Ikoma Kazuya, Kido Masamitsu, Maki Masahiro, Imai Kan, Hara Yusuke, Ikeda Ryosuke, Ohashi Suzuyo, Shirai Toshiharu, Kubo Toshikazu
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.
J Orthop Sci. 2020 Jan;25(1):178-182. doi: 10.1016/j.jos.2019.02.003. Epub 2019 Feb 21.
In chronic lateral ankle instability (CLAI), the instability of the ankle joint results in repeated microtrauma to the articular cartilage. How the lesion condition or stage is affected by the presence of lateral instability in medial osteochondral lesions of the talus (OLT) is unclear. We aimed to examine whether CLAI is associated with the size and staging of medial OLT on radiographs, magnetic resonance (MR) images, and arthroscopy.
Forty-five patients with medial OLTs in 45 ankles were reviewed. Radiographs were assessed for damage and lesion classification. The tibio-talar tilting angle (TTA) was measured. The patients were divided into two groups: the CLAI group and the stable group. The lesion classification on radiographs, MR images, and arthroscopy, and size on MR images were statistically compared.
The CLAI group had a mean TTA of 8.15 ± 3.41°, whereas the stable group had a mean TTA of 2.24 ± 1.64°. The CLAI group had a lower clinical score than the stable group at the initial visit to our clinic. The CLAI group presented with lesions of significantly shorter longitudinal and transverse diameters. Stages of medial OLT on radiographs, MR images, and arthroscopic evaluation were earlier in the CLAI group than those in the stable group.
Patients with CLAI presented in the early stages of OLT and had significantly smaller lesions than those without CLAI. The patients without CLAI may be selected for surgery at an early phase.
在慢性外侧踝关节不稳（CLAI）中，踝关节不稳会导致关节软骨反复受到微创伤。距骨内侧骨软骨损伤（OLT）中，外侧不稳的存在如何影响损伤状况或阶段尚不清楚。我们旨在研究CLAI是否与X线片、磁共振（MR）图像及关节镜检查下内侧OLT的大小和分期相关。
对45例踝关节存在内侧OLT的患者进行回顾性研究。评估X线片的损伤情况及病变分类。测量胫距倾斜角（TTA）。将患者分为两组：CLAI组和稳定组。对X线片、MR图像及关节镜检查的病变分类以及MR图像上的大小进行统计学比较。
CLAI组的平均TTA为8.15±3.41°，而稳定组的平均TTA为2.24±1.64°。在初次就诊时，CLAI组的临床评分低于稳定组。CLAI组的病变纵径和横径明显较短。在X线片、MR图像及关节镜评估中，CLAI组内侧OLT的分期早于稳定组。
CLAI患者OLT处于早期阶段，且病变明显小于无CLAI的患者。对于无CLAI的患者，可在早期选择手术治疗。
