Surgical treatment for medium-sized cystic osteochondral lesions of the talus: Autologous osteoperiosteal transplantation provides better clinical outcomes than bone marrow stimulation when cysts are deeper than 6 mm.

IF 3.3 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-08-02 DOI:10.1002/ksa.12388

Shuai Yang, Qirui Shao, Yu Zhu, Fengyi Hu, Dong Jiang, Chen Jiao, Yuelin Hu, Weili Shi, Qinwei Guo

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Abstract

Purpose: To compare clinical outcomes of autologous osteoperiosteal transplantation versus bone marrow stimulation (BMS) for medium-sized (100-150 mm²) cystic osteochondral lesions of the talus (OLTs) and assess the correlation between patient demographics and outcomes. It was hypothesised that autologous osteoperiosteal transplantation would provide better clinical outcomes than BMS for medium-sized cystic OLTs.

Methods: Patients who underwent autologous osteoperiosteal transplantation or BMS for medium-sized cystic OLTs between 2014 and 2019 were retrospectively evaluated. According to their characteristics, a 1:1 propensity-score matching was performed and 33 pairs of patients were matched. The visual analogue scale, American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot Ankle Outcome Score (FAOS) and Ankle Activity Score were collected preoperatively and at the last follow-up. In addition, a general linear model analysis was performed between patient demographics and clinical outcomes in two groups separately to detect potential risk factors.

Results: Finally, 28 patients in the grafted group and 27 patients in the BMS group completed the follow-up and were enrolled with a mean follow-up period of 63.5 ± 13.9 months. Both groups showed significant improvement in all patient-reported outcomes (p < 0.01). At the final follow-up, no significant differences between groups were found in all postoperative scores except FAOS Pain (p = 0.02). Correlation analysis showed a moderate correlation between cyst depth and the postoperative AOFAS score in the BMS group (r = -0.48, p = 0.01). Based on the regression line, the patients in the BMS group with a cyst deeper than 6 mm showed a lower AOFAS score than the mean score (88.7 ± 9.5) of the grafted group.

Conclusion: Autologous osteoperiosteal transplantation and BMS are both safe and effective for medium-sized cystic OLTs. However, autologous osteoperiosteal transplantation is expected to provide better clinical outcomes than BMS when the cysts are deeper than 6 mm.

Level of evidence: Level III.

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距骨中等大小囊性骨软骨损伤的手术治疗：当囊肿深度超过 6 毫米时，自体骨骨膜移植比骨髓刺激疗法具有更好的临床疗效。

目的：比较自体骨骨膜移植与骨髓刺激（BMS）治疗中等大小（100-150 mm2）的距骨囊性骨软骨损伤（OLTs）的临床疗效，并评估患者人口统计学特征与疗效之间的相关性。假设对于中等大小的囊性OLTs，自体骨骨膜移植比BMS能提供更好的临床疗效：对2014年至2019年期间接受自体骨膜移植或BMS治疗中型囊性OLT的患者进行回顾性评估。根据他们的特征，进行了1:1倾向分数匹配，33对患者匹配成功。在术前和最后一次随访时，收集了视觉模拟量表、美国骨科足踝协会（AOFAS）评分、足踝结果评分（FAOS）和踝关节活动评分。此外，还分别对两组患者的人口统计学特征和临床结果进行了一般线性模型分析，以检测潜在的风险因素：最后，移植组和 BMS 组分别有 28 名和 27 名患者完成了随访，平均随访时间为（63.5 ± 13.9）个月。两组患者在所有患者报告的结果方面均有明显改善（P 结论：两组患者在所有患者报告的结果方面均有明显改善：自体骨膜移植和 BMS 对中等大小的囊性 OLT 均安全有效。然而，当囊肿深度超过 6 毫米时，自体骨膜移植的临床疗效有望优于 BMS：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).