Valderrabano Victor, Leumann André, Rasch Helmut, Egelhof Thomas, Hintermann Beat, Pagenstert Geert
Orthopaedic Department, University Hospital of Basel, Basel, Switzerland.
Orthopaedic Department, University Hospital of Basel, Basel, Switzerland the Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.
Am J Sports Med. 2009 Nov;37(1_suppl):105S-111S. doi: 10.1177/0363546509351481.
Osteochondral lesions are frequently seen in athletes after ankle injuries. At this time, osteochondral autologous transplantation (OATS, mosaicplasty) is the only surgical treatment that replaces the entire osteochondral unit in symptomatic lesions.
To evaluate the clinical and radiological midterm to long-term outcome of ankles treated with knee-to-ankle mosaicplasty.
Case series; Level of evidence, 4.
Clinical evaluation consisted of patient satisfaction, pain evaluation (visual analog scale [VAS]), American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, sports activity score, range of motion, the radiological evaluation of magnetic resonance imaging (MRI), and single photon emission computed tomography-computed tomography (SPECT-CT) analysis of both the ankle and the knee joint.
Twelve of 21 patients (mean age, 43 years; male, 8; female, 4) were available for latest follow-up (mean, 72 months). At follow-up, patients reported a satisfaction rate of good to excellent in 92% (n 5 11) and poor in 8% (n 5 1). The average VAS pain score was 3.9 (preoperative, 5.9; P 5 .02), AOFAS ankle score significantly increased from 45.9 to 80.2 points (P< .0001), sports activity score remained significantly decreased with 1.25 (preinjury level, 2.3; P 5 .035), and ankle dorsiflexion was significantly reduced (P 5 .003). Knee pain was reported in 6 patients (50%). Radiologically, recurrent lesions were found in 10 of 10 cases (100%) and some degree of cartilage degeneration and discontinuity of the subchondral bone plate in 100%.
Indications for mosaicplasty with a plug transfer from the knee to the talus must be considered carefully, as at midterm, moderate outcome and considerable donor-site morbidity may be found.
踝关节损伤后，运动员中经常出现骨软骨损伤。目前，自体骨软骨移植术（OATS，镶嵌成形术）是唯一一种能替换有症状损伤中整个骨软骨单元的手术治疗方法。
评估膝至踝镶嵌成形术治疗踝关节的临床和影像学中期至长期疗效。
病例系列；证据等级，4级。
临床评估包括患者满意度、疼痛评估（视觉模拟评分法[VAS]）、美国矫形足踝协会（AOFAS）踝关节评分、体育活动评分、活动范围、踝关节和膝关节的磁共振成像（MRI）影像学评估以及单光子发射计算机断层扫描-计算机断层扫描（SPECT-CT）分析。
21例患者中有12例（平均年龄43岁；男性8例，女性4例）获得了最新随访（平均72个月）。随访时，患者报告满意度为良好至优秀的占92%（n = 11），差的占8%（n = 1）。平均VAS疼痛评分为3.9（术前为5.9；P = 0.02），AOFAS踝关节评分从45.9显著提高到80.2分（P < 0.0001），体育活动评分仍显著降低，为1.25（伤前水平为2.3；P = 0.035），踝关节背屈明显减少（P = 0.003）。6例患者（50%）报告有膝关节疼痛。影像学检查发现，10例中有10例（100%）存在复发性损伤，100%存在一定程度的软骨退变和软骨下骨板连续性中断。
必须谨慎考虑采用从膝关节到距骨的塞状移植镶嵌成形术的适应证，因为在中期可能会出现中等疗效和相当程度的供区并发症。
