DeBernardis Dennis, Stark Michael, Ford Elizabeth, McDowell Christopher, McMillan Sean
Orthopaedic Surgery Department, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.
Department of Orthopedics, Inspira Health, Vineland, New Jersey, U.S.A.
Arthrosc Sports Med Rehabil. 2020 Oct 5;2(5):e583-e590. doi: 10.1016/j.asmr.2020.07.006. eCollection 2020 Oct.
To investigate the change in patient-reported pain after percutaneous skeletal fixation (PSF) and to determine the success rate of PSF in the prevention of additional intervention for the treatment of painful subchondral bone marrow edema (SBME) of the knee over a 2-year postoperative period.
This was a retrospective, single-surgeon analysis of patients undergoing PSF for painful, atraumatic SBME of the knee confirmed on preoperative magnetic resonance imaging with a minimum 2-year follow-up. Inclusion criteria were age >18 years, pain localized to the area of edema, failure of nonsurgical intervention (4 weeks of physical therapy and non-steroidal medication use), and absence of tricompartmental Kellgren-Lawrence grade 4 osteoarthritis. All patients underwent arthroscopy, followed by isolated PSF without additional chondral procedures. Pre- and postoperative visual analog scale scores were compared. The primary outcome measure of success was defined as a lack of additional intervention. This included viscosupplementation, corticosteroid injection, or conversion to arthroplasty.
A total of 74 patients with a mean age of 47.2 years and average follow-up time of 38.9 months (range 24-61 months) were evaluated. Successful treatment was noted in 61 patients (82.4%). Of the 13 patients who did not respond to PSF, 5 (6.8%) had been converted to arthroplasty, 11 received viscosupplementation, and 8 required cortisone injections. The average visual analog scale score decreased from 7.55 preoperatively to 3.16 at 2-year follow-up ( < .001). The average body mass index of successfully treated patients (28.2) was significantly less than that of the patients experiencing failure (32.2) ( = .001).
Patients undergoing PSF for the treatment of painful SBME may expect a decrease in knee pain and low rates of additional intervention over a 2-year postoperative period.
Level IV; Therapeutic Case Series.
研究经皮骨骼固定术（PSF）后患者自述疼痛的变化，并确定PSF在预防膝关节疼痛性软骨下骨髓水肿（SBME）术后2年内进行额外干预治疗方面的成功率。
这是一项对接受PSF治疗膝关节疼痛性、非创伤性SBME患者的回顾性单术者分析，术前磁共振成像确诊，随访至少2年。纳入标准为年龄>18岁，疼痛局限于水肿区域，非手术干预失败（4周物理治疗和使用非甾体类药物），且不存在三关节面Kellgren-Lawrence 4级骨关节炎。所有患者均接受关节镜检查，随后进行单纯PSF，不进行额外的软骨手术。比较术前和术后视觉模拟量表评分。成功的主要结局指标定义为无需额外干预。这包括关节腔注射透明质酸钠、皮质类固醇注射或转换为关节成形术。
共评估了74例患者，平均年龄47.2岁，平均随访时间38.9个月（范围24 - 61个月）。61例患者（82.4%）治疗成功。在13例对PSF无反应的患者中，5例（6.8%）转换为关节成形术，11例接受了关节腔注射透明质酸钠，8例需要注射皮质类固醇。视觉模拟量表平均评分从术前的7.55降至2年随访时的3.16（P <.001）。成功治疗患者的平均体重指数（28.2）显著低于治疗失败患者（32.2）（P = .001）。
接受PSF治疗疼痛性SBME的患者在术后2年内膝关节疼痛可能会减轻，额外干预率较低。
IV级；治疗性病例系列。
