Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2021 Nov;29(11):3525-3533. doi: 10.1007/s00167-021-06630-8. Epub 2021 Jun 29.
The purpose of the present study was to evaluate the clinical and radiological outcomes of arthroscopic bone marrow stimulation (BMS) for the treatment of osteochondral lesions of the talus (OLTs) at long-term follow-up.
A literature search was conducted from the earliest record until March 2021 to identify studies published using the PubMed, EMBASE (Ovid), and Cochrane Library databases. Clinical studies reporting on arthroscopic BMS for OLTs at a minimum of 8-year follow-up were included. The review was performed according to the PRISMA guidelines. Two authors independently conducted the article selection and conducted the quality assessment using the Methodological index for Non-randomized Studies (MINORS). The primary outcome was defined as clinical outcomes consisting of pain scores and patient-reported outcome measures. Secondary outcomes concerned the return to sport rate, reoperation rate, complication rate, and the rate of progression of degenerative changes within the tibiotalar joint as a measure of ankle osteoarthritis. Associated 95% confidence intervals (95% CI) were calculated based on the primary and secondary outcome measures.
Six studies with a total of 323 ankles (310 patients) were included at a mean pooled follow-up of 13.0 (9.5-13.9) years. The mean MINORS score of the included studies was 7.7 out of 16 points (range 6-9), indicating a low to moderate quality. The mean postoperative pooled American Orthopaedic Foot and Ankle Society (AOFAS) score was 83.8 (95% CI 83.6-84.1). 78% (95% CI 69.5-86.8) participated in sports (at any level) at final follow-up. Return to preinjury level of sports was not reported. Reoperations were performed in 6.9% (95% CI 4.1-9.7) of ankles and complications related to the BMS procedure were observed in 2% (95% CI 0.4-3.0) of ankles. Progression of degenerative changes was observed in 28% (95% CI 22.3-33.2) of ankles.
Long-term clinical outcomes following arthroscopic BMS can be considered satisfactory even though one in three patients show progression of degenerative changes from a radiological perspective. These findings indicate that OLTs treated with BMS may be at risk of progressing towards end-stage ankle osteoarthritis over time in light of the incremental cartilage damage cascade. The findings of this study can aid clinicians and patients with the shared decision-making process when considering the long-term outcomes of BMS.
Level IV.
本研究旨在评估关节镜下骨髓刺激术（BMS）治疗距骨骨软骨病变（OLTs）的临床和影像学结果，随访时间至少为 8 年。
从最早的记录到 2021 年 3 月，通过 PubMed、EMBASE（Ovid）和 Cochrane 图书馆数据库进行文献检索，以确定使用至少 8 年随访的关节镜下 BMS 治疗 OLT 的临床研究。纳入了对 OLTs 进行关节镜下 BMS 治疗的临床研究，随访时间至少为 8 年。本综述按照 PRISMA 指南进行。两名作者独立进行文章选择，并使用非随机研究方法学指数（MINORS）进行质量评估。主要结果定义为包括疼痛评分和患者报告的结果测量在内的临床结果。次要结果包括重返运动率、再次手术率、并发症率以及距下关节退行性改变的进展率，作为踝关节骨关节炎的衡量标准。根据主要和次要结果测量值计算了相关的 95%置信区间（95%CI）。
共纳入 6 项研究，共 323 个踝关节（310 例患者），平均随访时间为 13.0（9.5-13.9）年。纳入研究的 MINORS 平均得分为 7.7 分（16 分制）（范围 6-9 分），表明质量为低到中等。术后平均美国矫形足踝协会（AOFAS）评分总和为 83.8（95%CI 83.6-84.1）。78%（95%CI 69.5-86.8）的患者在最终随访时参加了（任何水平的）运动。未报告重返术前运动水平。6.9%（95%CI 4.1-9.7）的踝关节进行了再次手术，2%（95%CI 0.4-3.0）的踝关节出现与 BMS 手术相关的并发症。28%（95%CI 22.3-33.2）的踝关节出现退行性改变进展。
即使三分之一的患者从影像学角度显示退行性改变进展，关节镜下 BMS 治疗后的长期临床结果仍可认为是满意的。这些发现表明，随着时间的推移，接受 BMS 治疗的 OLTs 可能有进展为终末期踝关节骨关节炎的风险，这是基于渐进性软骨损伤级联反应。本研究的结果可以帮助临床医生和患者在考虑 BMS 的长期结果时进行共同决策。
IV 级。
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