Wang Ding-Yu, Jiao Chen, Ao Ying-Fang, Yu Jia-Kuo, Guo Qin-Wei, Xie Xing, Chen Lin-Xin, Zhao Feng, Pi Yan-Bin, Li Nan, Hu Yue-Lin, Jiang Dong
Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Haidian, Beijing, China.
Orthop J Sports Med. 2020 May 26;8(5):2325967120922821. doi: 10.1177/2325967120922821. eCollection 2020 May.
Osteochondral lesions (OCLs) and bony impingement are common secondary lesions of chronic lateral ankle instability (CLAI), but the risk factors that predict OCLs and bony impingement are unknown.
To analyze the risk factors for the development of OCLs and osteophytes in patients with CLAI.
Case-control study; Level of evidence, 3.
Patients diagnosed with CLAI at our institution from June 2007 to May 2018 were enrolled. The assessed potential risk factors were age, sex, postinjury duration, body mass index, injury side, and ligament injury type (isolated anterior talofibular ligament [ATFL] injury, isolated calcaneofibular ligament [CFL] injury, or concomitant ATFL and CFL injuries). Univariate and multivariate logistic regression analyses were performed to evaluate the association between these factors and the presence of OCLs and osteophytes.
A total of 1169 patients with CLAI were included; 436 patients (37%) had OCLs and 334 (31%) had osteophytes. The presence of OCLs was significantly associated with the presence of osteophytes ( < .001). Male sex and older age were significantly associated with the presence of OCLs in the medial and lateral talus. A postinjury duration of 5 years or longer was significantly associated with the presence of OCLs in the medial talus (odds ratio [OR], 1.532; 95% CI, 1.023-2.293; = .038) but not in the lateral talus. ATFL and CFL injuries were both significantly associated with the presence of lateral OCLs. Risk factors for the presence of osteophytes were male sex, older age, postinjury duration 5 years or longer, and CFL injury. Patients with concomitant ATFL and CFL injuries were significantly more likely to have osteophytes than were patients with single-ligament injuries ( = .018).
Risk factors for OCLs and osteophytes were postinjury duration of 5 years or longer, older age, and male sex. ATFL injury was associated with the presence of lateral OCLs, whereas CFL injury was associated with the presence of lateral OCLs and osteophytes. Patients with these risk factors should be closely monitored and treated to reduce the incidence of ankle arthritis.
骨软骨损伤（OCLs）和骨撞击是慢性外侧踝关节不稳（CLAI）常见的继发性损伤，但预测OCLs和骨撞击的危险因素尚不清楚。
分析CLAI患者发生OCLs和骨赘的危险因素。
病例对照研究；证据等级，3级。
纳入2007年6月至2018年5月在本机构诊断为CLAI的患者。评估的潜在危险因素包括年龄、性别、伤后持续时间、体重指数、受伤侧别以及韧带损伤类型（单纯距腓前韧带[ATFL]损伤、单纯跟腓韧带[CFL]损伤或ATFL和CFL联合损伤）。进行单因素和多因素逻辑回归分析，以评估这些因素与OCLs和骨赘存在之间的关联。
共纳入1169例CLAI患者；436例（37%）有OCLs，334例（31%）有骨赘。OCLs的存在与骨赘的存在显著相关（P<0.001）。男性和年龄较大与距骨内侧和外侧OCLs的存在显著相关。伤后持续时间5年或更长与距骨内侧OCLs的存在显著相关（比值比[OR]，1.532；95%可信区间，1.023 - 2.293；P = 0.038），但与距骨外侧无关。ATFL和CFL损伤均与外侧OCLs的存在显著相关。骨赘存在的危险因素为男性、年龄较大、伤后持续时间5年或更长以及CFL损伤。ATFL和CFL联合损伤的患者比单韧带损伤的患者更易出现骨赘（P = 0.018）。
OCLs和骨赘的危险因素为伤后持续时间5年或更长、年龄较大和男性。ATFL损伤与外侧OCLs的存在相关，而CFL损伤与外侧OCLs和骨赘的存在相关。具有这些危险因素的患者应密切监测和治疗，以降低踝关节关节炎的发生率。
