ABSTRACT
Objective To compare the outcomes of bone marrow stimulation techniques-drilling by a Kirschner needle versus microfracturing technique in the treatment of small osteochondral lesions of the talus.Methods From February 2014 to June 2017,57 patients were treated at Department of Orthopaedics,Sun Yat-sen Memorial Hospital for small osteochondral lesions of the talus.Of them,26 were treated by arthroscopic drilling with a Kirschner needle.They were 15 males and 11 females,aged from 20 to 57 years.The areas of osteochondral lesion ranged from 0.6 to 1.4 cm2.By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films,there were 9 cases of stage Ⅰ,8 cases of stage Ⅱ,6 cases of stage Ⅲ and 3 cases of stage Ⅳ.The other 31 patients of them were treated by arthroscopic microfracturing technique.They were 17 males and 14 females,aged from 24 to 55 years.The areas of osteochondral lesion ranged from 0.5 to 1.5 cm2.By the Berndt & Harty classification of ankle osteochondral lesions based on X-ray films,there were 10 cases of stage Ⅰ,11 cases of stage Ⅱ,8 cases of stage Ⅲ and 2 cases of stage Ⅳ.The 2 groups were compared in terms of visual analogue scale (VAS),the American Orthopaedic Foot and Ankle Society (AOFAS) score,the ankle activity score (AAS) and the Berndt & Harty staging of osteochondral lesions based on ankle X-ray films at the final follow-up.Results All the 57 patients were followed up for 13 to 27 mouths.The VAS,AOFAS and AAS scores and Berndt & Harty stages at the final follow-up were significantly improved in all the patients compared with their preoperative values (P ＜ 0.05).There were no significant differences between the 2 groups in the VAS (2.2 ± 1.6 versus 2.1 ± 1.4),AOFAS (89.1 ±6.3versus 90.4±5.8) or AAS scores (6 versus 6) at the final follow-up (P ＞ 0.05).There was no significant difference between the 2 groups either in the excellent and good rate by the AOFAS ankle-hindfoot scoring [88.5％ (23/26) versus90.3％ (28/31)] at the final follow-up (x2 =0.052,P=0.820).Conclusion In the treatment of small osteochondral lesions of the talus,both arthroscopic drilling with a Kirschner needle and microfracturing technique can achieve satisfactory short-term curative effects,but the long-term effects need to be further studied.
ABSTRACT
Objective@#To compare the clinical effects of autologous semitendinosus tendon and allogenic tendon arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) combined with calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability.@*Methods@#A retrospective analysis was made of 55 patients with chronic lateral ankle instability who underwent arthroscopic reconstruction of ATFL combined with CFL from January 2012 to June 2017. A total of 28 cases were treated with autologous semitendinosus tendon (autologous group), including 19 males and 9 females, with an average age of 28.5±8.03 years (range, 16-46 years). A total of 27 cases were treated with allogenic tendon (allogenic group), including 17 males and 10 females, with an average age of 27.48±7.89 years (range, 16-46 years). ATFL/CFL was reconstructed by the same method in both groups. The reconstruction methods were the same between the groups. The talus and calcaneus were fixed with absorbable compression nails.@*Results@#The operation duration in the autologous group was 94.07±7.83 min, which was longer than that in the allogeneic group 63.56±7.96 min (t=14.51, P<0.001). Fever days 5.26±0.90 days in allogeneic group were longer than 2.46±0.74 days in autologous group (t=-12.55, P<0.001). Wound healing duration in allogeneic group was 13.44±3.33 days longer than that in autologous group 10.32±2.34 days (t=-4.01, P<0.001). In the autologous group, 28 cases were followed up for 34.54±16.04 months, and 27 cases in the allograft group were followed up for 42.74±17.79 months. The mean AOFAS score improved from 63.64±11.20 before operation to 90.21±4.48 after operation in the autologous group, and that improved from 63.93±10.59 before operation to 89.56±5.15 after operation in the allogeneic group with no significant difference between the two groups after operation (t=0.506, P=0.615). The mean VAS score decreased from 5.79±1.79 before operation to 1.54±1.35 after operation in the autologous group, and from 5.89±1.78 before operation to 2.04±1.32 after operation in the allogeneic group. There was no significant difference between the two groups after operation (t=-1.396, P=0.168). Tegner score increased from 4.07±1.39 to 6.43±1.14 in the autologous group and from 3.85±1.06 to 6.52±0.85 in the allogeneic group with no significant difference between the two groups after operation (t=-0.333, P=0.740). Stress radiographic showed that the talar tilt angle decreased from 15.60°±3.86° to 6.01°±2.64° in the autologous group, 16.99°±3.78° to 7.14°±3.34° in the allogeneic group, and there was no significant difference between the two groups after operation (t=-1.382, P=0.171). Anterior talar displacement reduced from 10.82±3.12 mm to 4.03±1.69 mm in the autologous group, from 10.10±2.02 mm to 4.17±1.52 mm in the allogeneic group, and there was no significant difference between the two groups after operation (t=-0.326, P=0.746). No donor tendon dysfunction was found in the autologous group. At the end of follow-up, there was no difference in ankle dorsiflexion, plantar flexion and hind foot mobility between autologous group and allogeneic group.@*Conclusion@#Arthroscopic autologous tendon and allogeneic tendon reconstruction of AFTL combined with CFL can obtain satisfactory short-term results. The autologous tendon group was superior to the allogeneic group in terms of fever, wound healing time. However, there was no significant difference in clinical effects between the two groups.
