Körner Daniel, Gueorguiev Boyko, Niemeyer Philipp, Bangert Yannic, Zinser Wolfgang, Aurich Matthias, Walther Markus, Becher Christoph, Ateschrang Atesch, Schröter Steffen
Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Schnarrrenbergstr. 95, 72076, Tübingen, Germany.
AO Research Institute Davos, Davos, Switzerland.
Arch Orthop Trauma Surg. 2017 Mar;137(3):367-373. doi: 10.1007/s00402-017-2638-6. Epub 2017 Feb 6.
Patients with osteochondral lesions of the ankle represent a heterogeneous population with traumatic, posttraumatic and idiopathic forms of this pathology, where the etiology of the idiopathic form is principally unknown. The aim of this study was to classify the heterogeneous patient population according to the patients' complaints and joint function. Data from the German Cartilage Registry (KnorpelRegister DGOU) was analyzed for this purpose to investigate whether traumatic and posttraumatic lesions cause more complaints and loss of joint function than idiopathic lesions. Moreover, it was sought to determine if lesion localization, defective area, stage, patient age, gender, and body mass index (BMI) are related to patients' complaints and loss of joint function.
A 117 patients with osteochondral lesions of the ankle were operated in 20 clinical centers in the period between October 2014 and January 2016. Data collection was performed by means of a web-based Remote Data Entry system at the time of surgery. Patients' complaints and joint function were assessed with online questionnaires using the German versions of the Foot and Ankle Ability Measure (FAAM) and the Foot and Ankle Outcome Score (FAOS), followed by statistical data evaluation.
No significant difference was indicated between the groups with traumatic/posttraumatic lesions and idiopathic lesions with regard to most of the patients' complaints and joint function, excluding the category Life quality of the FAOS score, where patients with idiopathic lesions had a significantly better quality of life (p = 0.02). No significant association was detected between lesion localization, defective area, patient age, gender, and BMI on the one hand, and patients' complaints and joint function on the other. Similarly, no significant association was found between lesion stage according to the International Cartilage Repair Society (ICRS) classification and patients' complaints and joint function. However, a higher lesion stage according to the classification of Berndt and Harty, modified by Loomer, was significantly associated with more complaints and loss of joint function in some categories of the FAAM and FAOS scores (p ≤ 0.04).
Etiology of the lesion, lesion localization, defective area, lesion stage according to the ICRS classification, patient age, gender, and BMI do not seem to be of considerable relevance for prediction of patients' complaints and loss of joint function in osteochondral lesions of the ankle. Using the classification of Berndt and Harty, modified by Loomer, seems to be more conclusive.
踝关节骨软骨损伤患者群体具有异质性，包括创伤性、创伤后及特发性等多种病理形式，其中特发性形式的病因主要不明。本研究的目的是根据患者的主诉和关节功能对异质性患者群体进行分类。为此，分析了德国软骨登记处（KnorpelRegister DGOU）的数据，以调查创伤性和创伤后损伤是否比特发性损伤导致更多的主诉和关节功能丧失。此外，还试图确定病变部位、缺损面积、分期、患者年龄、性别和体重指数（BMI）是否与患者的主诉和关节功能丧失有关。
2014年10月至2016年1月期间，117例踝关节骨软骨损伤患者在20个临床中心接受了手术。数据收集通过基于网络的远程数据录入系统在手术时进行。使用德语版的足踝能力测量（FAAM）和足踝结果评分（FAOS）通过在线问卷对患者的主诉和关节功能进行评估，随后进行统计数据评估。
在大多数患者的主诉和关节功能方面，创伤性/创伤后损伤组与特发性损伤组之间未显示出显著差异，但FAOS评分中的生活质量类别除外，特发性损伤患者的生活质量明显更好（p = 0.02）。一方面，病变部位、缺损面积、患者年龄、性别和BMI与另一方面患者的主诉和关节功能之间未检测到显著关联。同样，根据国际软骨修复协会（ICRS）分类的病变分期与患者的主诉和关节功能之间也未发现显著关联。然而，根据Loomer修改的Berndt和Harty分类，较高的病变分期在FAAM和FAOS评分的某些类别中与更多的主诉和关节功能丧失显著相关（p≤0.04）。
病变的病因、病变部位、缺损面积、根据ICRS分类的病变分期、患者年龄、性别和BMI似乎与踝关节骨软骨损伤患者的主诉和关节功能丧失的预测没有显著相关性。使用Loomer修改的Berndt和Harty分类似乎更具决定性。
