Ankle Arthroscopy for Diagnosis of Full-thickness Talar Cartilage Lesions in the Setting of Acute Ankle Fractures

Abstract

To delineate the prevalence of chondral lesions, in particular full-thickness talar dome lesions, with concurrent arthroscopy in acute ankle fracture open reduction-internal fixation (ORIF) and evaluate the impact on clinical outcomes. We conducted a retrospective chart review of prospectively collected registry data at our institution from 2012 to 2016. Consecutive patients who underwent acute ankle fracture ORIF with concurrent arthroscopy were identified. Charts were reviewed to determine the prevalence and grade of chondral lesions, fracture type, and associated factors. Clinical outcomes with a minimum of 1year of follow-up were assessed using the Foot and Ankle Outcome Score. The study included 116 consecutive patients undergoing acute ankle fracture ORIF with concurrent arthroscopy. A chondral lesion was identified in 78% (90 of 116). A full-thickness talar dome chondral lesion was identified in 43% of these patients (39 of 90). Patient age was a significant predictor, with patients younger than 30years being less likely to have a chondral injury than those aged 30years or older (59% vs 85%, P= .0077). Of the patients who sustained a dislocation at the time of injury, 100% had a chondral lesion (P= .039). Patients with complete syndesmosis disruption and instability were also more likely to have a chondral lesion (96% vs 73%, P= .013). Patients with chondral lesions had statistically significantly worse clinical outcomes than those without them (Foot and Ankle Outcome Score, 81.2 vs 92.1; P= .009). Ankle arthroscopy performed concomitantly with ankle ORIF is a useful tool in diagnosing chondral injuries. Chondral lesions are common with ankle fractures. An ankle with a dislocation at presentation or a syndesmotic injury may be more likely to present with a chondral lesion and should thus prompt evaluation. The presence of a talar chondral injury may be associated with a negative impact on clinical outcomes. Level IV, therapeutic case series.