Tang Xinyu, Han Xinkun, Fu Haitao, Shen Youliang, Zhang Dongfang, Guo Qinwei, Qi Chao
Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, Shandong, 266071, P. R. China.
Medical Department of Qingdao University, Qingdao, Shandong, 266071, P. R. China.
J Orthop Surg Res. 2025 Jan 17;20(1):60. doi: 10.1186/s13018-025-05468-x.
Surgical management methods for Hepple IV-V osteochondral lesions of the talus (OLT) are diverse. This study aimed to compare the clinical efficacy of arthroscopic autologous cancellous bone grafting and medial malleolar osteotomy combined with autologous periosteal iliac bone grafting in the treatment of medial Hepple IV-V OLT.
A retrospective analysis of clinical data from patients who underwent surgical treatment for Hepple IV-V OLT (2020-2023) was conducted. A total of 37 patients were included, with 17 receiving arthroscopic autologous cancellous bone grafting (Group A) and 20 receiving medial malleolar osteotomy combined with autologous periosteal iliac bone grafting (Group B). Compared the surgical time of the two groups; the visual analog scale (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, and ankle joint mobility were used preoperatively, and at 3 months and 1 year postoperatively to assess clinical efficacy; the magnetic resonance observation of cartilage repair tissue (MOCART) 2.0 ankle scores were evaluated at early postoperatively and 1 year postoperatively to assess cartilage repair.
The surgical time for Group A was significantly shorter than Group B (P < 0.05). At 3 months and 1 year postoperatively, both groups showed a significant improvements in VAS scores, AOFAS scores, and ankle joint mobility compared to preoperative levels (P < 0.05). At 3 months postoperatively, Group A had significantly higher AOFAS scores and ankle joint mobility than Group B (P < 0.05), while there was no statistically significant difference in VAS scores between the two groups (P > 0.05). At 1 year postoperatively, no significant differences in any of the assessed parameters were found between the two groups (P > 0.05). The MOCART 2.0 ankle scores at 1 year postoperatively were significantly higher than early postoperatively for both groups (P < 0.05), with no significant differences between the two groups (P > 0.05).
Arthroscopic autologous cancellous bone grafting showed superior early functional recovery at the 3-month follow-up compared to medial malleolar osteotomy combined with autologous periosteal iliac bone grafting, with shorter surgical time and avoiding osteotomy. Both surgical methods were able to relieve patients' pain, restore function, and improve cartilage repair.
III, retrospective comparative study.
距骨Hepple IV-V型骨软骨损伤（OLT）的手术治疗方法多样。本研究旨在比较关节镜下自体松质骨移植与内踝截骨联合自体髂骨骨膜移植治疗内侧Hepple IV-V型OLT的临床疗效。
对2020年至2023年接受Hepple IV-V型OLT手术治疗的患者的临床资料进行回顾性分析。共纳入37例患者，其中17例接受关节镜下自体松质骨移植（A组），20例接受内踝截骨联合自体髂骨骨膜移植（B组）。比较两组的手术时间；术前、术后3个月和1年采用视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）评分及踝关节活动度评估临床疗效；术后早期及术后1年采用磁共振软骨修复组织观察（MOCART）2.0踝关节评分评估软骨修复情况。
A组手术时间明显短于B组（P<0.05）。术后3个月和1年，两组的VAS评分、AOFAS评分及踝关节活动度均较术前明显改善（P<0.05）。术后3个月，A组的AOFAS评分及踝关节活动度明显高于B组（P<0.05），而两组VAS评分差异无统计学意义（P>0.05）。术后1年，两组各评估参数差异均无统计学意义（P>0.05）。两组术后1年的MOCART 2.0踝关节评分均明显高于术后早期（P<0.05），两组间差异无统计学意义（P>0.05）。
与内踝截骨联合自体髂骨骨膜移植相比，关节镜下自体松质骨移植在3个月随访时早期功能恢复更佳，手术时间更短且避免了截骨。两种手术方法均能缓解患者疼痛、恢复功能并改善软骨修复。
III级，回顾性比较研究。
