Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2021 May;29(5):1570-1576. doi: 10.1007/s00167-020-06303-y. Epub 2020 Oct 3.
Magnetic resonance imaging (MRI) findings of subchondral bone marrow edema (SBME) in osteochondral lesions of the talus (OLT) after arthroscopic microfracture are associated with poor clinical outcomes. However, the relationship between SBME volume change and clinical outcomes has not been analyzed. It was hypothesized that clinical outcomes correlated with SBME volume change and extent of cartilage regeneration in patients with OLT.
64 patients who underwent arthroscopic microfracture for OLT were followed up for more than 2 years. SBME volume change was measured by comparing preoperative and 2-year follow-up MRI. Clinical outcomes were assessed using the visual analogue scale (VAS) and the American orthopedic foot and ankle society ankle-hindfoot scale (AOFAS) at the 2-year and final follow-up. To compare clinical outcomes, patients were categorized into two groups: decreased SBME (DSBME) group (cases without SBME on either MRI or with a decreased SBME volume between the MRIs) and increased SBME (ISBME) group (cases with new SBME on postoperative MRI or with an increased SBME volume between the MRIs). Additionally, the effects of age, sex, body mass index, symptom duration, OLT size, OLT location, containment/uncontainment, preoperative subchondral cysts, pre- and postoperative SBME volumes, and MRI observation of cartilage repair tissue score on clinical outcomes were analyzed.
The DSBME group included 45 patients, whereas the ISBME group included 19. The mean age was 40.1 ± 17.2 years, and mean follow-up period was 35.7 ± 18.3 months. Preoperative SBME volume was significantly higher in the DSBME group, while the ISBME group had higher volumes at the final follow-up. In both groups, the VAS and AOFAS scores significantly improved at the final follow-up (p < 0.001, < 0.001). The VAS scores were significantly lower in the DSBME group at the 2-year and final follow-up (p = 0.004, 0.011), while the AOFAS scores were significantly higher (p = 0.019, 0.028). Other factors including cartilage regeneration did not affect clinical outcomes.
SBME volume change correlated with clinical outcomes after arthroscopic microfracture for OLT. Clinical outcomes were worse in patients with new postoperative SBME and increased postoperative SBME volume. In patients with an unsatisfactory clinical course that show decreased SBME via postoperative MRI, an extended follow-up in a conservative manner could be considered.
Level III.
关节镜下微骨折治疗距骨骨软骨病变（OLT）后，软骨下骨髓水肿（SBME）的磁共振成像（MRI）表现与临床结果不良相关。然而，SBME 体积变化与临床结果之间的关系尚未得到分析。据推测，OLT 患者的 SBME 体积变化和软骨再生程度与临床结果相关。
对 64 例行关节镜下微骨折治疗的 OLT 患者进行了超过 2 年的随访。通过比较术前和 2 年随访的 MRI 来测量 SBME 体积变化。在 2 年和最终随访时，使用视觉模拟量表（VAS）和美国矫形足踝协会踝关节-后足量表（AOFAS）评估临床结果。为了比较临床结果，将患者分为两组：SBME 减少（DSBME）组（MRI 上无 SBME 或 MRI 之间 SBME 体积减少）和 SBME 增加（ISBME）组（术后 MRI 上出现新的 SBME 或 MRI 之间 SBME 体积增加）。此外，分析了年龄、性别、体重指数、症状持续时间、OLT 大小、OLT 位置、包容/非包容、术前软骨下囊肿、术前和术后 SBME 体积以及 MRI 观察软骨修复组织评分对临床结果的影响。
DSBME 组包括 45 例患者，ISBME 组包括 19 例患者。平均年龄为 40.1±17.2 岁，平均随访时间为 35.7±18.3 个月。术前 SBME 体积在 DSBME 组中明显较高，而 ISBME 组在最终随访时体积较高。在两组中，VAS 和 AOFAS 评分在最终随访时均显著改善（p<0.001，p<0.001）。在 2 年和最终随访时，DSBME 组的 VAS 评分明显较低（p=0.004，0.011），而 AOFAS 评分明显较高（p=0.019，0.028）。包括软骨再生在内的其他因素并不影响临床结果。
OLT 关节镜下微骨折术后 SBME 体积变化与临床结果相关。术后出现新的 SBME 和术后 SBME 体积增加的患者临床结果较差。在术后 MRI 显示 SBME 减少的情况下，临床过程不满意的患者，可以考虑以保守的方式进行更长时间的随访。
III 级。
