Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Jonan-ku, Fukuoka, Japan.
Faculty of Sports and Health Science, Fukuoka University, Jonan-ku, Fukuoka, Japan.
Foot Ankle Int. 2024 Jul;45(7):711-722. doi: 10.1177/10711007241241067. Epub 2024 Apr 3.
Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children.
This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months.
The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up ( < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm in area ( = .02) and from 283.2 to 185.6 mm in volume ( = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively ( = .05).
All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes.
Level IV, retrospective case-control study.
距骨骨软骨损伤（OLTs）是常见的与运动相关的损伤之一。然而，在骨骼未成熟的儿童中，关于 OLT 手术后重返运动的报道很少。本研究旨在评估骨骼未成熟儿童接受微骨折治疗 OLT 后的重返运动情况。
本研究纳入了 17 例踝关节（16 例患者，平均年龄 13.2 岁；范围，10-16 岁），这些患者的胫骨骨骺在 MRI 上呈开放状态，且关节镜下证实存在 OLT 不稳定，OLT 直径＜10mm，接受了微骨折治疗。17 例踝关节中有 9 例进行了外侧踝关节韧带稳定术。所有患者均参加某种形式的运动。评估微骨折治疗后日本足踝外科协会（JSSF）评分、踝关节活动评分（AAS）、重返运动率、病变大小、软骨下骨髓水肿程度和磁共振软骨修复组织观察评分（MOCART）。平均术后随访时间为 53.5 个月。
JSSF 评分从术前的 76.1 分显著提高到末次随访时的 94.9 分（ < .01）。AAS 评分从术前到末次随访时没有变化。重返运动率为 100%。病变面积从 76.3 降至 56.7mm²（ = .02），体积从 283.2 降至 185.6mm³（ = .05），显著缩小。17 例踝关节中有 8 例骨髓水肿程度降低。总 MOCART 评分从术后 6 个月到 1 年显著提高（ = .05）。
本研究中所有接受微骨折治疗 OLT 的骨骼未成熟儿童均能重返运动，并在临床评分和 MRI 参数方面得到改善。微骨折术可能是骨骼未成熟运动员直径＜10mm OLT 的有效一线治疗方法。
IV 级，回顾性病例对照研究。
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