Waltenspül Manuel, Zindel Christoph, Altorfer Franziska C S, Wirth Stephan, Ackermann Jakob
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Clinic for Orthopaedics and Traumatology, Department of Surgery, Triemli Hospital, Zürich, Switzerland.
Foot Ankle Orthop. 2022 Apr 29;7(2):24730114221092021. doi: 10.1177/24730114221092021. eCollection 2022 Apr.
Magnetic resonance imaging (MRI) is commonly used for evaluation of ankle cartilage repair, yet its association with clinical outcome is controversial. This study analyzes the correlation between MRI and clinical outcome after cartilage repair of the talus including bone marrow stimulation, cell-based techniques, as well as restoration with allo- or autografting.
A systematic search was performed in MEDLINE, Embase, and Cochrane Collaboration. Articles were screened for correlation of MRI and clinical outcome. Guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used. Chi-square test and regression analysis were performed to identify variables that determine correlation between clinical and radiologic outcome.
Of 2687 articles, a total of 43 studies (total 1212 cases) were included with a mean Coleman score of 57 (range, 33-70). Overall, 93% were case series, and 5% were retrospective and 2% prospective cohort studies. Associations between clinical outcome and ≥1 imaging variable were found in 21 studies (49%). Of 24 studies (56%) using the composite magnetic resonance observation of cartilage repair tissue (MOCART) score, 7 (29%) reported a correlation of the composite score with clinical outcome. Defect fill was associated with clinical outcome in 5 studies (12%), and 5 studies (50%) reported a correlation of T2 mapping and clinical outcome. Advanced age, shorter follow-up, and larger study size were associated with established correlation between clinical and radiographic outcome ( = .021, = .028, and = .033).
Interpreting MRI in prediction of clinical outcome in ankle cartilage repair remains challenging; however, it seems to hold some value in reflecting clinical outcome in patients with advanced age and/or at a shorter follow-up. Yet, further research is warranted to optimize postoperative MRI protocols and assessments allowing for a more comprehensive repair tissue evaluation, which eventually reflect clinical outcome in patients after cartilage repair of the ankle. Level III, systematic review and meta-analysis.
磁共振成像（MRI）常用于评估踝关节软骨修复情况，但其与临床结局的相关性存在争议。本研究分析了距骨软骨修复术后MRI与临床结局之间的相关性，包括骨髓刺激、基于细胞的技术以及同种异体或自体移植修复。
在MEDLINE、Embase和Cochrane协作网进行系统检索。筛选有关MRI与临床结局相关性的文章。采用系统评价和Meta分析的首选报告项目（PRISMA）指南。进行卡方检验和回归分析以确定决定临床和影像学结局相关性的变量。
在2687篇文章中，共纳入43项研究（共1212例），平均科尔曼评分为57分（范围33 - 70分）。总体而言，93%为病例系列研究，5%为回顾性研究，2%为前瞻性队列研究。21项研究（49%）发现临床结局与≥1个影像变量之间存在关联。在24项（56%）使用软骨修复组织磁共振综合观察（MOCART）评分的研究中，7项（29%）报告综合评分与临床结局存在相关性。5项研究（12%）发现缺损填充与临床结局相关，5项研究（50%）报告T2成像与临床结局存在相关性。高龄、随访时间短和研究规模大与临床和影像学结局之间已确立的相关性相关（P = 0.021、P = 0.028和P = 0.033）。
解读MRI对踝关节软骨修复临床结局的预测仍具有挑战性；然而，它似乎在反映高龄和/或随访时间短的患者的临床结局方面具有一定价值。然而，仍需进一步研究以优化术后MRI方案和评估，从而实现更全面的修复组织评估，最终反映踝关节软骨修复患者的临床结局。三级，系统评价和Meta分析。
