Department of Orthopedics and Traumatology, Bakırköy Dr. Sadi Konuk Education and Research Hospital, Tevfik Sağlam St. Number 11, Bakırköy, 34147, Istanbul, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2018 Oct;26(10):3089-3095. doi: 10.1007/s00167-018-4963-x. Epub 2018 Apr 25.
Ankle arthroscopy is a useful tool for detection and treatment of accompanying intraarticular pathologies in acute ankle fractures. The purpose of this study was to compare the treatment results of talus osteochondral lesions (OLT) with debridement and microfracture in arthroscopy assisted surgery of acute ankle fractures.
Eleven consecutive patients who were treated with arthroscopic acute debridement and 14 consecutive patients who were treated with arthroscopic acute microfracture in the treatment of ankle fracture were included in the study. All patients were controlled clinically and radiologically in the postoperative period. Ankle pain was evaluated with the visual analog score (VAS), ankle functions were assessed with American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), and osteoarthritic changes were analyzed with Van Dijk score.
There was no significant difference between the groups in terms of age, gender, injury side and trauma mechanism (n.s). Mean time to surgery, fracture healing duration, first weight-bearing and full weight-bearing, follow-up period and Van Dijk score were all similar in both groups (n.s). The AOFAS score and VAS activity score were statistically significantly better in the microfracture group (p = 0.044 and p = 0.001).
The clinical relevance of the present study is to define the acute treatment of the first osteochondral damage that occurred simultaneously with ankle fracture, to improve postoperative functional outcomes and to prevent post-traumatic osteoarthritis. Both debridement and microfracture yield good functional outcomes in the second year of the treatment. Microfracture ensures significantly more successful clinical results than debridement.
Level III.
踝关节镜检查是一种用于检测和治疗急性踝关节骨折伴随的关节内病变的有用工具。本研究的目的是比较踝关节镜辅助手术治疗急性踝关节骨折时，距骨骨软骨病变（OLT）的清理术和微骨折术的治疗效果。
研究纳入了 11 例接受关节镜下急性清创术和 14 例接受关节镜下急性微骨折术治疗的急性踝关节骨折患者。所有患者均在术后进行临床和影像学随访。采用视觉模拟评分（VAS）评估踝关节疼痛，采用美国矫形足踝协会踝关节后足评分（AOFAS）评估踝关节功能，采用范迪克评分分析骨关节炎变化。
两组患者在年龄、性别、损伤侧和创伤机制方面无显著差异（n.s）。手术时间、骨折愈合时间、首次负重和完全负重时间、随访时间和范迪克评分在两组间均相似（n.s）。微骨折组的 AOFAS 评分和 VAS 活动评分均显著更好（p = 0.044 和 p = 0.001）。
本研究的临床意义在于明确同时发生的踝关节骨折的第一骨软骨损伤的急性治疗方法，改善术后功能结果，预防创伤后骨关节炎。清创术和微骨折术在治疗的第二年都能获得良好的功能结果。微骨折术比清创术确保了更显著的临床效果。
III 级。
