Abstract：
OBJECTIVE: To investigate the medium and long-term follow-up outcomes of large cystic medial osteochondral lesions of the talus (OLTs) treated with autologous tibial osteoperiosteal grafts from the medial tibia and to explore the risk factors influencing the treatment outcomes.
METHODS: The retrospective study included 75 patients with large cystic medial OLTs who underwent autologous osteoperiosteal cylinder graft taken from the medial tibia between January 2004 and August 2018. They were assessed preoperatively and postoperatively using a visual analog scale, the Orthopedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS), and short-form 36-item Short Form Health Survey score. Magnetic resonance observation of cartilage repair tissue, second-look arthroscopy, and biopsy were used to evaluate the grafting areas.
RESULTS: After a follow-up period of 6.3 years, the virtual analog scale score decreased to 1.47 ± 1.32, and the AOFAS and 36-item Short Form Health Survey scores increased to 82.78 ± 11.65 and 83.26 ± 8.49, respectively, all of which showed significant improvement over preoperative scores (P < .001), and the average magnetic resonance observation of cartilage repair tissue score was 82.6 ± 8.4 (56.0-91.6). Eight patients underwent a second-look arthroscopic examination and were rated by the International Cartilage Repair Society scale; of them, 2 patients were rated grade Ⅰ, 4 were rated grade Ⅱ, and 2 were rated grade Ⅲ. Three patients underwent grafting area biopsy during the second-look arthroscopy, and the results showed that the grafting areas were rich in chondrocytes. Large OLTs (≥200 mm2) and obesity (body mass index ≥25) were responsible for the poor improvement of AOFAS score, according to multivariate Cox regression analysis.
CONCLUSIONS: Autologous osteoperiosteal grafting was an effective treatment for large cystic medial OLTs, with effective cartilage regeneration in the grafted areas in the medium and long term. However, the large OLTs and obesity may reduce the treatment outcomes.
METHODS: Level IV, case series.
METHODS: The retrospective study included 75 patients with large cystic medial OLTs who underwent autologous osteoperiosteal cylinder graft taken from the medial tibia between January 2004 and August 2018. They were assessed preoperatively and postoperatively using a visual analog scale, the Orthopedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS), and short-form 36-item Short Form Health Survey score. Magnetic resonance observation of cartilage repair tissue, second-look arthroscopy, and biopsy were used to evaluate the grafting areas.
RESULTS: After a follow-up period of 6.3 years, the virtual analog scale score decreased to 1.47 ± 1.32, and the AOFAS and 36-item Short Form Health Survey scores increased to 82.78 ± 11.65 and 83.26 ± 8.49, respectively, all of which showed significant improvement over preoperative scores (P < .001), and the average magnetic resonance observation of cartilage repair tissue score was 82.6 ± 8.4 (56.0-91.6). Eight patients underwent a second-look arthroscopic examination and were rated by the International Cartilage Repair Society scale; of them, 2 patients were rated grade Ⅰ, 4 were rated grade Ⅱ, and 2 were rated grade Ⅲ. Three patients underwent grafting area biopsy during the second-look arthroscopy, and the results showed that the grafting areas were rich in chondrocytes. Large OLTs (≥200 mm2) and obesity (body mass index ≥25) were responsible for the poor improvement of AOFAS score, according to multivariate Cox regression analysis.
CONCLUSIONS: Autologous osteoperiosteal grafting was an effective treatment for large cystic medial OLTs, with effective cartilage regeneration in the grafted areas in the medium and long term. However, the large OLTs and obesity may reduce the treatment outcomes.
METHODS: Level IV, case series.
摘要：
目的：探讨胫骨内侧自体胫骨骨膜骨移植物治疗距骨大囊性内侧骨软骨损伤（OLTs）的中长期随访结果，探讨影响治疗结局的危险因素。
方法：回顾性研究包括2004年1月至2018年8月期间，75例大囊性内侧OLT患者接受了自体胫骨内侧骨膜柱体移植。术前和术后使用视觉模拟量表（VAS）进行评估，美国矫形外科足踝协会踝足后足量表(AOFAS)和短式36项问卷评分(SF-36)。软骨修复组织（MOCART）的磁共振观察，采用二次关节镜和活检评估移植面积.
结果：经过6.3年的随访，VAS评分降至1.47±1.32,AOFAS和SF-36评分分别升至82.78±11.65和83.26±8.49,所有这些都显示与术前评分相比有显著改善（P<.001），平均MOCART评分为82.6±8.4(56.0～91.6)。8例患者接受了二次关节镜检查，并通过国际软骨修复协会量表进行了评级。其中,2例患者分级为Ⅰ级,4Ⅱ级,和2级Ⅲ。3例患者在第二次关节镜检查期间接受了移植区活检，结果表明，移植区富含软骨细胞。根据多变量Cox回归分析，大尺寸OLT（≥200mm2）和肥胖（BMI≥25kg/m2）是AOFAS改善不良的原因。
结论：自体骨膜移植是治疗大囊性内侧OLT的有效方法，在中长期移植区具有有效的软骨再生。然而,大尺寸OLT和肥胖可能降低治疗结局.
方法：回顾性研究包括2004年1月至2018年8月期间，75例大囊性内侧OLT患者接受了自体胫骨内侧骨膜柱体移植。术前和术后使用视觉模拟量表（VAS）进行评估，美国矫形外科足踝协会踝足后足量表(AOFAS)和短式36项问卷评分(SF-36)。软骨修复组织（MOCART）的磁共振观察，采用二次关节镜和活检评估移植面积.
结果：经过6.3年的随访，VAS评分降至1.47±1.32,AOFAS和SF-36评分分别升至82.78±11.65和83.26±8.49,所有这些都显示与术前评分相比有显著改善（P<.001），平均MOCART评分为82.6±8.4(56.0～91.6)。8例患者接受了二次关节镜检查，并通过国际软骨修复协会量表进行了评级。其中,2例患者分级为Ⅰ级,4Ⅱ级,和2级Ⅲ。3例患者在第二次关节镜检查期间接受了移植区活检，结果表明，移植区富含软骨细胞。根据多变量Cox回归分析，大尺寸OLT（≥200mm2）和肥胖（BMI≥25kg/m2）是AOFAS改善不良的原因。
结论：自体骨膜移植是治疗大囊性内侧OLT的有效方法，在中长期移植区具有有效的软骨再生。然而,大尺寸OLT和肥胖可能降低治疗结局.
