Baldassarri Matteo, Perazzo Luca, Ricciarelli Marco, Natali Simone, Vannini Francesca, Buda Roberto
I Clinic, Rizzoli Orthopedic Institute of Bologna, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.
Eur J Orthop Surg Traumatol. 2018 Aug;28(6):1199-1207. doi: 10.1007/s00590-018-2161-7. Epub 2018 Feb 23.
Osteochondral lesions of the distal tibial plafond (OLTP) are rare and far less common than osteochondral lesions of the talus. Literature data do not report clinical records with significant number of cases and follow-up. The aim of our study was to evaluate clinical and MRI outcomes following arthroscopic treatment of distal tibia osteochondral lesions and to report our results with treating these rare lesions.
Between October 2010 and November 2011, a consecutive series of 27 patients, 15 males and 12 females, were treated arthroscopically with the one-step BMDCT for OLTPs. Exclusion criteria were: age < 18 or > 50 years, patients with severe osteoarthritis (stage III according to Van Dijk classification), presence of kissing lesions of the ankle and patients with rheumatoid or hemophilic arthritis. All patients were evaluated through X-rays; MRI was performed preoperatively and at the final follow-up with MOCART score; clinical evaluation was assessed by AOFAS score at various follow-ups of 12, 24, 36, 60 and 72 months.
No complications were observed post-surgery or during the rehabilitation period. The AOFAS score improved from 52.4 preoperatively to 80.6 at the mean final follow-up. All the patients were satisfied with the procedure. In 14 cases the MRI showed a complete filling of the osteochondral defect, in three patients a hypertrophic tissue was observed, and in the other two patients an incomplete repair of the lesion associated with a persistent slight subchondral edema was reported. A topographic study was also performed.
Osteochondral lesions of the distal tibia represent a challenge for the orthopedic surgeon because of their difficulty diagnostic and rarities. The high incidence of good outcome in our series indicates that the one-step BMDCT could be a valid option for the treatment of this rare type of lesions. Further studies with a longer follow-up and more accurate imaging studies are necessary to confirm these results.
胫骨远端关节面骨软骨损伤（OLTP）较为罕见，比距骨骨软骨损伤少见得多。文献数据中没有大量病例及随访的临床记录。我们研究的目的是评估关节镜治疗胫骨远端骨软骨损伤后的临床和MRI结果，并报告我们治疗这些罕见损伤的结果。
2010年10月至2011年11月期间，连续27例患者（15例男性和12例女性）接受了关节镜下一步BMDCT治疗OLTP。排除标准为：年龄<18岁或>50岁、患有严重骨关节炎（根据Van Dijk分类为III期）、存在踝关节亲吻损伤以及患有类风湿性或血友病性关节炎的患者。所有患者均通过X线进行评估；术前及最终随访时进行MRI检查并采用MOCART评分；在12、24、36、60和72个月的不同随访期通过AOFAS评分进行临床评估。
术后及康复期间未观察到并发症。AOFAS评分从术前的52.4提高到最终随访时的平均80.6。所有患者对手术都很满意。14例患者的MRI显示骨软骨缺损完全填充，3例患者观察到肥厚组织，另外2例患者报告病变修复不完全并伴有持续的轻微软骨下水肿。还进行了一项地形学研究。
胫骨远端骨软骨损伤因其诊断困难和罕见性，对骨科医生来说是一项挑战。我们系列中良好结果的高发生率表明，一步BMDCT可能是治疗这种罕见类型损伤的有效选择。需要进一步进行更长时间随访和更精确影像学研究来证实这些结果。
