J Am Podiatr Med Assoc. 2021 Feb 1;111(1). doi: 10.7547/19-101.
The purpose of the present study was to retrospectively compare the outcomes of patients who underwent arthroscopic thermal capsular shrinkage with those who underwent both arthroscopic thermal capsular shrinkage and arthroscopic osteochondral lesion (OCL) treatment with microfractures. Our hypothesis was that the simultaneous treatment does not negatively affect the outcome of the combined surgical procedure by influencing the postoperative rehabilitation protocol and does not significantly differ from capsular shrinkage alone in terms of subjective and objective outcomes.
Seventy-six patients with chronic ankle instability were treated at our department from 2004 to 2012 and reviewed retrospectively. Forty-two patients underwent arthroscopic thermal-assisted capsular shrinkage (group A), and 34 patients underwent combined arthroscopic capsular shrinkage and microfractures for OCL lesions of the talus (group B). All patients underwent a four-step surgical procedure including synovectomy, debridement, capsular shrinkage, and bracing and nonweightbearing for 21 days. In patients with OCL lesions, microfractures of the OCL were associated. Clinical assessment included objective examination, the American Orthopaedic Foot and Ankle Society ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and Sefton articular stability scale.
The median follow-up was 6 years (range, 2-9 years). The median postoperative visual analogue scale score, American Orthopaedic Foot and Ankle Society score, and Tegner score were improved from the preoperative level for both groups (P < .001). No significant difference was found between the two groups for the subjective scores and satisfaction rate (P = not significant). Similarly, no significant difference regarding the incidence of range-of-motion restriction was reported between the two groups (P = not significant).
The association of microfractures for the treatment of osteochondral lesions does not affect the outcome following arthroscopic treatment for chronic ankle instability up to 6 years from surgery.
本研究的目的是回顾性比较接受关节镜下热囊收缩术与同时接受关节镜下热囊收缩术和关节镜下骨软骨损伤（OCL）治疗联合微骨折术的患者的治疗效果。我们的假设是，同时治疗不会通过影响术后康复方案对联合手术的结果产生负面影响，并且在主观和客观结果方面与单纯囊收缩术无显著差异。
2004 年至 2012 年，我们科室对 76 例慢性踝关节不稳定患者进行了治疗，并进行了回顾性研究。42 例患者接受了关节镜下热辅助囊收缩术（A 组），34 例患者接受了关节镜下囊收缩术和距骨 OCL 微骨折术联合治疗（B 组）。所有患者均接受了包括滑膜切除术、清创术、囊收缩术、支具固定和 21 天非负重在内的四步手术。对于 OCL 病变患者，还进行了 OCL 的微骨折术。临床评估包括客观检查、美国矫形足踝协会踝和后足评分系统、Karlsson-Peterson 评分、Tegner 活动水平和 Sefton 关节稳定性评分。
中位随访时间为 6 年（范围 2-9 年）。两组患者的术后 VAS 评分、美国矫形足踝协会评分和 Tegner 评分均较术前明显改善（P<0.001）。两组患者的主观评分和满意度均无显著差异（P=无显著差异）。同样，两组患者的活动范围受限发生率也无显著差异（P=无显著差异）。
在接受慢性踝关节不稳定的关节镜治疗后，6 年内联合微骨折术治疗骨软骨损伤不会影响治疗效果。
