PROGNOSTIC FACTORS IN THE TREATMENT OF FOCAL OSTEOCHONDRAL LESIONS OF THE KNEE AND ANKLE

Abstract

Osteochondral lesions of the knee and ankle joints are a common pathology that often results in decreased physical activity and early osteoarthritis. Despite the wide range of available surgical techniques, their efficacy varies considerably. Identifying prognostic factors is essential for optimizing treatment strategies. Studying and taking into account the factors that determine the outcome of treatment is a relevant issue in terms of improving the efficiency of providing care to patients in this category. Objective. To identify prognostic factors and informativeness coefficients in treatment of patients with osteochondral lesions. Methods. A retrospective study included 390 patients with focal osteochondral lesions treated with arthroscopic debridement, microfracture, drilling, or osteochondral autograft transplantation. Treatment effectiveness was evaluated using 21 clinical and morphological parameters and functional scores (Lysholm, AOFAS, SF-36, NRS) at 12–36-month follow-up. Statistical analysis included Bayesian probabilistic methods adapted for clinical research, Kulback’s information measure to assess information coefficients, and a heterogeneous sequential procedure based on Wald analysis to determine prognostic coefficients. Results. Positive outcomes were observed in 284 patients (72.8 %), while 106 (27.2 %) had negative outcomes. Key prognostic factors included age, body mass index, lesion size, Kellgren & Lawrence osteoarthritis stage, lesion chronicity, limb axis deviations, and prior surgical history. Conclusions. The identified prognostic and informativeness coefficients have practical value for establishing an individualized approach to selecting the optimal treatment strategy and improving long-term outcomes.