Purpose

Although bone marrow stimulation (BMS) as a treatment for osteochondral lesions of the talus (OCLT) shows high rates of sport resumption at short-term follow-up, it is unclear whether the sports activity is still possible at longer follow-up. The purpose of this study was, therefore, to evaluate sports activity after arthroscopic BMS at long-term follow-up.

Methods

Sixty patients included in a previously published randomized-controlled trial were analyzed in the present study. All patients had undergone arthroscopic debridement and BMS for OCLT. Return to sports, level, and type were assessed in the first year post-operative and at final follow-up. Secondary outcome measures were assessed by standardized questionnaires with use of numeric rating scales for pain and satisfaction and the Foot and Ankle Outcome Score (FAOS).

Results

The mean follow-up was 6.4 years (SD ± 1.1 years). The mean level of activity measured with the AAS was 6.2 pre-injury and 3.4 post-injury. It increased to 5.2 at 1 year after surgery and was 5.8 at final follow-up. At final follow-up, 54 patients (90%) participated in 16 different sports. Thirty-three patients (53%) indicated they returned to play sport at their pre-injury level. Twenty patients (33%) were not able to obtain their pre-injury level of sport because of ankle problems and eight other patients (13%) because of other reasons. Mean NRS for pain during rest was 2.7 pre-operative, 1.1 at 1 year, and 1.0 at final follow-up. Mean NRS during activity changed from 7.9 to 3.7 to 4.4, respectively. The FAOS scores improved at 1 year follow-up, but all subscores significantly decreased at final follow-up.

Conclusion

At long-term follow-up (mean 6.4 years) after BMS for OCLT, 90% of patients still participate in sports activities, of whom 53% at pre-injury level. The AAS of the patients participating in sports remains similar pre-injury and post-operatively at final follow-up. A decrease over time in clinical outcomes was, however, seen when the follow-up scores at 1 year post-operatively were compared with the final follow-up.

Level of evidence

Level II.

中文翻译：

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长期随访中距骨骨软骨病变的骨髓刺激显示出较高的运动参与度，但随着时间的推移临床结果有所下降。

目的

尽管骨髓刺激 (BMS) 作为距骨骨软骨病变 (OCLT) 的治疗方法在短期随访中显示出较高的运动恢复率，但尚不清楚在较长的随访中是否仍可进行运动活动。因此，本研究的目的是在长期随访中评估关节镜 BMS 后的运动活动。

方法

本研究分析了先前发表的随机对照试验中包括的 60 名患者。所有患者都接受了关节镜下清创术和 OCLT 的 BMS。在术后第一年和最终随访时评估恢复运动、水平和类型。次要结局指标通过标准化问卷进行评估，使用疼痛和满意度的数字评分量表以及足踝结局评分 (FAOS)。

结果

平均随访时间为 6.4 年（SD ± 1.1 年）。用 AAS 测量的平均活动水平是受伤前 6.2 和受伤后 3.4。术后 1 年增加至 5.2，末次随访时为 5.8。在最终随访时，54 名患者 (90%) 参加了 16 项不同的运动。33 名患者 (53%) 表示他们恢复了受伤前水平的运动。20 名患者 (33%) 由于脚踝问题而无法获得他们受伤前的运动水平，另外 8 名患者 (13%) 由于其他原因无法获得他们受伤前的运动水平。休息时疼痛的平均 NRS 术前为 2.7，1 年为 1.1，最后随访时为 1.0。活动期间的平均 NRS 分别从 7.9 变为 3.7 到 4.4。随访 1 年时，FAOS 评分有所提高，但在最终随访时所有分项评分均显着下降。

结论

在 OCLT 的 BMS 后长期随访（平均 6.4 年）中，90% 的患者仍然参加体育活动，其中 53% 处于损伤前水平。参加运动的患者的 AAS 在最终随访时在受伤前和手术后保持相似。然而，当将术后 1 年的随访评分与最终随访进行比较时，可以看到临床结果随着时间的推移而下降。

证据水平

二级。