Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
Foot Ankle Int. 2020 Nov;41(11):1419-1426. doi: 10.1177/1071100720938049. Epub 2020 Jul 19.
Chronic ankle instability (CAI) induces osteoarthritis (OA) by inflicting abnormal stresses on the medial gutter. It is important to detect early OA change and to explore factors likely to induce the OA. The purpose of this study was to evaluate subchondral bone change in the medial gutter of CAI using computed tomography (CT) scans.
Thirty-five ankles with CAI (CAI group) and 35 ankles without CAI (control group) were included. The region of interest (ROI) in the subchondral bone of the medial gutter on CT axial images was set on the tibia and talus. The Hounsfield unit (HU) in ROIs was measured and corrected by the HU of the fibula in the same slice. HU ratios were compared between the CAI and control groups. In the CAI group, the relationship between the HU ratio and the talar tilt angle (TTA), OA change, and the anterior talofibular ligament (ATFL) remnant quality were analyzed.
The mean HU ratio in the CAI group was significantly higher than that in the control. In the CAI group, HU ratios in ≥10 degrees of TTA were significantly higher than those in <10 degrees. But there was no significant difference in the HU ratios with or without OA change in the medial gutter. A good-quality ATFL remnant showed a low HU ratio compared with that with poor quality.
CAI patients exhibited subchondral bone change in the medial gutter, which suggests that the elimination of instability may help to prevent or decrease the development and/or progression of osteoarthritis.
Level III, comparative series.
慢性踝关节不稳（CAI）通过对内侧沟施加异常应力导致骨关节炎（OA）。早期发现 OA 变化并探索可能导致 OA 的因素非常重要。本研究旨在使用计算机断层扫描（CT）评估 CAI 患者内侧沟的软骨下骨变化。
纳入 35 例 CAI 踝关节（CAI 组）和 35 例无 CAI 踝关节（对照组）。在 CT 轴位图像上，在胫骨和距骨的内侧沟软骨下骨的感兴趣区域（ROI）上设置 ROI。测量 ROI 中的亨氏单位（HU），并通过同一切片的腓骨 HU 进行校正。比较 CAI 组和对照组之间 ROI 的 HU 比值。在 CAI 组中，分析 HU 比值与距骨倾斜角（TTA）、OA 变化和前距腓韧带（ATFL）残端质量之间的关系。
CAI 组的平均 HU 比值明显高于对照组。在 CAI 组中，TTA≥10 度的 HU 比值明显高于 TTA<10 度的 HU 比值。但是，在有或没有内侧沟 OA 变化的 CAI 组中，HU 比值没有差异。质量好的 ATFL 残端与质量差的 ATFL 残端相比 HU 比值较低。
CAI 患者的内侧沟存在软骨下骨变化，这表明消除不稳定可能有助于预防或减少骨关节炎的发生和/或进展。
III 级，比较系列。
