Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
Cartilage. 2024 Mar;15(1):16-25. doi: 10.1177/19476035231200339. Epub 2023 Oct 5.
The purpose of this retrospective case series was to evaluate clinical outcomes following both conservative treatment and arthroscopic bone marrow stimulation (BMS) for the management of symptomatic subtalar osteochondral lesions (OCLs).
All symptomatic subtalar OCLs with a minimum of 12 months follow-up having undergone either a conservative management or arthroscopic procedure were included. Patient-reported outcomes were collected via questionnaires consisting of the Foot and Ankle Outcome Score (FAOS), Numeric Rating Scale (NRS) of pain in rest, during walking, during stair climbing, and during running. In addition, return to sports data, return to work data, reoperations, and complications were collected and assessed. In total, 11 patients across 2 academic institutions were included (3 males, 8 females). The median age was 43 years (interquartile range [IQR]: 32-53).
All patients underwent conservative treatment first; in addition, 9 patients underwent subtalar arthroscopic debridement with or without BMS. The median follow-up time was 15 months (IQR: 14-100). In the surgically treated group, the median NRS scores were 2 (IQR: 1-3) during rest, 3 (IQR: 2-4) during walking, 4 (IQR: 4-5) during stair climbing, 5 (IQR: 4-5) during running and the median FAOS score at final follow-up was 74 (IQR: 65-83). In the conservatively treated patients, the median NRS scores were all 0 (IQR: 0-0) and the median FAOS scores were 90 (IQR: 85-94). In the group of surgical treated patients, 4 were able to return to the same level of sports, 2 returned to a lower level of sports. Both conservatively treated patients returned to the sport and the same level of prior participation. All patients except one in the surgical group returned to work.
This retrospective case series demonstrated that a high number of patients converted to surgery after initial conservative treatment. In addition, debridement and BMS show good clinical outcomes for the management of symptomatic subtalar OCLs at short-term follow-up. No complications nor secondary surgical procedures were noted in the surgically treated group. The high rate of failure of conservative treatment suggests that surgical intervention for symptomatic subtalar OCLs can be the primary treatment strategy; however, further research is warranted in light of the small number of patients.
本回顾性病例系列研究旨在评估保守治疗和关节镜下骨髓刺激（BMS）治疗症状性距骨骨软骨病变（OCL）的临床结果。
纳入所有接受过保守治疗或关节镜手术治疗且至少随访 12 个月的症状性距骨 OCL 患者。通过包括足踝结局评分（FAOS）和休息时、行走时、爬楼梯时和跑步时疼痛数字评分量表（NRS）在内的问卷收集患者报告的结果。此外，还收集和评估了重返运动数据、重返工作数据、再次手术和并发症。共有来自 2 所学术机构的 11 名患者（3 名男性，8 名女性）纳入本研究。中位年龄为 43 岁（四分位距[IQR]：32-53）。
所有患者均首先接受保守治疗，此外，9 名患者接受了关节镜下距骨清创术，其中部分患者联合 BMS 治疗。中位随访时间为 15 个月（IQR：14-100）。在手术治疗组中，休息时的 NRS 评分为 2 分（IQR：1-3），行走时为 3 分（IQR：2-4），爬楼梯时为 4 分（IQR：4-5），跑步时为 5 分（IQR：4-5），末次随访时 FAOS 评分为 74 分（IQR：65-83）。在保守治疗患者中，NRS 评分均为 0 分（IQR：0-0），FAOS 评分为 90 分（IQR：85-94）。在手术治疗组中，4 名患者能重返相同运动水平，2 名患者重返运动水平降低。2 名保守治疗患者均重返运动且能达到先前参与运动的相同水平。除 1 名手术治疗组患者外，所有患者均已重返工作岗位。
本回顾性病例系列研究表明，在初始保守治疗后，有大量患者转为手术治疗。此外，在短期随访中，清创术和 BMS 治疗症状性距骨 OCL 可取得良好的临床效果。手术治疗组无并发症或二次手术。保守治疗的高失败率表明，对于症状性距骨 OCL，手术干预可能是主要的治疗策略；但是，鉴于患者数量较少，需要进一步的研究。
