目的:比较骨髓刺激(BMS)后,距骨内侧和外侧囊性骨软骨损伤(OLTs)患者的患者报告结果和放射学结果。
方法:对2016年1月至2021年2月接受BMS的囊性OLT患者进行回顾性分析,最短随访时间超过24个月。根据30mm2内的OLT面积,患者以1:1的比例配对(中-:侧囊性OLT;MC-OLT:LC-OLT),随访1年内,5岁以内,和韧带手术(是/否)。视觉模拟量表,足踝能力测量(FAAM)-术前和术后评估日常生活活动和运动评分。磁共振不雅察软骨修复组织(MOCART)评分,还评估了BMS后囊肿的存在。此外,进行了受试者工作特性曲线。
结果:将匹配的患者分为MC-OLT组(n=31,43.35±12.32个月)和LC-OLT组(n=31,43.32±14.88个月,P=.986)。在这项研究中,每组30名患者的功率达到80%,α=0.05。MC-OLT组在FAAM-ADL和运动成绩方面的改善明显较少(分别为P=0.034,P<0.001),MOCART得分较低(80.80±11.91vs.86.00±8.50,P=.010),BMS后囊肿的存在率较高(45.16%vs.16.12%,P=.013)。关于FAAM体育成绩,LC-OLT组有更多超过MCID的患者(80.64%vs.51.61%,P=.031)。此外,7.23mm的OLT深度(敏感性:78.6%;特异性:70.6%)可能作为预测BMS后内侧囊性OLT中囊肿存在的临界值。
结论:内侧囊性OLT表现出明显较低的运动水平,更高的囊肿存在率,BMS后的放射学结果比横向对应物差。此外,7.23mm的OLT深度可能是预测BMS后内侧囊性OLT囊肿存在的临界值。
方法:三级,回顾性比较研究。
OBJECTIVE: To compare the patient-reported outcomes and radiologic outcomes of the patients with medial and lateral cystic osteochondral lesions of the talus (OLTs) following bone marrow stimulation (BMS).
METHODS: Patients with cystic OLTs who underwent BMS between January 2016 and February 2021 were retrospectively analyzed, and the minimum follow-up time was more than 24 months. Patients were paired in a 1:1 ratio (medial cystic OLT [MC-OLT]/lateral cystic OLT [LC-OLT]) based on the OLT area within 30 mm2, follow-up within 1 year, age within 5 years, and ligament surgery (yes/no). The visual analog scale and Foot and Ankle Ability Measure (FAAM)-Activities of Daily Life and Sports scores were assessed preoperatively and postoperatively. The magnetic resonance observation of cartilage repair tissue scores and presence of cysts after BMS were also evaluated. Additionally, the receiver operating characteristic curve was performed.
RESULTS: The matched patients were divided into the MC-OLT (n = 31, 43.35 ± 12.32 months) and LC-OLT groups (n = 31, 43.32 ± 14.88 months, P = .986). Thirty patients of each group achieved a power of 80% and an α = 0.05 in this study. The MC-OLT group showed significantly less improvement in FAAM-Activities of Daily Life and sports scores (P = .034, P < .001, respectively), lower magnetic resonance observation of cartilage repair tissue scores (80.80 ± 11.91 vs 86.00 ± 8.50, P = .010), and higher presence rate of cysts after BMS (45.16% vs 16.12%, P = .013). Regarding FAAM sports scores, the LC-OLT group had significantly more patients exceeding the minimal clinically important difference (80.64% vs 51.61%, P = .031). Furthermore, an OLT depth of 7.23 mm (sensitivity: 78.6%; specificity: 70.6%) might serve as a cutoff value for predicting the presence of cysts in medial cystic OLTs following BMS.
CONCLUSIONS: Medial cystic OLTs exhibited markedly lower sports levels, higher cyst presence rate, and inferior radiologic outcomes following BMS than lateral counterparts. Additionally, an OLT depth of 7.23 mm could be the cutoff value for predicting the presence of cysts regarding medial cystic OLTs after BMS.
METHODS: Level III, retrospective comparative study.