Background: 

The primary aim of the present study was to determine the prevalence of osteochondral lesions of the contralateral talus in patients with computed tomography (CT)-confirmed osteochondral lesions of the talus (OLT). The secondary aims were to determine if the contralateral lesions were symptomatic and to describe the demographic characteristics and radiographic presentation of patients with bilateral OLT.

Methods: 

To identify patients with bilateral OLT, we utilized a cross-sectional database of consecutive patients with a CT-proven OLT who had undergone bilateral CT scanning at our hospital between January 1989 and June 2021. The primary outcome was the prevalence of bilateral OLT. Patients with bilateral OLT were grouped into a unilaterally symptomatic group and a bilaterally symptomatic group. Patient and lesion characteristics were compared between these groups as well as between the symptomatic and asymptomatic ankles in the unilaterally symptomatic group. Radiographic examination included lesion volume, location, and morphology.

Results: 

Of 1,062 patients with OLT, 161 (15%) had bilateral OLT. Of the patients with bilateral OLT, 53 (33%) were bilaterally symptomatic. Patients who were bilaterally symptomatic were younger (p = 0.03) and more likely to present with a non-traumatic etiology (p < 0.01) in comparison with those who were unilaterally symptomatic. No differences were observed between the unilaterally and bilaterally symptomatic groups in terms of lesion morphology, volume, or location. In the unilaterally symptomatic group, lesion volume was significantly larger in symptomatic ankles in comparison with the contralateral, asymptomatic ankles (p < 0.01), but no significant differences were observed in terms of lesion morphology or location.

Conclusions: 

In patients presenting with symptomatic OLT, the prevalence of bilateral OLT was 15%, and 1 in 3 patients with bilateral OLT were symptomatic on both sides. Larger lesion volume was associated with the presence of symptoms in patients with bilateral OLT. For patients with bilateral OLT, the treating team should be aware that younger patients and patients without a history of trauma are at a higher risk for having bilateral symptoms.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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15% 的距骨骨软骨病变出现在双侧，而只有三分之一的双侧病变出现双侧症状

背景： 

本研究的主要目的是确定计算机断层扫描 (CT) 证实距骨骨软骨损伤 (OLT) 的患者对侧距骨骨软骨损伤的患病率。次要目的是确定对侧病变是否有症状，并描述双侧 OLT 患者的人口特征和影像学表现。

方法： 

为了识别双侧 OLT 患者，我们利用了 1989 年 1 月至 2021 年 6 月期间在我们医院接受过双侧 CT 扫描的经 CT 证实的 OLT 连续患者的横断面数据库。主要结果是双侧 OLT 的患病率。双侧OLT患者分为单侧症状组和双侧症状组。比较这些组之间以及单侧症状组中有症状和无症状脚踝之间的患者和病变特征。射线照相检查包括病变体积、位置和形态。

结果： 

在 1,062 名 OLT 患者中，161 名 (15%) 患有双侧 OLT。在双侧 OLT 患者中，53 例 (33%) 出现双侧症状。与单侧有症状的患者相比，双侧有症状的患者更年轻 (p = 0.03)，且更有可能出现非创伤性病因 (p < 0.01)。单侧和双侧症状组之间在病变形态、体积或位置方面没有观察到差异。在单侧有症状组中，有症状脚踝的病变体积明显大于对侧无症状脚踝（p < 0.01），但在病变形态或位置方面没有观察到显着差异。

结论： 

在有症状的 OLT 患者中，双侧 OLT 的患病率为 15%，每 3 个双侧 OLT 患者中就有 1 例双侧都有症状。较大的病变体积与双侧 OLT 患者出现症状相关。对于双侧 OLT 患者，治疗团队应意识到年轻患者和无外伤史的患者出现双侧症状的风险较高。

证据级别： 

预后III 级。有关证据级别的完整描述，请参阅作者须知。