Zhang Jiayao, Cai Wufeng, Zhao Xiumei, Sun Yiyuan, Zhang Yiteng, Ma Wenjing, Li Jian, Zhang Chenghao, Li Qi
Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
Arthroscopy. 2025 Aug;41(8):3012-3023.e2. doi: 10.1016/j.arthro.2024.12.025. Epub 2024 Dec 26.
To investigate the effect of concomitant chronic lateral ankle instability (CLAI) on postoperative clinical outcomes in patients with osteochondral lesions of the talus (OLTs).
Patients who underwent surgery for OLTs between January 2018 and May 2022 were retrospectively evaluated. OLT patients underwent debridement, microfracture, or bone grafting, whereas patients with concomitant CLAI underwent lateral ligament repair or reconstruction. Functional assessments included the visual analog scale score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and Tegner score, with a minimum follow-up of 24 months. Cartilage repair was evaluated using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 1 and MOCART 2.0 scores based on postoperative magnetic resonance imaging. Additionally, multiple linear regression analysis was performed to explore the effects of potential factors, and Spearman correlation coefficients (r) were calculated to assess the relationship between these factors and outcome scores.
A total of 85 patients were included, with 39 in the OLT group and 46 in the OLT-CLAI group. The mean follow-up times were 46.95 ± 17.00 months (range, 24-76 months) and 41.80 ± 15.10 months (range, 24-76 months), respectively (P = .347). Compared with the OLT group, the OLT-CLAI group showed lower postoperative AOFAS and FAOS scores, with a significantly smaller overall improvement in the AOFAS score (P < .05). There was no significant difference in the number of patients achieving the minimal clinically important difference in functional scores between the groups. Multiple linear regression analysis showed that CLAI surgery negatively affected postoperative AOFAS (standardized β = -0.344, P = .001) and FAOS (standardized β = -0.332, P = .001) scores, with Spearman analysis indicating a moderate correlation (r = -0.442 [P < .001] and r = -0.339 [P = .002], respectively). No significant differences were observed between the groups in terms of MOCART 1 (61.52 ± 12.38 vs 65.89 ± 14.47) or MOCART 2.0 (68.70 ± 16.53 vs 73.75 ± 14.76) scores (P > .05), and multiple linear regression as well as Spearman analysis did not yield positive results.
OLT patients with concomitant CLAI had lower postoperative functional outcomes than those without CLAI. However, after surgical treatment of CLAI, cartilage repair in OLT patients was not affected.
Level III, retrospective comparative study.
探讨合并慢性外侧踝关节不稳（CLAI）对距骨骨软骨损伤（OLT）患者术后临床疗效的影响。
对2018年1月至2022年5月期间接受OLT手术的患者进行回顾性评估。OLT患者接受清创、微骨折或骨移植，而合并CLAI的患者接受外侧韧带修复或重建。功能评估包括视觉模拟量表评分、美国矫形足踝协会（AOFAS）评分、足踝结果评分（FAOS）和特格纳评分，最短随访24个月。根据术后磁共振成像，使用软骨修复组织磁共振观察（MOCART）1和MOCART 2.0评分评估软骨修复情况。此外，进行多元线性回归分析以探讨潜在因素的影响，并计算Spearman相关系数（r）以评估这些因素与结果评分之间的关系。
共纳入85例患者，OLT组39例，OLT-CLAI组46例。平均随访时间分别为46.95±17.00个月（范围24-76个月）和41.80±15.10个月（范围24-76个月）（P = 0.347）。与OLT组相比，OLT-CLAI组术后AOFAS和FAOS评分较低，AOFAS评分的总体改善明显较小（P < 0.05）。两组间功能评分达到最小临床重要差异的患者数量无显著差异。多元线性回归分析显示，CLAI手术对术后AOFAS（标准化β = -0.344，P = 0.001）和FAOS（标准化β = -0.332，P = 0.001）评分有负面影响，Spearman分析表明存在中度相关性（分别为r = -0.442 [P < 0.001]和r = -0.339 [P = 0.002]）。两组间MOCART 1（61.52±12.38 vs 65.89±14.47）或MOCART 2.0（68.70±16.53 vs 73.75±14.76）评分无显著差异（P > 0.05），多元线性回归以及Spearman分析未得出阳性结果。
合并CLAI的OLT患者术后功能结局低于未合并CLAI的患者。然而，CLAI手术治疗后，OLT患者的软骨修复未受影响。
III级，回顾性比较研究。
