Abstract
PurposeTo determine the incidence and location of osteochondral lesions (OCLs) following ankle fractures as well as to determine the association between fracture type and the presence of OCLs. Up to 50% of patients with ankle fractures that receive surgical treatment show suboptimal functional results with residual complaints at a long-term follow-up. This might be due to the presence of intra-articular osteochondral lesions (OCL).MethodsA literature search was carried out in PubMed (MEDLINE), EMBASE, CDSR, DARE and CENTRAL to identify relevant studies. Two authors separately and independently screened the search results and conducted the quality assessment using the MINORS criteria. Available full-text clinical articles on ankle fractures published in English, Dutch and German were eligible for inclusion. Per fracture classification, the OCL incidence and location were extracted from the included articles. Where possible, OCL incidence per fracture classification (Danis–Weber and/or Lauge–Hansen classification) was calculated and pooled. Two-sided p values of less than 0.05 were considered statistically significant.ResultsTwenty articles were included with a total of 1707 ankle fractures in 1707 patients. When focusing on ankle fractures that were assessed directly after the trauma, the OCL incidence was 45% (n = 1404). Furthermore, the most common location of an OCL following an ankle fractures was the talus (43% of all OCLs). A significant difference in OCL incidence was observed among Lauge–Hansen categories (p = 0.049). Post hoc pairwise comparisons between Lauge–Hansen categories (with adjusted significance level of 0.01) revealed no significant difference (n.s.).ConclusionOCLs are frequently seen in patients with ankle fractures when assessed both directly after and at least 12 months after initial trauma (45–47%, respectively). Moreover, the vast majority of post-traumatic OCLs were located in the talus (42.7% of all OCLs). A higher incidence of OCLs was observed with rotational type fractures. The clinical relevance of the present systematic review is that it provides an overview of the incidence and location of OCLs in ankle fractures, hereby raising awareness to surgeons of these treatable concomitant injuries. As a result, this may improve the clinical outcomes when directly addressed during index surgery.Level of evidenceIV.
Highlights
Ankle fractures are common injuries, with a global annual incidence of 0.1–0.2% [49, 53, 54]
When studying the relationship between ankle fractures and the presence of osteochondral lesions (OCLs) in the ankle, it becomes clear that there is a substantial lack of knowledge on (1) the exact incidence of these lesions in ankle fractures, (2) the location of these OCLs and (3) the association between OCLs and ankle fracture type
Three [5, 12, 30] of the remaining four studies were excluded for subanalysis of OCL location and subanalysis of association between OCL location and fracture type
Summary
Ankle fractures are common injuries, with a global annual incidence of 0.1–0.2% [49, 53, 54]. A frequent residual complaint is a persistent pain, which can have a large impact on the daily-functioning of patients [40]. One of the potential explanations for this residual pain could be the presence of (osteo)chondral lesions (OCLs) thereby impeding the clinical recovery of the individual patients [32, 49, 53, 54]. When studying the relationship between ankle fractures and the presence of OCLs in the ankle, it becomes clear that there is a substantial lack of knowledge on (1) the exact incidence of these lesions in ankle fractures, (2) the location of these OCLs and (3) the association between OCLs and ankle fracture type
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