Hospital for Special Surgery, New York, New York, USA.
Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Am J Sports Med. 2018 Jul;46(9):2096-2102. doi: 10.1177/0363546518776659. Epub 2018 Jun 5.
Uncontained-type osteochondral lesions of the talus (OLTs) have been shown to have inferior clinical outcomes after treatment with bone marrow stimulation. While autologous osteochondral transplantation (AOT) is indicated for larger lesions, no study has reported on the prognostic significance of the containment of OLTs treated with the AOT procedure.
To clarify the effect of the containment of OLTs on clinical and radiological outcomes in patients who underwent AOT for OLTs.
Case control study; Level of evidence, 3.
A retrospective cohort study comparing patients with contained-type and uncontained-type OLTs was undertaken to include all patients who underwent AOT for the treatment of OLTs between 2006 and 2014. Analyses were performed by grouping the patients according to the containment type. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and the 12-Item Short Form Health Survey (SF-12) preoperatively and at final follow-up. Magnetic resonance imaging (MRI) at 2 years' follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score. Multivariate regression models were used to evaluate factors affecting postoperative FAOS, SF-12, and MOCART scores.
Ninety-four patients were included: 31 patients with a contained-type OLT and 63 patients with an uncontained-type OLT. The median patient age was 34 years (interquartile range [IQR], 28-48 years) in the contained-type group and 36 years (IQR, 27-46 years) in the uncontained-type group. The median follow-up time was 45 months (IQR, 38-63 months) in the contained-type group and 52 months (IQR, 40-66 months) in the uncontained-type group. The median FAOS and SF-12 scores improved significantly after surgery in both contained-type and uncontained-type lesions ( P < .001). The median postoperative FAOS score of patients with contained-type OLTs was higher than that of patients with uncontained-type OLTs (91.7 vs 85.0, respectively; P = .009), but no significant differences were found between the contained-type and uncontained-type groups for postoperative SF-12 and MOCART scores. The multivariate regression models showed that patients with contained-type OLTs had an approximately 10-point better score on the FAOS compared with patients with uncontained-type OLTs ( P = .006). There was a nonsignificant trend for the rate of cystic occurrence in uncontained-type OLTs to be higher than that of contained-type OLTs (55.6% vs 38.7%, respectively; P = .125).
Patients with contained-type OLTs experienced better clinical outcomes than those with uncontained-type OLTs after AOT for the treatment of OLTs. However, the AOT procedure still provided good clinical and MRI outcomes in both contained-type and uncontained-type OLTs at midterm follow-up.
骨髓刺激治疗未能控制的距骨骨软骨病变（OLT）的临床结果较差。虽然自体软骨移植（AOT）适用于较大的病变，但尚无研究报告 AOT 治疗 OLT 的病变封闭对预后的影响。
阐明 AOT 治疗 OLT 中病变封闭对患者临床和影像学结果的影响。
病例对照研究；证据水平，3 级。
回顾性队列研究，比较了 2006 年至 2014 年间接受 AOT 治疗 OLT 的包含型和未包含型 OLT 患者，以包括所有接受 AOT 治疗的患者。根据病变封闭类型对患者进行分组分析。术前和末次随访时采用足踝结局评分（FAOS）和 12 项简明健康调查问卷（SF-12）评估临床结果。2 年随访时的 MRI 采用改良的软骨修复组织磁共振观察评分（MOCART）进行评估。采用多元回归模型评估影响术后 FAOS、SF-12 和 MOCART 评分的因素。
共纳入 94 例患者：31 例为包含型 OLT，63 例为未包含型 OLT。包含型组患者的中位年龄为 34 岁（四分位距[IQR]，28-48 岁），未包含型组为 36 岁（IQR，27-46 岁）。包含型组的中位随访时间为 45 个月（IQR，38-63 个月），未包含型组为 52 个月（IQR，40-66 个月）。包含型和未包含型病变患者术后 FAOS 和 SF-12 评分均显著提高（均 P <.001）。包含型 OLT 患者术后 FAOS 评分高于未包含型 OLT 患者（分别为 91.7 和 85.0，P =.009），但两组患者术后 SF-12 和 MOCART 评分无显著差异。多元回归模型显示，与未包含型 OLT 患者相比，包含型 OLT 患者的 FAOS 评分平均提高约 10 分（P =.006）。未包含型 OLT 中囊性病变发生率的趋势高于包含型 OLT（分别为 55.6%和 38.7%，P =.125）。
与未包含型 OLT 患者相比，AOT 治疗 OLT 后包含型 OLT 患者的临床结果更好。然而，在中期随访中，AOT 治疗仍为包含型和未包含型 OLT 提供了良好的临床和 MRI 结果。
