Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Int Orthop. 2024 Jul;48(7):1821-1829. doi: 10.1007/s00264-024-06159-8. Epub 2024 Mar 25.
To compare the clinical efficacy and complication rates between the medial midline and anterolateral portals in ankle arthroscopy for treating medial osteochondral lesions of the talus (OLTs).
We retrospectively analyzed patients with medial OLTs who underwent either a dual medial approach (via the medial midline and anteromedial portal) or a traditional approach (via the anterolateral and anteromedial portal) between June 2017 and January 2023. The degree of injury was evaluated by radiographs, computed tomography, and magnetic resonance imaging. Clinical outcomes were assessed using the visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system. The incidence of postoperative complications, including superficial peroneal nerve (SPN) injury, was evaluated in all patients.
There were 39 patients in total; 16 patients underwent the dual medial approach, and 23 patients underwent the traditional approach. The mean age was 39.4 ± 9.0 years, and the mean follow-up duration was 18.7 ± 6.4 months. The clinical outcomes improved significantly in both groups (*P < 0.05), but there was no significant difference between the two groups (P > 0.05). Postoperative complications were mainly SPN injury. The incidence of SPN injury was 13.0% in the traditional approach group and 0% in the dual medial approach group, with no significant difference between the two groups (P > 0.05), but a trend of reduction in SPN injury was observed in the dual medial approach group.
The dual medial approach can also treat medial OLTs well, providing clear visualization and more convenient operation and reducing the possibility of injury to the SPN compared with the traditional approach. Therefore, we consider that the MM portal would be a good alternative to the anterolateral portal in treating medial OLTs.
比较踝关节镜下经内侧正中入路与前外侧入路治疗距骨内侧骨软骨损伤（OLTs）的临床疗效和并发症发生率。
回顾性分析 2017 年 6 月至 2023 年 1 月间采用双内侧入路（经内侧正中入路和前内侧入路）或传统入路（经前外侧入路和前内侧入路）治疗内侧 OLTs 的患者。通过 X 线、CT 和 MRI 评估损伤程度。采用视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）评分和磁共振软骨修复组织观察评分（MOCART）系统评估临床结果。所有患者均评估术后并发症（包括腓浅神经（SPN）损伤）的发生率。
共 39 例患者，其中 16 例行双内侧入路，23 例行传统入路。平均年龄 39.4±9.0 岁，平均随访时间 18.7±6.4 个月。两组临床结果均显著改善（均 P<0.05），但两组间无显著差异（P>0.05）。术后并发症主要为 SPN 损伤。传统入路组 SPN 损伤发生率为 13.0%，双内侧入路组为 0%，两组间无显著差异（P>0.05），但双内侧入路组 SPN 损伤发生率有降低趋势。
与传统入路相比，双内侧入路也能很好地治疗内侧 OLTs，提供更清晰的可视化效果，操作更方便，降低 SPN 损伤的可能性。因此，我们认为 MM 入路是治疗内侧 OLTs 的一种较好的前外侧入路替代方法。
