Xu Mingliang, Li Renlong, Chen Guoliang, Li Lin, Chen Jing, Shi Rongjian
Department of Foot and Ankle Surgery, Xuzhou Renci Hospital, Xuzhou, 221000, Jiangsu, China.
Xuzhou Economic and Technological Development Zone, No. 11, Yangshan Road, Xuzhou, Jiangsu Province, China.
Int Orthop. 2025 Feb;49(2):485-493. doi: 10.1007/s00264-024-06384-1. Epub 2024 Dec 9.
To explore the efficacy and feasibility of arthroscopy combined with bone tunnel technique in treating Berndt and Harty stage III or IV osteochondral lesions of the talus (OLT).
A retrospective analysis was conducted on the clinical data of 21 patients with Berndt and Harty stage III or IV OLT who underwent surgical treatment at our institution from September 2017 to September 2022. Under arthroscopy, the displaced talar osteochondral lesion was restored. A 2.0 mm Kirschner wire (K-wire) was used to create a bone tunnel from the medial (or lateral) malleolus to the realigned osteochondral lesion. A 1.5 mm K-wire was then used to drill through this tunnel into the osteochondral fragment, and a 1.5 mm absorbable bone rod was inserted for fixation. Preoperative and final follow-up visual analogue scale (VAS) for pain and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale were recorded and compared.
All 21 patients were followed up for an average of 23.95 ± 6.01 months. All wounds healed by primary intention, with no nerve, blood vessel, or tendon injuries. All osteochondral lesions healed, with an average healing time of 3.71 ± 0.62 months. The VAS score decreased from a preoperative average of 5.38 ± 0.59 to 0.48 ± 0.51 at the final follow-up. The AOFAS ankle-hindfoot scale increased from a preoperative average of 56.29 ± 5.98 to 88.43 ± 2.68 at the final follow-up (P < 0.05), showing statistically significant differences. Two cases experienced medial pain after 12 months, which was tolerable with non-steroidal anti-inflammatory drugs.
Arthroscopy combined with bone tunnel technique for treating Berndt and Harty stage III or IV OLT has the advantages of minimal injury, visualization of fracture reduction, and fewer complications.
探讨关节镜联合骨隧道技术治疗Berndt和Harty III期或IV期距骨骨软骨损伤（OLT）的疗效及可行性。
回顾性分析2017年9月至2022年9月在我院接受手术治疗的21例Berndt和Harty III期或IV期OLT患者的临床资料。在关节镜下，将移位的距骨骨软骨损伤复位。使用2.0毫米克氏针（K针）从内（或外）踝向复位的骨软骨损伤处建立骨隧道。然后用1.5毫米K针穿过该隧道钻入骨软骨碎片，插入1.5毫米可吸收骨棒进行固定。记录并比较术前及末次随访时的疼痛视觉模拟评分（VAS）和美国矫形足踝协会（AOFAS）踝-后足评分。
21例患者均获随访，平均随访时间为23.95±6.01个月。所有伤口均一期愈合，无神经、血管或肌腱损伤。所有骨软骨损伤均愈合，平均愈合时间为3.71±0.62个月。VAS评分从术前平均5.38±0.59降至末次随访时的0.48±0.51。AOFAS踝-后足评分从术前平均56.29±5.98升至末次随访时的88.43±2.68（P<0.05），差异有统计学意义。2例患者在12个月后出现内侧疼痛，使用非甾体类抗炎药后可耐受。
关节镜联合骨隧道技术治疗Berndt和Harty III期或IV期OLT具有损伤小、骨折复位可视化、并发症少等优点。