ABSTRACT
Objective To compare the clinical effects of autologous semitendinosus tendon and allogenic tendon arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) combined with calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability.Methods A retrospective analysis was made of 55 patients with chronic lateral ankle instability who underwent arthroscopic reconstruction of ATFL combined with CFL from January 2012 to June 2017.A total of 28 cases were treated with autologous semitendinosus tendon (autologous group),including 19 males and 9 females,with an average age of 28.5±8.03 years (range,16-46 years).A total of 27 cases were treated with allogenic tendon (allogenic group),including 17 males and 10 females,with an average age of 27.48±7.89 years (range,16-46 years).ATFL/CFL was reconstructed by the same method in both groups.The reconstruction methods were the same between the groups.The talus and calcaneus were fixed with absorbable compression nails.Results The operation duration in the autologous group was 94.07±7.83 min,which was longer than that in the allogeneic group 63.56±7.96 min (t=14.51,P＜0.001).Fever days 5.26±0.90 days in allogeneic group were longer than 2.46±0.74 days in autologous group (t=-12.55,P＜0.001).Wound healing duration in allogeneic group was 13.44±3.33 days longer than that in autologous group 10.32±2.34 days (t=-4.01,P＜0.001).In the autologous group,28 cases were followed up for 34.54± 16.04 months,and 27 cases in the allograft group were followed up for 42.74± 17.79 months.The mean AOFAS score improved from 63.64± 11.20 before operation to 90.21 ±4.48 after operation in the autologous group,and that improved from 63.93± 10.59 before operation to 89.56±5.15 after operation in the allogeneic group with no significant difference between the two groups after operation (t=0.506,P=0.615).The mean VAS score decreased from 5.79± 1.79 before operation to 1.54± 1.35 after operation in the autologous group,and from 5.89± 1.78 before operation to 2.04± 1.32 after operation in the allogeneic group.There was no significant difference between the two groups after operation (t=-1.396,P=0.168).Tegner score increased from 4.07± 1.39 to 6.43± 1.14 in the autologous group and from 3.85±1.06 to 6.52±0.85 in the allogeneic group with no significant difference between the two groups after operation (t=-0.333,P=0.740).Stress radiographic showed that the talar tilt angle decreased from 15.60°±3.86° to 6.01°±2.64° in the autologous group,16.99°±3.78° to 7.14°±3.34° in the allogeneic group,and there was no significant difference between the two groups after operation (t=-1.382,P=0.171).Anterior talar displacement reduced from 10.82±3.12 mm to 4.03±1.69 mm in the autologous group,from 10.10±2.02 mm to 4.17±1.52 mm in the allogeneic group,and there was no significant difference between the two groups after operation (t=-0.326,P=0.746).No donor tendon dysfunction was found in the autologous group.At the end of follow-up,there was no difference in ankle dorsiflexion,plantar flexion and hind foot mobility between autologous group and allogeneic group.Conclusion Arthroscopic autologous tendon and allogeneic tendon reconstruction of AFTL combined with CFL can obtain satisfactory short-term results.The autologous tendon group was superior to the allogeneic group in terms of fever,wound healing time.However,there was no significant difference in clinical effects between the two groups.