Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
Am J Sports Med. 2022 Sep;50(11):3019-3027. doi: 10.1177/03635465221109596. Epub 2022 Jul 28.
The bone marrow stimulation (BMS) technique is performed for osteochondral lesions of the talus (OLTs) with a lesion size of <100 mm. The lesion defect is covered with fibrocartilage, and the clinical outcomes deteriorate over time. In contrast, the osteochondral fragment fixation can restore the native articular surface. The difference in clinical outcomes between these procedures is unclear.
To compare the clinical outcomes of BMS and osteochondral fragment fixation for OLTs and examine the characteristics of patients with poor clinical outcomes of BMS.
Cohort study; Level of evidence, 3.
In total, 62 ankles in 59 patients with OLTs were included. BMS was performed for 26 ankles, and fixation was performed for 36 ankles. Clinical outcomes, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale and bone marrow edema (BME) as identified on magnetic resonance imaging, were compared between the 2 groups. On computed tomography scans, the lesion location was compared with or without BME in each group.
The AOFAS scores in the fixation group (97.3 ± 4.3 points) were significantly higher than those in the BMS group (91.3 ± 7.7 points), even when the lesion size was <100 mm ( < .05). When comparing the ankles with or without BME in each group, the AOFAS scores at the final follow-up were significantly lower for the ankles with BME (88.6 ± 7.8 points) than for those without BME (95.0 ± 6.1 points) in the BMS group ( < .05). Lesions with BME in the sagittal plane were located more centrally than those without BME in the BMS group. In the fixation group, there were no significant differences in AOFAS scores and location of the lesion in ankles with or without BME.
The clinical outcomes of osteochondral fragment fixation are superior to those of BMS in OLTs, even for lesions sized <100 mm. Fixation is recommended even for small lesions, especially for more centralized lesions in the medial and lateral sides of the talus.
骨髓刺激（BMS）技术适用于直径<100mm 的距骨骨软骨病变（OLTs）。病变部位被纤维软骨覆盖，且临床结果会随时间推移而恶化。相比之下，骨软骨碎片固定术可恢复关节面的自然形态。这两种术式的临床结果存在差异。
比较 BMS 和骨软骨碎片固定术治疗 OLTs 的临床结果，并探讨 BMS 临床结果较差患者的特点。
队列研究；证据等级 3。
共纳入 59 例患者的 62 例踝关节 OLTs 患者。其中 26 例接受 BMS 治疗，36 例接受固定术治疗。比较两组的美国矫形足踝协会（AOFAS）踝后足评分和磁共振成像（MRI）上骨髓水肿（BME）情况。在 CT 扫描上，比较两组中病变位置与 MRI 上 BME 的关系。
固定组的 AOFAS 评分（97.3±4.3 分）明显高于 BMS 组（91.3±7.7 分），即使病变直径<100mm 也是如此（<.05）。在每组比较 MRI 上有无 BME 的踝关节时，BMS 组中存在 BME 的踝关节最终随访时的 AOFAS 评分（88.6±7.8 分）明显低于无 BME 的踝关节（95.0±6.1 分）（<.05）。BMS 组中存在 BME 的矢状位病变位于更中心部位，而无 BME 的病变位于更偏侧部位。固定组中，有无 BME 的踝关节 AOFAS 评分和病变位置均无显著差异。
即使是直径<100mm 的 OLTs，骨软骨碎片固定术的临床结果也优于 BMS。即使是小病变，尤其是距骨内外侧更中心部位的病变，也推荐采用固定术。
