Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Foot Ankle Int. 2024 Aug;45(8):862-869. doi: 10.1177/10711007241250007. Epub 2024 May 21.
Bone marrow stimulation (BMS) is presently considered first-line surgical treatment for osteochondral lesions of the talus (OLTs); however, some patients still experience pain or dysfunction after surgery, and the reasons for success or failure remain somewhat unclear. This study aimed to investigate the effect of smoking on postoperative outcomes after arthroscopic BMS for OLTs.
Consecutive patients with OLTs who underwent BMS between January 2017 and January 2020 were included. Smokers were defined as patients who actively consumed cigarettes before surgery and postoperatively, whereas nonsmokers were patients who never smoked. Visual analog scale (VAS), American Orthopaedic Foot & Ankle Society ankle hindfoot score (AOFAS), Karlsson-Peterson, and Tegner scores were assessed preoperatively and at follow-up. Additionally, a general linear model (GLM) was performed, followed by the interaction analysis to explore the potential influence of smoking.
The study enrolled 104 patients with a mean follow-up of 30.91 ± 7.03 months, including 28 smokers and 76 nonsmokers. There were no significant differences in patient age (35.2 ± 10.0 years vs 37.6 ± 9.7 years, = .282) or OLT area (63.7 ± 38.7 mm vs 52.8 ± 37.0 mm, = .782). Both univariate analysis and GLM revealed that smoking was associated with worse postoperative pain levels, Karlsson-Peterson, and AOFAS scores ( < .05). The interaction analysis showed a significant interaction between smoking and OLT area for postoperative Karlsson-Peterson scores (general ankle function) ( = .031). Simple main effects analysis revealed that the negative effect of smoking on Tegner score significantly increased among patients >32 years old or with OLT area>50 mm ( < .05).
Smoking was associated with worse clinical outcomes following BMS of OLTs. As the size of OLTs increased, the difference in general ankle function between smokers and nonsmokers also increased. Furthermore, smokers who were older than 32 years or had larger OLTs were less likely to resume participation in high-level activities.
骨髓刺激（BMS）目前被认为是距骨骨软骨病变（OLTs）的一线手术治疗方法；然而，一些患者在手术后仍会出现疼痛或功能障碍，手术成功或失败的原因仍不太清楚。本研究旨在探讨吸烟对关节镜下 BMS 治疗 OLT 术后结果的影响。
纳入 2017 年 1 月至 2020 年 1 月期间接受 BMS 治疗的 OLT 患者。吸烟者定义为术前和术后主动吸烟的患者，而非吸烟者为从不吸烟的患者。术前和随访时评估视觉模拟量表（VAS）、美国矫形足踝协会踝后足评分（AOFAS）、Karlsson-Peterson 和 Tegner 评分。此外，还进行了一般线性模型（GLM）分析，然后进行交互分析以探讨吸烟的潜在影响。
本研究共纳入 104 例患者，平均随访 30.91±7.03 个月，其中 28 例为吸烟者，76 例为非吸烟者。两组患者年龄（35.2±10.0 岁比 37.6±9.7 岁，=0.282）或 OLT 面积（63.7±38.7 毫米比 52.8±37.0 毫米，=0.782）无显著差异。单变量分析和 GLM 均显示，吸烟与术后疼痛程度、Karlsson-Peterson 和 AOFAS 评分较差有关（<0.05）。交互分析显示，吸烟与 OLT 面积对术后 Karlsson-Peterson 评分（一般踝关节功能）的影响存在显著交互作用（=0.031）。简单主要效应分析显示，在年龄>32 岁或 OLT 面积>50 毫米的患者中，吸烟对 Tegner 评分的负面影响显著增加（<0.05）。
吸烟与 BMS 治疗 OLT 后的临床结果较差有关。随着 OLT 大小的增加，吸烟者和非吸烟者之间一般踝关节功能的差异也增大。此外，年龄>32 岁或 OLT 较大的吸烟者不太可能恢复参加高水平活动。
