Background:

The bone marrow stimulation (BMS) technique is performed for osteochondral lesions of the talus (OLTs) with a lesion size of <100 mm². The lesion defect is covered with fibrocartilage, and the clinical outcomes deteriorate over time. In contrast, the osteochondral fragment fixation can restore the native articular surface. The difference in clinical outcomes between these procedures is unclear.

Purpose:

To compare the clinical outcomes of BMS and osteochondral fragment fixation for OLTs and examine the characteristics of patients with poor clinical outcomes of BMS.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

In total, 62 ankles in 59 patients with OLTs were included. BMS was performed for 26 ankles, and fixation was performed for 36 ankles. Clinical outcomes, including the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale and bone marrow edema (BME) as identified on magnetic resonance imaging, were compared between the 2 groups. On computed tomography scans, the lesion location was compared with or without BME in each group.

Results:

The AOFAS scores in the fixation group (97.3 ± 4.3 points) were significantly higher than those in the BMS group (91.3 ± 7.7 points), even when the lesion size was <100 mm² (P < .05). When comparing the ankles with or without BME in each group, the AOFAS scores at the final follow-up were significantly lower for the ankles with BME (88.6 ± 7.8 points) than for those without BME (95.0 ± 6.1 points) in the BMS group (P < .05). Lesions with BME in the sagittal plane were located more centrally than those without BME in the BMS group. In the fixation group, there were no significant differences in AOFAS scores and location of the lesion in ankles with or without BME.

Conclusion:

The clinical outcomes of osteochondral fragment fixation are superior to those of BMS in OLTs, even for lesions sized <100 mm². Fixation is recommended even for small lesions, especially for more centralized lesions in the medial and lateral sides of the talus.

中文翻译：

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即使对于距骨小的骨软骨病变，骨软骨碎片固定与微骨折的临床结果

背景：

骨髓刺激 (BMS) 技术用于距骨 (OLTs) 的骨软骨病变，病变大小 <100 mm ²。病变缺损被纤维软骨覆盖，临床结果随着时间的推移而恶化。相比之下，骨软骨碎片固定可以恢复天然关节面。这些程序之间临床结果的差异尚不清楚。

目的：

比较 BMS 和 OLT 骨软骨碎片固定的临床结果，并检查 BMS 临床结果较差的患者的特征。

学习规划：

队列研究；证据水平，3。

方法：

总共包括 59 名 OLT 患者的 62 个脚踝。26个踝关节进行BMS，36个踝关节进行固定。临床结果，包括美国骨科足踝协会 (AOFAS) 踝后足量表和磁共振成像确定的骨髓水肿 (BME)，在 2 组之间进行了比较。在计算机断层扫描中，比较了每组中是否有 BME 的病变位置。

结果：

固定组的AOFAS评分（97.3±4.3分）显着高于BMS组（91.3±7.7分），即使病变大小<100 mm ² ( P < .05)。在比较各组有无BME的踝关节时，BMS组有BME的踝关节AOFAS评分（88.6±7.8分）显着低于无BME的踝关节（95.0±6.1分）。 ( P < .05)。在矢状面上有 BME 的病灶比 BMS 组中没有 BME 的病灶更位于中央。在固定组中，有或没有 BME 的踝关节 AOFAS 评分和病变位置没有显着差异。

结论：

在 OLT 中，骨软骨碎片固定的临床结果优于 BMS，即使对于小于 100 mm ²的病变也是如此。即使对于较小的病变，也建议进行固定，特别是对于距骨内侧和外侧更集中的病变。