SLR - January 2018 - Nooreen Ibrahim

Concurrent Arthroscopic Osteochondral Lesion Treatment and Lateral Ankle Ligament Repair Has No Substantial Effect on the Outcome of Chronic Lateral Ankle Instability

Reference: Jiang D, Yin-fang A, Jiao C, Xing X, Lin-xin C, Qin-wei G, Yue-lin H. Concurrent Arthroscopic Osteochondral Lesion Treatment and Lateral Ankle Ligament Repair Has No Substantial Effect on the Outcome of Chronic Lateral Ankle Instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2017 Oct 30. doi:10.1007/s00167-017-4774-5  

Scientific Literature Review

Reviewed By: Nooreen Ibrahim, DPM
Residency Program: Wheaton Franciscan Healthcare, St. Joseph Hospital, Milwaukee, WI

Podiatric Relevance: Patients with chronic lateral ankle instability often have concurrent ankle pain and an osteochondral lesion. Once conservative treatment has been exhausted, surgical intervention often consists of arthroscopic treatment of the osteochondral lesion and lateral ankle ligament repair. This study was designed to determine if arthroscopic osteochondral lesion treatment might have a negative effect on the outcome of lateral ankle instability by compromising the rehabilitation program.

Methods: This is a Level III retrospective review of ankle arthroscopy and anatomic lateral ankle ligament repair with suture anchors between 2010 and 2012 at the Institute of Sports Medicine of Peking University. The exclusion criteria were: 1) if OCL was more than 15 mm2 or the depth was more than 8 mm, 2) OCL that required more than debridement or microfracture, 3) history of previous operation to the site and 4) preoperative ROM restrictions. Group A (34 patients) had ankle arthroscopy as well as a Broström-Gould procedure, while Group B (36 patients) only had the Broström-Gould procedure. For Group A, at postoperative week 2, the splint was removed daily for joint motion exercises, and full weightbearing was between postoperative weeks 8 and 12. For Group B, joint motion exercises were started at week 3, and full weightbearing was allowed at weeks 4 to 6. Outcomes were measured with Visual Analog Scale, American Orthopaedic Foot and Ankle Society scores, Tegner scores, sprain recurrence, ankle instability and range of motion.

Results: The median postoperative VAS score, AOFAS score and Tegner score were improved from pre to postoperative level for both groups. All patients were able to return to preinjury work after surgery. Although it was not statistically significant, there was no difference between the two groups for satisfaction rate, subjective scores, pre-postoperative score changes and sprain recurrence. The incidence of Range of Motion restriction of Group A was significantly higher than in group B (23.5 vs. 5.6 percent, P = 0.043).

Conclusion: The authors conclude that simultaneous ankle arthroscopy for osteochondral lesions with lateral ankle ligament reconstruction has no significant negative effect on overall midterm outcome of patients with chronic lateral ankle instability and prove to be reliable procedures. However, the authors showed that compared to patients with isolated chronic lateral ankle instability, those with concurrent OCL have poorer results in terms of ROM because they are more restricted postoperatively. It is important to inform patients undergoing ankle arthroscopy and a Broström-Gould procedure that they may be restricted with ROM postoperatively. 

Educational Opportunities