Danilkowicz Richard M, Grimm Nathan L, Zhang Gloria X, Lefebvre Thomas A, Lau Brian, Adams Samuel B, Amendola Annunziato
Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Idaho Sports Medicine Institute, Boise, Idaho, USA.
Orthop J Sports Med. 2021 Sep 13;9(9):23259671211029883. doi: 10.1177/23259671211029883. eCollection 2021 Sep.
Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method.
To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status.
Cohort study; Level of evidence, 3.
We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the test was used for continuous variables.
A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group ( > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance ( = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort.
The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.
距骨骨软骨损伤（OLT）可能由剥脱性骨软骨炎、骨软骨骨折、缺血性坏死或局灶性关节炎改变引起。对于某些局灶性软骨缺损，骨髓刺激（BMS）一直是一种广泛应用的技术，用于在缺损上方恢复纤维软骨替代物。该手术有多种术后负重方案，没有单一的金标准方法。
回顾性分析接受踝关节镜检查并同时进行BMS的患者的预后，以根据术后负重状态确定预后情况。
队列研究；证据等级为3级。
我们回顾性分析了2015年至2018年间因OLT接受踝关节镜检查并进行BMS的患者的记录。根据术后固定状态将患者分为2个队列：非负重（NWB）组和可耐受负重（WBAT）组。获取的患者特征包括年龄、性别、合并症和距骨病变的病因。预后指标包括疼痛视觉模拟量表（VAS）、活动范围（ROM）、并发症、首次负重时间以及固定方法和时间。排除在30天前失访的患者。采用卡方检验比较队列之间的分类变量，采用t检验比较连续变量。
共有69例患者符合本研究的纳入标准，其中WBAT组18例，NWB组51例。NWB组平均损伤大小为9.48×9.21mm（范围3 - 15mm×2 - 20mm），WBAT组为9.36×9.72mm（范围5 - 14mm×6 - 20mm）（P > 0.05）。WBAT组VAS评分从4.40改善至0.67，NWB组从6.33改善至2.55，最终值差异具有统计学意义（P = 0.0002）。两组术后ROM无显著差异。NWB队列中有4例再次手术。
OLT的手术治疗具有挑战性，术后负重方案可能成为患者需要应对的额外障碍。我们发现允许立即完全WBAT时，在疼痛、ROM或并发症方面没有差异。
