The importance of early arthroscopy in athletes with painful cartilage lesions of the ankle: a prospective study of 61 consecutive cases

Abstract

BackgroundAnkle sprains are common in sports and can sometimes result in a persistent pain condition.PurposePrimarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes. Secondly, in applicable cases, to evaluate the accuracy of MRI in detecting these injuries. Type of study: Prospective consecutive series.MethodsOver around 4 years we studied 61 consecutive athletes with symptomatic chondral lesions to the talocrural joint causing persistent exertion ankle pain.Results43% were professional full time athletes and 67% were semi-professional, elite or amateur athletes, main sports being soccer (49%) and rugby (14%). The main subjective complaint was exertion ankle pain (93%). Effusion (75%) and joint line tenderness on palpation (92%) were the most common clinical findings. The duration from injury to arthroscopy for 58/61 cases was 7 months (5.7–7.9). 3/61 cases were referred within 3 weeks from injury. There were in total 75 cartilage lesions. Of these, 52 were located on the Talus dome, 17 on the medial malleolus and 6 on the Tibia plafond. Of the Talus dome injuries 18 were anteromedial, 14 anterolateral, 9 posteromedial, 3 posterolateral and 8 affecting mid talus. 50% were grade 4 lesions, 13.3% grade 3, 16.7% grade 2 and 20% grade 1. MRI had been performed pre operatively in 26/61 (39%) and 59% of these had been interpreted as normal. Detection rate of cartilage lesions was only 19%, but subchondral oedema was present in 55%. At clinical follow up average 24 months after surgery (10–48 months), 73% were playing at pre-injury level. The average return to that level of sports after surgery was 16 weeks (3–32 weeks). However 43% still suffered minor symptoms.ConclusionArthroscopy should be considered early when an athlete presents with exertion ankle pain, effusion and joint line tenderness on palpation after a previous sprain. Conventional MRI is not reliable for detecting isolated cartilage lesions, but the presence of subchondral oedema should raise such suspicion.

Acute, isolated and unstable syndesmotic injuries are frequently associated with intra-articular pathologies

“…In the current study, pre-operative MRI had a sensitivity/specificity of 100/79% for chondral lesions and 50/93% for loose bodies. The herein observed sensitivity compares favorably to previous studies with reported sensitivity rates ranging from 19 to 71% [ 2 , 18 , 26 , 30 ]. This high rate could be explained either by the rather small cohort or the experience of the senior radiologist reviewing the images especially for intra-articular pathologies.…”

“…Magnetic resonance imaging (MRI) is often considered a non-invasive alternative to pre-operatively identify patients with intra-articular pathologies. Still, MRI has been reported to have a limited sensitivity in detecting chondral lesion and loose bodies [ 2 , 18 , 26 , 30 ]. Arthroscopy on the other hand does not only allow to reliably identify and treat intra-articular pathologies but also seems to improve the patient reported outcomes [ 23 , 34 , 35 , 39 ].…”

Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: A comparative study with surgical findings and timings of scans

“… 9 One study noted an MRI accuracy of 80% in detecting osteochondral lesions in the talus and peroneus brevis tendon tears, 10 whereas another study reported a 19% detection rate of cartilage lesions found at surgery. 11 For the few studies that evaluated the lateral ankle ligamentous complex, significantly different sensitivities and specificities for detecting ATFL and CFL tears have been reported. 12 , 13 In addition, these studies had focused only on patients with chronic symptoms and injuries and there remains a paucity in the literature on the accuracy of MRI in the acute setting.…”

Osteochondral defects of the talus with a focus on platelet-rich plasma as a potential treatment option: a review

“… 15 In 1996, Ferkal modified the previous classification system of Berndt and Harty with findings based on CT, listed in table 2 . 16 Instead, MRI is considered the gold standard in recognising osteochondral lesions, with 100% specificity and anywhere between 73% and 95% sensitivity. 15 …”

“…Less sensitivity, likely secondary to the thickness of imaging slices on MRI (3 mm taken in 1 mm intervals), compared with the thickness of the talar cartilage (0.4–2.1 mm), means that the false-negatives are possible, so a negative MRI with clinical symptoms requires further work-up with arthroscopy. 16 Further staging based on MRI was developed by Hepple et al , listed in table 3 . 17 …”