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Published on: January 23, 2018
Jumping Dot Sign: A New Radiological Sign Predicting Inferior Clinical Outcome and Higher Cyst Recurrence Following
Xiangyun Cheng1, Yuqing Zhao2, Hao Xu1
1Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Beijing, China.
Background:
Bone marrow stimulation (BMS) is the most commonly performed surgery for osteochondral lesion of the talus (OLT), but there is a risk of poor outcome when cysts recur. The indications of BMS in the presence of cystic OLT remain controversial.
Purpose:
To investigate whether a new "jumping dot (JD) sign," manifesting as speckle-like areas of elevated signals surrounding the subchondral bone cyst (SBC) on preoperative magnetic resonance imaging (MRI) against the background of bone marrow edema (BME), could be a predictor of clinical outcome and recurrence of SBCs following BMS and to further propose a more precise indication regarding BMS surgery for cystic OLT.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients with cystic OLTs (<150 mm2) who received BMS between November 2016 and January 2021 were retrospectively studied. Visual analog scale for pain and American Orthopaedic Foot & Ankle Society (AOFAS) scores were assessed preoperatively and at follow-up. The normal bone marrow, BME, and SBCs (including size) were quantified, and the JD sign was evaluated on the preoperative MRI. Notably, the maximal vertical diameter of the cyst was rigorously defined as the greatest distance measured from the superior to the inferior margins of the cyst in this study. The MOCART (magnetic resonance observation of cartilage repair tissue) score and the cyst recurrence were evaluated, and multivariate analysis was performed to evaluate the association of the JD sign with outcomes at the final follow-up.
Results:
A total of 117 patients were divided into the JD sign group (n = 41) and no JD sign group (n = 76), and no significant difference was found for the follow-up duration (48.04 ± 14.78 months vs 48.46 ± 15.38 months; P = .89). Overall, the patients had significantly improved AOFAS scores (68.69 ± 7.46 vs 86.40 ± 10.75; P = .009) and lessened postoperative cysts (117/117 vs 43/117; P = .000). However, both uni- and multivariate analysis revealed that the JD sign was negatively associated with clinical outcomes following BMS (P < .05). Additionally, the JD sign group showed significantly higher cyst recurrence rate (75.60% vs 15.78%; P < .001) and lower MOCART score (73.04 ± 11.28 vs 80.59 ± 19.07; P = .008). When the maximal vertical diameter of the cyst was >5.4 mm, the JD sign showed excellent effectiveness in predicting the postoperative cyst recurrence (sensitivity, 81.4%; specificity, 68.9%; positive predictive value, 61.34%; and negative predictive value, 86.44%).
Conclusion:
The JD sign might be significantly associated with inferior clinical outcomes and higher SBC recurrence following BMS for cystic OLT. For those patients with the maximal vertical diameter of the cyst >5.4 mm and with JD signs, BMS may not be an appropriate option.
