Yang Shuai, Shao Qirui, Zhu Yu, Hu Fengyi, Jiang Dong, Jiao Chen, Hu Yuelin, Shi Weili, Guo Qinwei
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
Beijing Key Laboratory of Sports Injuries, Beijing, China.
Knee Surg Sports Traumatol Arthrosc. 2025 Feb;33(2):750-759. doi: 10.1002/ksa.12388. Epub 2024 Aug 2.
To compare clinical outcomes of autologous osteoperiosteal transplantation versus bone marrow stimulation (BMS) for medium-sized (100-150 mm) cystic osteochondral lesions of the talus (OLTs) and assess the correlation between patient demographics and outcomes. It was hypothesised that autologous osteoperiosteal transplantation would provide better clinical outcomes than BMS for medium-sized cystic OLTs.
Patients who underwent autologous osteoperiosteal transplantation or BMS for medium-sized cystic OLTs between 2014 and 2019 were retrospectively evaluated. According to their characteristics, a 1:1 propensity-score matching was performed and 33 pairs of patients were matched. The visual analogue scale, American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot Ankle Outcome Score (FAOS) and Ankle Activity Score were collected preoperatively and at the last follow-up. In addition, a general linear model analysis was performed between patient demographics and clinical outcomes in two groups separately to detect potential risk factors.
Finally, 28 patients in the grafted group and 27 patients in the BMS group completed the follow-up and were enrolled with a mean follow-up period of 63.5 ± 13.9 months. Both groups showed significant improvement in all patient-reported outcomes (p < 0.01). At the final follow-up, no significant differences between groups were found in all postoperative scores except FAOS Pain (p = 0.02). Correlation analysis showed a moderate correlation between cyst depth and the postoperative AOFAS score in the BMS group (r = -0.48, p = 0.01). Based on the regression line, the patients in the BMS group with a cyst deeper than 6 mm showed a lower AOFAS score than the mean score (88.7 ± 9.5) of the grafted group.
Autologous osteoperiosteal transplantation and BMS are both safe and effective for medium-sized cystic OLTs. However, autologous osteoperiosteal transplantation is expected to provide better clinical outcomes than BMS when the cysts are deeper than 6 mm.
Level III.
比较自体骨膜移植与骨髓刺激术（BMS）治疗中型（100 - 150毫米）距骨囊性骨软骨损伤（OLTs）的临床疗效，并评估患者人口统计学特征与疗效之间的相关性。研究假设为，对于中型囊性OLTs，自体骨膜移植比BMS能提供更好的临床疗效。
对2014年至2019年间接受自体骨膜移植或BMS治疗中型囊性OLTs的患者进行回顾性评估。根据患者特征进行1:1倾向评分匹配，共匹配33对患者。收集术前及末次随访时的视觉模拟评分、美国矫形足踝协会（AOFAS）评分、足踝结局评分（FAOS）和踝关节活动评分。此外，分别对两组患者的人口统计学特征和临床疗效进行一般线性模型分析，以检测潜在风险因素。
最终，移植组28例患者和BMS组27例患者完成随访，平均随访时间为63.5±13.9个月。两组患者报告的所有结局均有显著改善（p < 0.01）。在末次随访时，除FAOS疼痛评分外（p = 0.02），两组术后各项评分均无显著差异。相关性分析显示，BMS组囊肿深度与术后AOFAS评分呈中度相关（r = -0.48，p = 0.01）。根据回归线，囊肿深度超过6毫米的BMS组患者AOFAS评分低于移植组平均评分（88.7±9.5）。
自体骨膜移植和BMS治疗中型囊性OLTs均安全有效。然而，当囊肿深度超过6毫米时，自体骨膜移植有望比BMS提供更好的临床疗效。
三级。
