Rikken Quinten G H, Dahmen Jari, Stufkens Sjoerd A S, Kerkhoffs Gino M M J
Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
Department of Orthopedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands; Academic Center for Evidence based Sports medicine (ACES), Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center, Amsterdam UMC, Amsterdam, The Netherlands.
Arthroscopy. 2024 Mar;40(3):910-918.e2. doi: 10.1016/j.arthro.2023.07.038. Epub 2023 Aug 4.
To assess the patient-reported outcomes, as well as the revision and complication rates, of patients who underwent arthroscopic bone marrow stimulation (BMS) for an osteochondral lesion of the tibial plafond (OLTP).
Patients with an OLTP treated with arthroscopic BMS at a minimum follow-up of 2-years were cross-sectionally included from a historical database. The primary outcome was the Numeric Rating Scale (NRS) during walking. Secondary outcomes included the NRS in rest and during running, and the Foot and Ankle Outcome Score. Additionally, the association of baseline patient and lesion demographics with follow-up patient-reported outcome measures (PROMs) was assessed with the Spearman rank correlation test. A subanalysis was performed for PROMs in patients with or without a coexisting talar (i.e., bipolar) lesion. Finally, the revision surgery (i.e., repeat surgery for the OLTP) and complication rates were assessed.
Fifty-one patients were included at a mean 8.8 (standard deviation [SD] = 5.7, range, 2-22) years follow-up. Seventy-three percent of patients had a solitary OLTP, and 27% had a coexisting talar (bipolar) lesion. Males had a significantly higher rate of bipolar lesions compared to females (P ≤ .01), and patients with a bipolar lesion had a significantly larger OLTP lesion diameter (P = .02) and volume (P = .04). At final follow-up, the mean NRS during walking was 1.9 (SD = 2.3) out of 10. Anterior-posterior OLTP size (r = 0.36; P ≤ .01) was significantly associated with a higher NRS pain score during walking, although the presence of bipolar lesions did not result in inferior clinical outcomes. At final follow-up, 6% of patients underwent revision surgery. Minor complications were observed in 12% of patients.
Arthroscopic BMS for OLTP results in favorable patient-reported outcomes at mid- to long-term follow-up, although moderate outcomes were observed in sports activities. Lesion size was associated with increased pain scores, although bipolar lesions did not result in inferior patient-reported outcomes. Six percent of patients required revision surgery, and 12% of patients had minor complications after surgery.
Level III, retrospective cohort study.
评估接受关节镜下骨髓刺激术（BMS）治疗胫骨平台骨软骨损伤（OLTP）患者的患者报告结局、翻修率和并发症发生率。
从历史数据库中横断面纳入接受关节镜下BMS治疗OLTP且至少随访2年的患者。主要结局是步行时的数字评定量表（NRS）。次要结局包括休息和跑步时的NRS以及足踝结局评分。此外，采用Spearman等级相关检验评估基线患者和损伤特征与随访患者报告结局指标（PROMs）之间的关联。对合并或不合并距骨（即双极）损伤的患者的PROMs进行亚分析。最后，评估翻修手术（即OLTP再次手术）和并发症发生率。
纳入51例患者，平均随访8.8年（标准差[SD]=5.7，范围2 - 22年）。73%的患者为孤立性OLTP，27%的患者合并距骨（双极）损伤。男性双极损伤发生率显著高于女性（P≤0.01），合并双极损伤的患者OLTP损伤直径（P = 0.02）和体积（P = 0.04）显著更大。末次随访时，步行时的平均NRS为1.9（SD = 2.3）（满分10分）。OLTP前后径大小（r = 0.36；P≤0.01）与步行时较高的NRS疼痛评分显著相关，尽管双极损伤的存在并未导致较差的临床结局。末次随访时，6%的患者接受了翻修手术。12%的患者观察到轻微并发症。
关节镜下BMS治疗OLTP在中长期随访中患者报告结局良好，尽管在体育活动中观察到的结果一般。损伤大小与疼痛评分增加相关，尽管双极损伤并未导致较差的患者报告结局。6%的患者需要翻修手术，12%的患者术后出现轻微并发症。
III级，回顾性队列研究。
