Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.
J Bone Joint Surg Am. 2020 Jan 2;102(1):10-20. doi: 10.2106/JBJS.19.00208.
Arthroscopic microfracture is considered the primary treatment strategy for osteochondral lesions of the talus and has been shown to provide successful outcomes. However, deterioration of clinical outcomes and fibrocartilage infill over time is now a recognized concern. The purpose of the present study was to evaluate the outcomes related to cartilage repair tissue after microfracture with use of second-look arthroscopy and magnetic resonance imaging (MRI) and to compare these findings with functional outcomes.
Twenty-five patients underwent second-look arthroscopy and MRI at a mean of 3.6 years (range, 2.2 to 8.1 years) after microfracture. Second-look arthroscopic findings were assessed according to the system of the International Cartilage Repair Society (ICRS). MRI was evaluated postoperatively with use of the magnetic resonance observation of cartilage repair tissue (MOCART) score. Clinical outcomes were determined with use of the Foot and Ankle Outcome Score (FAOS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and the Short Form-36 (SF-36) score.
On second-look arthroscopy, 9 ankles (36%) were still abnormal according to the ICRS overall repair grades. The average postoperative MOCART score was 67.8 (range, 30 to 95), with good association with functional outcome. In addition, 6 patients (24%) had a mismatch between the MRI and second-look arthroscopic findings. Significant improvements were observed in all functional outcome categories between the preoperative and latest follow-up evaluations (p < 0.001). The mean FAOS scores for ICRS repair grades I and II (n = 16) and grades III and IV (n = 9) were 86.8 and 75.6, respectively. There was a significant correlation between FAOS scores and ICRS grades (p = 0.004).
Second-look arthroscopic results revealed that 36% of lesions were incompletely healed and had inferior quality of repair tissue compared with that of native cartilage at a mean of 3.6 years, although arthroscopic microfracture provided functional improvements. Magnetic resonance analysis demonstrated some limitations in comparison with arthroscopy for the evaluation of cartilage repair. Therefore, second-look arthroscopy has an important role in accurately assessing the status of the cartilage repair tissue beyond the use of the MOCART score and functional outcomes.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
关节镜下微骨折术被认为是距骨骨软骨病变的主要治疗策略，已被证明可获得成功的结果。然而，临床结果的恶化和纤维软骨填充随时间推移而恶化，现在是一个公认的问题。本研究的目的是评估微骨折术后通过二次关节镜检查和磁共振成像（MRI）评估软骨修复组织的结果，并将这些发现与功能结果进行比较。
25 例患者在微骨折术后平均 3.6 年（范围，2.2 至 8.1 年）行二次关节镜检查和 MRI。根据国际软骨修复协会（ICRS）系统评估二次关节镜检查结果。术后使用磁共振软骨修复组织观察评分（MOCART）对 MRI 进行评估。使用足部和踝关节结局评分（FAOS）、美国矫形足踝协会（AOFAS）踝关节-后足量表和简短形式 36 项健康调查量表（SF-36）评分来确定临床结果。
根据 ICRS 整体修复等级，9 个踝关节（36%）在二次关节镜检查中仍存在异常。术后平均 MOCART 评分为 67.8（范围，30 至 95），与功能结果有良好的相关性。此外，6 例患者（24%）的 MRI 与二次关节镜检查结果不匹配。所有功能结果类别在术前和最新随访评估之间均有显著改善（p < 0.001）。ICRS 修复等级 I 和 II（n = 16）和等级 III 和 IV（n = 9）的 FAOS 评分分别为 86.8 和 75.6。FAOS 评分与 ICRS 等级之间存在显著相关性（p = 0.004）。
二次关节镜检查结果显示，在平均 3.6 年时，36%的病变未完全愈合，修复组织的质量与正常软骨相比较差，尽管关节镜下微骨折术可改善功能。磁共振分析与关节镜检查相比，在评估软骨修复方面存在一些局限性。因此，二次关节镜检查在准确评估软骨修复组织的状态方面具有重要作用，而不仅仅是基于 MOCART 评分和功能结果。
治疗学 IV 级。有关证据水平的完整描述，请参见作者说明。
