Summary

One in four patients with symptomatic lateral ankle sprains have OCLs of the ankle joint, more commonly of the medial talar dome, which tended to have larger surface areas than lateral dome OCLs. In patients with chronic lateral ankle instability, they showed preponderance of lateral talar dome OCLs. Almost half of patients with associated syndesmotic injuries had associated tibial plafond OCLs.

Abstract

Introduction

Lateral ankle sprains are common and are not as simple as it was thought to be. There are substantial associated comorbidities such as chondral or osteochondral lesions (OCL). We aim to review the prevalence and characteristics of cartilage lesions in patients treated for lateral ankle instability.

Materials And Methods

A retrospective review of 231 patients who were treated surgically for symptomatic lateral ankle instability from 2017 to 2022 was performed. Patient demographics, cartilage lesion characteristics including location, size and associated injuries were investigated.

Result: Of the 231 patients reviewed, there were 60 (26%) patients with cartilage lesions in the ankle joint of which all were osteochondral in nature. 51 (85%) of these OCLs were located at the talus only while 3 (5%) were located at the tibial plafond only. 6 (10%) patients had OCLs in both the talus and tibial plafond. These patients were predominantly males (43; 71.7%) with an average age of 34.8 years (S.D.=11.9) and average body mass index (BMI) of 26.8 (s.d.=4.4). More than two thirds (71.7%) of them had recurrent ankle sprains and all of them had associated injuries such as deltoid ligament injuries (45%), peroneal tendon injuries (21.7%) and syndesmotic injuries (15%). On the talus (n=57), 61.4% of these OCL were located at the medial talar dome and 31.6% were on the lateral talar dome while the remnant 7% had combined lesions of the medial and lateral talar domes. Location of these OCLs did not differ significantly in terms of age, gender, BMI and type of associated injuries. Interestingly, medial talar dome OCLs were found to have significantly larger surface areas than lateral talar dome OCLs (74.8mm2 vs 55.9mm2; p=0.041). The surface area of talar dome OCLs was not affected by age, gender, BMI, presence of associated injuries and recurrence of sprain. Recurrent sprains had a stronger association with OCLs of the lateral talar instead compared to the medial talar dome (94.4% vs 62.9%; p=0.020). Lastly, almost half of patients with associated syndesmotic injury had tibial plafond OCL (44.4% vs 55.6%; p=0.022).

Conclusion

One in four patients with symptomatic lateral ankle instability have an OCL – with preponderance of talar dome OCLs most commonly found on the medial aspect. Medial talar dome OCLs had a significantly larger surface area than lateral talar dome OCLs. Patients with recurrent sprains had more OCLs of the lateral than medial talar dome. Physicians should be cognizant of associated cartilage lesions in the ankle when treating patients with lateral ankle instability.