Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Am J Sports Med. 2018 Jan;46(1):208-216. doi: 10.1177/0363546517732035. Epub 2017 Oct 10.
Osteochondral lesions of the talar dome (OLTs) involve the articular cartilage and subchondral bone. The subchondral bone plate (SBP) plays a crucial role in cartilage metabolism, and computed tomography (CT) can provide more precise information on subchondral bone. CT image prediction of the histological findings on OLT will be useful to determine the most appropriate therapeutic strategy.
To evaluate the unique features of the CT findings that relate to the condition of the articular cartilage in OLT.
Cohort study; Level of evidence, 3.
Thirty ankles in 29 patients who had OLT with an osteochondral fragment were retrospectively reviewed. At surgery, the osteochondral fragment of 19 ankles could be preserved (preservation group) by fixation or drilling, and in the remaining 11 ankles, the osteochondral fragment was removed (excision group). Preoperative CT findings were compared between the 2 groups. Biopsies of the osteochondral fragment from 13 ankles were performed. The relationship between the CT and histological findings were evaluated.
The area of lesion in the preservation group was significantly larger than that in the excision group. The CT images of the lesion showed the rate of absorption of the SBP in the preservation group to be lower than that in the excision group. As for the lesion bed absorption, it was higher in the preservation group than in the excision group. All cases in the excision group showed bed sclerosis, compared with 42.1% in the preservation group. The specimens with disruption of the SBP exhibited cartilage degeneration and abundant chondrocyte cloning. OLT with absorption of the SBP on CT showed severe cartilage degeneration, while the remaining SBP on CT showed low-grade cartilage degeneration.
This study shows the features of preoperative CT and histological findings in OLT with osteochondral fragments. The condition of the SBP affects the cartilage degeneration. CT findings provide important information for the determination of surgical treatment.
距骨穹隆骨软骨损伤（OLTs）涉及关节软骨和软骨下骨。软骨下骨板（SBP）在软骨代谢中起着至关重要的作用，而计算机断层扫描（CT）可以提供更精确的软骨下骨信息。预测 OLT 的 CT 图像下的组织学发现将有助于确定最合适的治疗策略。
评估与 OLT 中关节软骨状况相关的 CT 发现的独特特征。
队列研究；证据水平，3 级。
回顾性分析了 29 名患者的 30 个踝关节 OLT 伴骨软骨碎片。在手术中，19 个踝关节的骨软骨碎片可通过固定或钻孔保留（保留组），而在另外 11 个踝关节中，骨软骨碎片被切除（切除组）。比较了两组之间的术前 CT 发现。对 13 个踝关节的骨软骨碎片进行了活检。评估了 CT 和组织学发现之间的关系。
保留组的病变面积明显大于切除组。保留组的 SBP 吸收率低于切除组。至于病变床吸收，保留组高于切除组。切除组所有病例均显示床骨硬化，而保留组仅 42.1%。SBP 破裂的标本显示软骨退化和大量软骨细胞克隆。CT 显示 SBP 吸收的 OLT 表现为严重的软骨退化，而 CT 显示 SBP 保留的 OLT 表现为低级别软骨退化。
本研究显示了 OLT 伴骨软骨碎片的术前 CT 和组织学发现的特征。SBP 的状况影响软骨退化。CT 发现为确定手术治疗提供了重要信息。
