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.
Radiology Department, Peking University Third Hospital, Haidian, Beijing, China.
Knee Surg Sports Traumatol Arthrosc. 2024 Sep;32(9):2440-2451. doi: 10.1002/ksa.12355. Epub 2024 Jul 15.
The purpose of this study was to study the effects of the severity of preoperative bone marrow oedema (BME) on the postoperative short-term outcomes following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLTs) and to propose a new metric that combines volume and signal density to evaluate BME.
Sixty-five patients with symptomatic OLTs (<100 mm) and preoperative BME, who received BMS in our institution from April 2017 to July 2021 with follow-ups of 3, 6 and 12 months, were analysed retrospectively. The area, volume and signal value of the BME were collected on preoperative magnetic resonance imaging. The enroled patients were divided into two groups according to the BME index (BMEI), which was defined as the product of oedema relative signal intensity and the relation of oedema volume to total talar volume. Visual analogue scale, American Orthopedic Foot and Ankle Society (AOFAS), Tegner, Foot and Ankle Ability Measure (FAAM)-activities of daily living (ADL) and Sports scores were assessed before surgery and at each follow-up. The relationship between the scores and the volume, relative signal intensity and BMEI was explored.
Sixty-five patients with preoperative BME were divided into the mild (n = 33) and severe (n = 32) groups based on the BMEI. A significant difference was found for each score with the general linear model for repeated measures through all follow-up time points (p < 0.001). For the preoperative and 12-month postoperative changes of the enroled patients, 53 patients (81.5%) exceeded the minimal clinically important difference of AOFAS and 26 (40.0%) exceeded that of FAAM-sports in this study. The mild group showed significantly more improvement in AOFAS scores at 12 months (89.6 ± 7.0 vs. 86.2 ± 6.2) and FAAM-ADL scores at 6 months (83.6 ± 7.6 vs. 79.7 ± 7.7) and 12 months (88.5 ± 8.5 vs. 84.4 ± 7.7) than the severe group (p < 0.05). No significant difference of all the scores between the groups was found at 3 months. No significant correlation was found in each group between BMEI and clinical outcomes.
The severity of the preoperative BME negatively affected short-term clinical outcomes following arthroscopic BMS for OLTs. Worse clinical outcomes were shown at postoperative 6 and 12 months in patients with a high preoperative BMEI, which could be a favourable parameter for assessing the severity of BME and assist in developing personalised rehabilitation plans and determining the approach and timing of surgery.
Level III.
本研究旨在探讨术前骨髓水肿（BME）严重程度对距骨骨软骨病变（OLTs）骨髓刺激（BMS）后短期术后结果的影响，并提出一种新的指标，该指标将体积和信号密度相结合来评估 BME。
回顾性分析了 2017 年 4 月至 2021 年 7 月在我院接受 BMS 治疗且术前有 BME（<100mm）的 65 例有症状的 OLTs 患者的资料，随访时间为 3、6 和 12 个月。术前磁共振成像（MRI）采集 BME 的面积、体积和信号值。根据 BME 指数（BMEI）将纳入的患者分为两组，BMEI 定义为水肿相对信号强度与水肿体积与整个距骨体积之比的乘积。术前及每次随访时均采用视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）评分、Tegner 评分、足部踝能力测量（FAAM）-日常生活活动（ADL）评分和运动评分进行评估。通过重复测量的一般线性模型探索了评分与体积、相对信号强度和 BMEI 之间的关系。
根据 BMEI，65 例术前 BME 患者被分为轻度（n=33）和重度（n=32）组。通过所有随访时间点的重复测量的一般线性模型发现，每个评分均有显著差异（p<0.001）。对于纳入患者的术前和术后 12 个月的变化，53 例（81.5%）患者的 AOFAS 评分超过了最小临床重要差异，26 例（40.0%）患者的 FAAM-运动评分超过了最小临床重要差异。在 12 个月时，轻度组 AOFAS 评分（89.6±7.0 比 86.2±6.2）和 FAAM-ADL 评分（83.6±7.6 比 79.7±7.7）和 12 个月（88.5±8.5 比 84.4±7.7）的改善明显优于重度组（p<0.05）。在 3 个月时，两组间各项评分无显著差异。在各组中，BMEI 与临床结果之间均无显著相关性。
术前 BME 的严重程度对 OLTs 关节镜下 BMS 后的短期临床结果有负面影响。在术前 BMEI 较高的患者中，术后 6 个月和 12 个月的临床结果较差，这可能是评估 BME 严重程度的一个有利参数，并有助于制定个性化的康复计划以及确定手术的方法和时机。
III 级。
