Arthroscopic Findings Associated with the Unstable Ankle

Abstract

Before lateral ankle stabilization, arthroscopic surgery was performed on 54 patients (55 ankles) with chronic ankle instability. All patient charts, x-rays, operative reports, and surgical videotapes were reviewed. A detailed questionnaire was answered by all patients. The study population included 31 males and 23 females, with a mean age of 31 years (range, 14-64 years). The right ankle was involved in 64% of cases. Average follow-up was 9.6 months. Arthroscopic surgery was performed using small joint instrumentation including 30 degrees and 70 degrees 2.7-mm arthroscopes and a 30 degrees 1.9-mm arthroscope. At surgery, 51 ankles (93%) had intra-articular abnormalities including loose bodies (12), synovitis (38), osteochondral lesions of the talus (9), ossicles (14), osteophytes (6), adhesions (8), and chondromalacia (12). The most common arthroscopic procedures were synovectomy, removal of loose bodies and ossicles, excision and drilling of osteochondral lesions, debridement of the lateral gutter, excision of osteophytes, and removal of adhesions and scar tissue. There was a 25% incidence of chondral injuries, which differs considerably from the results of Taga et al., who found chondral injuries in 95% of ankles with lateral instability. Overall, there were excellent or good results in 96% of ankles. The incidence of excellent results was lower in the worker's compensation patients because of a greater incidence of complaints of pain with activity. There was no correlation between the presence of osteochondral lesions or amount of talar tilt and results.

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

“…However, in that study, ankle exploration was performed without arthroscopy through an anterolateral incision. This method may limit detection of medial or posterior lesions, of which a relatively high number were observed in our study and previous investigations [7,10,15,18,20,24]. In another report, eight of 21 (38%) chondral lesions were missed by preoperative MRI [25], similar to the rate found for the orthopaedic surgeon in the current study.…”

“…These associated lesions may be an important potential cause of long-term problems [7,10,15,19,24], and appropriate treatment depends on accurate diagnosis. Although studies have not established the longterm effect of chondral lesions and other disorders in ankle instability, it seems reasonable to assume diagnosis and treatment of these lesions are warranted in the absence of data to the contrary.…”

“…Twenty to 40% of patients with chronic instability have associated disorders, such as chondral lesions of the talus, peroneal tears, or loose bodies [2,3,7]. These lesions may contribute to morbidity after an ankle sprain [7,10,19,24]. In the absence of definitive data, diagnosis and treatment at the time of reconstructive ligament surgery appear desirable.…”

“…Often patients arrive for surgical consultation with MR images obtained and read at outside institutions, which may add additional variability to the scenario. Some authors have recommended routine ankle arthroscopy to detect intraarticular disorders at the time of ligament reconstruction [3,7,10].…”

Operative treatment of lateral ligament instability

“…Recurrent ankle sprains may alter the biomechanics at the ankle joint which can potentially lead to cartilage degeneration over time [9][10][11][12][13]. Up to 93% of patients with ankle instability have associated intra-articular pathology [14][15][16]. Varus instability of the ankle shifts the contact pressure medially and can lead to osteochondral lesions of the ankle particularly in the central medial talar region [17].…”