Medial Ankle Pain After Lateral Ligament Rupture

Abstract

A fter a severe ankle sprain the incidence of residual complaints, particularly on the medial side of the joint, is high. We studied a consecutive series of 30 patients who had operative repair of acute ruptures of lateral ligaments. During operation, arthroscopy revealed a fresh injury to the articular cartilage in 20 ankles, in 19 at the tip and/or anterior distal part of the medial malleolus as well as on the opposite medial facet of the talus. In six patients, a loose piece of articular cartilage was found.We conclude that in patients with a rupture of one or more of the lateral ankle ligaments after an inversion injury, an impingement occurs between the medial malleolus and the medial facet of the talus. Patients with a lesion of the lateral ankle ligament caused by a high-velocity injury (a faulty landing during jumping or running) had a higher incidence of macroscopic cartilage damage (p < 0.01), medially-located pressure pain (p = 0.06) and medially-located complaints at one-year follow-up (p = 0.02) than those with a low-velocity injury (a stumble).

Treatment of osteochondral defects of the talus

“…56 Later, van Dijk et al reported 4% fresh talar dome lesions and 67% fresh chondral lesions of any kind in 30 patients who had operative repair of acute ruptures of lateral ligaments. 422 More recently, an even higher incidence was reported, namely 41% of 86 patients with anterior talofibular ligament disruptions and 71% of 92 patients with distal fibular fractures. 376 However, the majority of these reported lesions were located at the cartilage covering the anterior aspect of the medial malleolus and the opposite medial talar facet or the anteromedial rim of the tibial plafond.…”

“…49,135,439 Ankle sprains cause intra-articular pressure impact and have a prominent role in the development of traumatic OCDs ( Figure 1). 230,422 The trauma causing the lesion can be a single event or a series of less intense (micro) traumas, which may remain unrecognized in some cases. 63,344 Lateral lesions usually are shallow and oval and caused by a shear mechanism.…”

“…In the 1990s and early 2000s, full thickness talar defects were found in 3% to 4% of patients with lateral ligament rupture or chronic ankle instability. 106,184,422 Later, studies reported OCD rates of 19% to 21% in patients with chronic ankle instability. 127,242 An incidence of up to 71% has been reported in patients with ankle fractures.…”

“…376 However, the majority of these reported lesions were located at the cartilage covering the anterior aspect of the medial malleolus and the opposite medial talar facet or the anteromedial rim of the tibial plafond. 376,422 Accordingly, talar OCDs were found in 28% to 40% of patients with ankle fractures treated by arthroscopically assisted open reduction and internal fixation. 11,259 In these series, the highest incidence was found in patients with distal fibular fractures.…”

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].…”