Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Inha University Hospital, Incheon, Republic of Korea.
Sci Rep. 2022 Jun 27;12(1):10833. doi: 10.1038/s41598-022-14990-5.
The purpose of this study was to evaluate cartilage quality after internal fixation of osteochondral lesion of the talus (OLT) using second-look arthroscopies and MRIs. Thirty-four patients underwent internal fixation of OLTs involving large bone fragments. Twenty-one of these patients underwent second-look arthroscopies and 23 patients underwent MRIs postoperatively. The arthroscopic findings were assessed using the International Cartilage Repair Society (ICRS) grading system, and the MRI findings were evaluated using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. Five of the patients who underwent second-look arthroscopies showed normal cartilage, 12 showed nearly normal cartilage, 3 showed abnormal cartilage, and 1 showed severely abnormal cartilage, according to the overall ICRS repair grades. All the patients who achieved bone fragment union showed normal, or nearly normal cartilage upon second-look arthroscopy. The ICRS and MOCART scores were significantly higher for the patients with bone fragment union compared to those with nonunion (ICRS scores: 10.3 ± 1.5 vs. 6.0 ± 2.0, p < 0.001, MOCART score: 88.3 ± 10.0 vs. 39.0 ± 20.4, p < 0.001). Low signal intensities of the bone fragments on preoperative T1-weighted MRIs were not associated with nonunion (Fisher's exact test, p = 0.55), and the signal intensities increased postoperatively to levels similar to the underlying talus when bone union was achieved. Second-look arthroscopy and MRI showed normal, or nearly normal, cartilage after internal fixation of OLTs when bone union was achieved. The nonunion of bone fragments resulted in inferior cartilage quality.
本研究旨在通过二次关节镜检查和 MRI 评估距骨骨软骨病变（OLT）内固定后的软骨质量。34 名患者接受了涉及大骨碎片的 OLT 内固定。其中 21 名患者接受了二次关节镜检查，23 名患者接受了术后 MRI。关节镜检查结果采用国际软骨修复协会（ICRS）分级系统评估，MRI 结果采用磁共振软骨修复组织观察评分（MOCART）评分评估。根据整体 ICRS 修复等级，5 名接受二次关节镜检查的患者表现为正常软骨，12 名表现为接近正常软骨，3 名表现为异常软骨，1 名表现为严重异常软骨。所有达到骨碎片愈合的患者在二次关节镜检查时均表现为正常或接近正常的软骨。与未愈合患者相比，骨碎片愈合患者的 ICRS 和 MOCART 评分显著更高（ICRS 评分：10.3±1.5 比 6.0±2.0，p<0.001，MOCART 评分：88.3±10.0 比 39.0±20.4，p<0.001）。术前 T1 加权 MRI 上骨碎片的低信号强度与未愈合无关（Fisher 确切检验，p=0.55），并且当骨愈合时，信号强度增加到与下面的距骨相似的水平。OLT 内固定后当达到骨愈合时，二次关节镜和 MRI 显示正常或接近正常的软骨。骨碎片的不愈合导致软骨质量下降。
