Concomitant ankle instability has a negative impact on the quality of life in patients with osteochondral lesions of the talus: data from the German Cartilage Registry (KnorpelRegister DGOU)

Körner, Daniel; Ateschrang, Atesch; Schröter, Steffen; Aurich, Matthias; Walther, Markus; Gottschalk, Oliver; Bangert, Yannic; Ettinger, Sarah; Plaaß, Christian; Ahrend, Marc-Daniel

doi:10.1007/s00167-020-05954-1

Cited by 20 publications

(18 citation statements)

References 30 publications

(45 reference statements)

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“…Recently, data from the German Cartilage Registry were published emphasizing the need for studies evaluating clinical outcomes of patients with ankle instability and concurrent cartilage repair for OLT. 21 The authors assessed and compared preoperative demographics and lesion characteristics of patients who underwent AMIC and concurrent LLS (group A) with those of patients who received isolated AMIC (group B). They reported that patients in group A tended to be older (median, 34 years [range, 20-65 years] vs 28.5 years [range, 18-72 years]) with smaller OLT lesion size (median, 100 mm 2 [range, 15-600 mm 2 ] vs 150 mm 2 [range, 25-448 mm 2 ]) than group B, yet neither reached statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“… 32 , 35 Nevertheless, a study showed that LLS with concomitant treatment of OLT utilizing retrograde drilling and microfracture is a safe procedure that leads to favorable clinical outcomes at a mean of 7.3 years postoperatively. 14 Moreover, a recently published article 21 highlighted the fact that the presence of concomitant ankle instability worsens the quality of life of patients with OLT. Thus, patients with OLT should be evaluated for ankle instability to integrate appropriate treatment for ankle instability if required.…”

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confidence: 99%

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Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Ackermann

Casari

Germann

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Ackermann

Casari

Germann

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…However, as we are aware of the fact that 24% of the OLTs are located on the lateral talar dome and that the laterally located OLTs are associated with chronic lateral ankle instability, there is a clinical need to present surgical techniques that are amenable and effective for laterally located OLTs [ 2 , 37 , 40 , 41 , 43 ]. Moreover, it is stated that concomitant lateral ankle instability is considered a negative prognostic factor regarding the clinical outcomes of surgical treatment of OLTs [ 17 , 20 , 27 ]. Consequently, this highlights the clinical relevance and importance of addressing laterally located lesions appropriately in the case of lesions of large (cystic) nature and in case of concomitant (chronic) lateral ankle instability.…”

Section: Surgical Principle and Objectivementioning

confidence: 99%

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for lateral osteochondral lesions of the talus: operative technique

Dahmen

Rikken

Kerkhoffs

et al. 2023

Oper Orthop Traumatol

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Objective To provide a natural scaffold, good quality cells, and growth factors to facilitate replacement of the complete osteochondral unit with matching talar curvature for large osteochondral lesions of the lateral talar dome. Indications Symptomatic primary and non-primary lateral osteochondral lesions of the talus not responding to conservative treatment. The anterior–posterior or medial–lateral diameter should exceed 10 mm on computed tomography (CT) for primary lesions; for secondary lesions, there are no size limitations. Contraindications Tibiotalar osteoarthritis grade III, malignancy, active infectious ankle joint pathology, and hemophilic or other diffuse arthropathy. Surgical technique Anterolateral arthrotomy is performed after which the Anterior TaloFibular Ligament (ATFL) is disinserted from the fibula. Additional exposure is achieved by placing a Hintermann distractor subluxating the talus ventrally. Thereafter, the osteochondral lesion is excised in toto from the talar dome. The recipient site is micro-drilled in order to disrupt subchondral bone vessels. Thereafter, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exactly fitting shape to match the extracted lateral osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the ATFL is re-inserted followed by potential augmentation with an InternalBrace™ (Arthrex, Naples, FL, USA). Postoperative management Non-weightbearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a computed tomography (CT) scan is performed to assess consolidation of the inserted autograft. The patient is referred to a physiotherapist.

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“…In CLAI patients, associated osteochondral lesions are typically located medially in the coronary plane and centrally in the sagittal plane [ 11 ]. Compared with isolated osteochondral lesions, osteochondral lesions in CLAI are larger, and additional chondral lesions at the tip of the medial malleolus are seen [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

Feng

Chen

et al. 2022

J Orthop Surg Res

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Background The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients. Methods This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups. Conclusion In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome. Level of Evidence Level III, a retrospective comparative study.

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Concomitant ankle instability has a negative impact on the quality of life in patients with osteochondral lesions of the talus: data from the German Cartilage Registry (KnorpelRegister DGOU)

Cited by 20 publications

References 30 publications

Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for lateral osteochondral lesions of the talus: operative technique

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

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