Addressing Large Osteochondral Lesions of the Talus in the setting of Chronic Ankle Instability: A Case Series

Abstract

Chronic ankle instability (CAI) has been implicated as a causative factor in the development of osteochondral lesions of the talus (OLT). Previous reports note larger OLT in patients with CAI and consequently inferior clinical outcomes. Common procedures for CAI and OLT are lateral ankle ligament stabilization and arthroscopic microfracture, respectively. The present study is novel in its observation of large OLT at the time of lateral ankle stabilization. Given the poorer outcome of large OLT treated arthroscopically, the present study demonstrates simultaneous osteochondral allograft transfer (OATS) and lateral ankle stabilization. With the purpose to observe patient outcomes and possible viability of the aforementioned combination of procedures. Seven patients met inclusion criteria, and were enrolled in pro- and retro-spective review. Obtained post-operatively were: Visual analog scores (VAS), Short Form Health Survey 36, and a validated patient reported outcome (PRO) in the form of the foot and ankle ability measure (FAAM). The mean age of patients was 48.14 and mean lesion size was 2.39 cm2. Mean VAS improved by an average of -4.86 points and mean FAAM at final follow-up was 74.29 (STD ± 5.39). Representing 88.4% of pre-symptomatic level of function. Two of the 7 patients reported minor complications which resolved routinely with conservative care. Given the improvement in pain and function and reasonable complication rate, undertaking an OATS and lateral ankle stabilization procedure together appears to be a safe and effective treatment method for this select group of patients.