肿的患者（平均年龄32.7岁）年龄更大（P = 0.041），在有囊肿的患者中，年龄较大的患者软骨下骨板受累更为常见（57.3岁对36.7岁）（P < 0.001）。没有其他与囊肿形成相关的变量具有统计学意义。患者的平均FAOS评分从术前的50（±19）增加到术后的87（±8）。平均SF-12评分从术前的52（±18）增加到术后的85（±6）。未被识别为有囊肿的患者术前SF-12（P = 0.028）和FAOS（P = 0.032）评分较低，且SF-12（P = 0.006）和FAOS（P = 0.016）评分的改善程度比有囊肿的患者更大。
发现OLT自体骨软骨移植术后MRI上的囊肿形成很常见。虽然年龄增加与囊肿患病率增加有关，但在短期随访中未发现囊肿形成的临床影响显著。需要对术后囊肿进行持续的长期纵向随访。
IV级，预后病例系列。
