Department of Orthopaedic Surgery, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima City, Hiroshima, Japan.
Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima City, Hiroshima, Japan.
Foot Ankle Int. 2019 Dec;40(12):1388-1396. doi: 10.1177/1071100719868726. Epub 2019 Aug 18.
Fixation of an osteochondral lesion of the talus (OLT) can restore the natural congruency of the joint surface with hyaline cartilage. In this procedure, the bone condition of the osteochondral fragment is important for stabilizing the lesion, and it may affect clinical outcomes. The aim of this study was to explore the influence of the fragment's bone condition on clinical outcomes.
Eighteen ankles in 17 patients with a mean age of 20.1 years, which had undergone fixation of an OLT using bioabsorbable pins, were included. Based on the fragment's bone condition on preoperative computed tomography scans, ankles were divided into 3 groups: normal, segmentation, and absorption. The American Orthopaedic Foot & Ankle Society (AOFAS) scale and magnetic resonance imaging (MRI) findings were evaluated both pre- and postoperatively. Second-look arthroscopic findings were evaluated in 15 ankles and were compared with biopsy specimens from the initial surgery.
The AOFAS scale significantly improved at the final follow-up in all groups with no significant differences among the 3 groups. MRI at 1 year showed good bone incorporation and a congruent cartilage surface in all groups, but the bone marrow lesion in the absorption group was significantly larger than that in the other groups. In second-look arthroscopy, all ankles showed stable and near-normal cartilage. There was no significant correlation between arthroscopic and histological findings.
We found that fixation can be considered when there is a good cartilage surface on a large OLT, even if bone absorption in the fragment exists.
Level III, comparative study.
固定距骨骨软骨病变（OLT）可以恢复透明软骨覆盖的关节表面的自然吻合度。在此过程中，骨软骨碎片的骨质状况对于稳定病变很重要，并且可能会影响临床结果。本研究旨在探讨碎片骨质状况对临床结果的影响。
17 例患者的 18 个踝关节接受了生物可吸收钉固定 OLT，平均年龄为 20.1 岁。根据术前 CT 扫描中碎片的骨质状况，踝关节分为 3 组：正常、骨段和吸收。术前和术后均评估美国矫形足踝协会（AOFAS）评分和磁共振成像（MRI）结果。15 个踝关节进行了二次关节镜检查，并与初次手术的活检标本进行了比较。
所有组的 AOFAS 评分在最终随访时均显著改善，3 组之间无显著差异。1 年时 MRI 显示所有组均有良好的骨融合和一致的软骨表面，但吸收组的骨髓病变明显大于其他组。在二次关节镜检查中，所有踝关节均表现为稳定且接近正常的软骨。关节镜和组织学检查之间无显著相关性。
我们发现，即使存在骨吸收，只要大的 OLT 软骨表面良好，仍可考虑进行固定。
III 级，比较研究。
