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Effect of subchondral edema on repaired tissue after bone marrow stimulation for osteochondral talar lesions
Author(s):
Yoshimura I. (Japan)
,
Yoshimura I. (Japan)
Affiliations:
Hagio T.
,
Hagio T.
Affiliations:
Minokawa S.
,
Minokawa S.
Affiliations:
Suzuki M.
,
Suzuki M.
Affiliations:
Noda M.
,
Noda M.
Affiliations:
Kanazawa K.
,
Kanazawa K.
Affiliations:
Yamamoto T.
Yamamoto T.
Affiliations:
ESSKA Academy. Yoshimura I. 05/09/18; 209243; P01-236 Topic: Arthroscopic Surgery
Dr. Ichiro Yoshimura
Dr. Ichiro Yoshimura
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Abstract
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Objectives: The arthroscopic bone marrow stimulation (ABMS) technique is recommended as the first-line treatment for osteochondral lesion of the talus (OLT), as ABMS promotes repaired tissue healing of the defect. Recently, T2 mapping has been used to evaluate the repair of cartilage tissue; however, the prognostic worth of T2 values after ABMS has not yet been clarified. Several articles have reported that the subchondral condition affects the articular cartilage condition, and subchondral bone edema (SBE) is reportedly associated with inferior outcome after ABMS. The purpose of the present study was to investigate the relationship between SBE and T2 values of repaired tissue on MRI after ABMS. We hypothesized that the presence of SBE before/after ABMS would affect the characteristics of the repaired tissue after ABMS.

Methods: We prospectively enrolled 18 patients (18 ankles) scheduled to undergo treatment with ABMS for OLT. The patients were six males and 12 females (age, 29.3 ± 22.1 years; lesion length, 10.8 ± 3.0 mm; lesion area, 59.7 ± 26.0 mm2). Repair tissue was assessed using a 3T MRI unit, and T2 maps were calculated. Patients were divided into two groups: those with SBE and those without SBE based on MRI performed pre-ABMS and 1 year post-ABMS. We investigated the relationship between T2 value and SBE presence. Clinical results were assessed using the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale. Student t tests were used to compare the T2 values and JSSF scores. Correlations between the T2 values and lesion length/ lesion area were assessed using the Pearson coefficient of correlation.

Results: There were no significant differences in mean T2 values and JSSF score before ABMS between those with SBE versus those without SBE (T2 values, 47.6 ± 9.6 ms vs. 50.9 ± 6.9 ms, P = 0.5; JSSF score, 91.8 ± 8.6 points vs. 92.0 ± 5.9 points, P = 0.9). At 1 year post-ABMS, there was no significant difference between groups in T2 value (48.9 ± 10.5 ms vs. 48.2 ± 6.9 ms, P = 0.8), but the JSSF score was significantly lower in the SBE group (88.9 ± 7.1 vs. 97.1 ± 4.9 points, P = 0.02). Lesion length/area were correlated with T2 values of repaired tissue (length: r = 0.50, P = 0.005; area: r = 0.29, P = 0.04).

Conclusions: The presence of pre- and/or post-ABMS SBE does not affect the T2 values of repaired tissue after ABMS for OLT. However, post-ABMS SBE was associated with poorer clinical outcome. Larger lesion size is correlated with poorer condition of repaired tissue.

Keywords:
talus,MRI,bone marrow stimulation,repair tissue,subchondral bone
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