PDF(Pubmed)
Abstract：
BACKGROUND: Although surgical treatment for osteochondral lesion of the talus (OLT) can obtain good clinical outcomes, the rate of return to sports is variable. It is reported that medial OLT unrelated to trauma has abnormal structures in the medial aspect, which may induce the medial OLT due to the medial instability. The posterior tibial tendon (PTT) plays an important role in the stabilization of the foot, and high mechanical stress may be added to the PTT to compensate for medial instability in medial OLT. We investigated whether abnormal PTT findings on preoperative magnetic resonance imaging (MRI) in patients with OLT affect clinical outcomes after surgery. Methods: Eighty-one ankles in 74 patients who were treated surgically for OLT were included in this study (41 men and 33 women; mean age, 26.0 years). Abnormalities of the PTT were evaluated using preoperative MRI. The Japanese Society for Surgery of the Foot (JSSF) scale, arch height, and ankle activity score (AAS) on standing plain radiogram were compared between patients with and those without preoperative PTT abnormalities.
RESULTS: Twenty-five ankles (30.9%) had PTT abnormalities on preoperative MRI. All patients with preoperative PTT abnormalities were medial OLT. There were no significant differences in the preoperative JSSF scale in the procedures for OLT. The postoperative JSSF scale and arch height were significantly lower in patients with preoperative PTT abnormalities than those without them. AAS in patients with preoperative abnormalities significantly decreased at the final follow-up. Conclusion: PTT abnormalities on preoperative MRI may affect clinical outcomes even in preoperative asymptomatic patients in the medial OLT unrelated to trauma.
RESULTS: Twenty-five ankles (30.9%) had PTT abnormalities on preoperative MRI. All patients with preoperative PTT abnormalities were medial OLT. There were no significant differences in the preoperative JSSF scale in the procedures for OLT. The postoperative JSSF scale and arch height were significantly lower in patients with preoperative PTT abnormalities than those without them. AAS in patients with preoperative abnormalities significantly decreased at the final follow-up. Conclusion: PTT abnormalities on preoperative MRI may affect clinical outcomes even in preoperative asymptomatic patients in the medial OLT unrelated to trauma.
摘要：
背景：尽管手术治疗距骨软骨病（OLT）可以获得良好的临床疗效，体育的回报率是可变的。据报道，与创伤无关的内侧OLT在内侧有异常结构，由于内侧不稳定，可能会导致内侧OLT。胫骨后肌腱（PTT）在足的稳定中起着重要作用，并且可以向PTT添加高机械应力以补偿内侧OLT中的内侧不稳定性。我们调查了OLT患者术前磁共振成像（MRI）的异常PTT发现是否会影响手术后的临床结局。方法：本研究包括74例经手术治疗的OLT患者中的81例脚踝（男性41例，女性33例；平均年龄，26.0年）。使用术前MRI评估PTT异常。日本足外科学会（JSSF）量表，拱高度,比较了术前PTT异常患者和无PTT异常患者的站立X线平片上的踝关节活动评分（AAS）。
结果：25个脚踝（30.9%）在术前MRI上有PTT异常。所有术前PTT异常的患者均为内侧型OLT。术前JSSF量表在OLT手术中没有显着差异。术前有PTT异常的患者术后JSSF尺度和足弓高度显著低于无PTT异常的患者。术前异常患者的AAS在末次随访时显著降低。结论：术前MRI上的PTT异常可能会影响临床结局，即使在术前无症状的患者中也与创伤无关。
结果：25个脚踝（30.9%）在术前MRI上有PTT异常。所有术前PTT异常的患者均为内侧型OLT。术前JSSF量表在OLT手术中没有显着差异。术前有PTT异常的患者术后JSSF尺度和足弓高度显著低于无PTT异常的患者。术前异常患者的AAS在末次随访时显著降低。结论：术前MRI上的PTT异常可能会影响临床结局，即使在术前无症状的患者中也与创伤无关。
