SLR - May 2023 - Hans Humrick, DPM
Title: Incidence of (Osteo)Chondral Lesions of the Ankle in Isolated Syndesmotic Injuries: A Systematic Review and Meta-AnalysisReference: Dahmen J, Jaddi S, Hagemeijer NC, Lubberts B, Sierevelt IN, Stufkens SAS, d'Hooghe P, Kennedy JG, Calder JDF, DiGiovanni CW, Kerkhoffs GMMJ. Incidence of (Osteo)Chondral Lesions of the Ankle in Isolated Syndesmotic Injuries: A Systematic Review and Meta-Analysis. Cartilage. 2022 Apr-Jun;13(2):19476035221102569. doi: 10.1177/19476035221102569. PMID: 35657299; PMCID: PMC9168886.
Level of Evidence: Level 4
Reviewed By: Hans Humrick, DPM
Residency Program: North Colorado Medical Center PMSR Greeley, Colorado
Podiatric Relevance: High-ankle sprains are caused by attenuation, damage, or tearing of the distal syndesmotic ankle ligaments and are difficult to treat due to many factors, including the tendency of these injuries to have numerous associated pathologies. Early recognition and treatment of these injuries can improve outcomes and decrease the risks of developing chronic deleterious effects to the patient.
Methods: A systematic review with meta-analysis was performed using 9 studies from 2000 to 2021 to review the incidence of osteochondral lesions (OCL) of the ankle in associated isolated syndesmotic injuries. The primary outcome measure was the incidence rate of ankle OCLs in acute (<6 weeks from initial injury to diagnosis) versus chronic (>6 weeks from initial injury to diagnosis) syndesmotic injuries. All patients underwent an MRI to diagnose an acute or chronic syndesmotic injury.
Results: Of 402 syndesmotic injuries, 95.4% were located on the talar dome and 4.5% on the tibia. The incidence of ankle OCL in acute versus chronic syndesmotic injury was 22.0% and 24.1% respectively with no statistical significance, and the combined overall incidence of OCL in syndesmotic injuries was 20.7%. No consistent data on OCL of the ankle size was reported.
Conclusion: Intra-articular osteochondral lesions (OCL) of the ankle are not typically considered as a major component in acute or chronic isolated syndesmotic injuries. However, this study and similar articles have reported a relatively high rate of concomitant OCL of the ankle in acute and chronic syndesmotic injuries at 21% in the current study looking at isolated syndesmotic injuries, but as high as 45% in other studies that included ankle fractures with associated syndesmotic injuries. The presence of a fracture generally indicates a higher energy of trauma, yet it appears the development of an OCL is still a significant risk in all syndesmotic injuries. Regardless of the presence of fracture or not, syndesmotic injuries alone have shown to have a significant impact on the intra-articular cartilage. Cartilaginous damage, particularly when left untreated, can rapidly progress to crippling arthritis, enlarged and painful cysts, loose bodies in the ankle joint, and the need for highly invasive surgical intervention. Although only about 5% of ankle OCLs occurred on the distal tibia in this study, the tibia should still be routinely assessed along with the talus for presence of a potentially detrimental OCL. Advanced imaging (MRI) should be performed in suspected syndesmotic or OCL injuries. Early recognition of a concomitant ankle OCL in both acute and chronic isolated syndesmotic injuries can further assist the podiatric surgeon appropriately diagnose and treat these injuries earlier, potentially with less invasive modalities such as ankle arthroscopy.