One in Three Patients With Chronic Lateral Ankle Instability Has a Cartilage Lesion

Abstract

Background: Chronic lateral ankle instability (CLAI) is associated with the presence or development of intra-articular pathologies such as chondral or osteochondral lesions, or (O)CLs. Currently, the incidence of (O)CLs in patients with CLAI is unknown. Purpose: To determine the incidence of (O)CLs in patients with CLAI. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A literature search was conducted in the PubMed (MEDLINE), Embase (Ovid), and Cochrane databases for articles published from January 2000 until December 2020. Two authors independently screened the search results and conducted the quality assessment using the methodological index for non-randomized studies (MINORS) criteria. Clinical studies were included that reported findings on the presence of ankle (O)CLs based on pre- or intraoperative diagnostic measures in patients with CLAI (>6 months of symptoms). Patient and lesion characteristics were pooled using a simplified method. Lesion characteristics included localization and chondral and osteochondral involvement. The primary outcome was the incidence of (O)CLs in ankles with CLAI. A random-effects model with 95% CIs was used to analyze the primary outcome. The distribution of (O)CLs in the ankle joint was reported according to talar or tibial involvement, with medial and lateral divisions for talar involvement. Results: Twelve studies were included with 2145 patients and 2170 ankles with CLAI. The pooled incidence of (O)CLs in ankles with CLAI was 32.2% (95% CI, 22.7%-41.7%). Among all lesions, 43% were chondral and 57% were osteochondral. Among all (O)CLs, 85% were located on the talus and 17% on the distal tibia. Of the talar (O)CLs, 68% were located medially and 32% laterally. Conclusion: (O)CLs were found in up to 32% of ankles with CLAI. The most common location was the talus (85%). Furthermore, most lesions were located on the medial talar dome (68%). These findings will aid physicians in the early recognition and treatment of ankle (O)CLs in the context of CLAI.

Evaluation of Open Versus Arthroscopic Anterior Talofibular Ligament Reconstruction for Chronic Lateral Ankle Instability With Talar and Subtalar Cartilage MRI T2 Mapping: A 3-Year Prospective Study

“…These findings were in agreement with our previous findings and those of several ankle studies that reported a T2/T2* increase in the talocrural cartilage of patients with CLAI, again with stronger effects in the medial joint regions, which has been proven in arthroscopic and cadaveric studies. 9,15 In the meta-analysis by Wijnhoud et al, 23 an overall 85% of osteochondral lesions in patients with CLAI were talar lesions; of the 2 studies that examined tibial lesions, 17% of osteochondral lesions were on the distal tibia. This finding could be explained by previous kinematic studies that reported increased stress distributions and reduced tibiotalar contact area in the medial compartment of the talus when the lateral ligaments were released.…”

Screening of Undiagnosed Increased Lateral Ankle Laxity Using Stress Ultrasonography

“… 15 According to a recent systematic review, 32% of patients with CLAI have chondral or osteochondral lesions. 42 Gradual cartilage degradation causes progression of the vicious cascade from a focal cartilage lesion toward osteoarthritis. 11 Based on the results of the present study, the incidence of undiagnosed ILAL was 35.8% (38/106).…”

Offene Lift-drill-fill-fix-Methode bei medialen osteochondralen Läsionen des Talus: Operationstechnik

“… Clinical evaluation, including patient history and physical examination is performed for all patients at the outpatient clinic in order to assess symptoms befitting an OLT. Additionally, care is taken to assess any relevant coexisting pathologies of the foot and ankle which may warrant treatment, such as symptomatic ankle instability which is frequently encountered in patients with OLT [ 1 , 22 ]. Radiological assessment of the lesion is preferably carried out through a preoperative computed tomography (CT) scan to assess the three-dimensional lesion and fragment size, lesion location, as well as the lesion and fragment morphology.…”

“…Clinical evaluation, including patient history and physical examination is performed for all patients at the outpatient clinic in order to assess symptoms befitting an OLT. Additionally, care is taken to assess any relevant coexisting pathologies of the foot and ankle which may warrant treatment, such as symptomatic ankle instability which is frequently encountered in patients with OLT [ 1 , 22 ].…”