Abstract
BackgroundAnkle sprains are common in sports and can sometimes result in a persistent pain condition.PurposePrimarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes. Secondly, in applicable cases, to evaluate the accuracy of MRI in detecting these injuries. Type of study: Prospective consecutive series.MethodsOver around 4 years we studied 61 consecutive athletes with symptomatic chondral lesions to the talocrural joint causing persistent exertion ankle pain.Results43% were professional full time athletes and 67% were semi-professional, elite or amateur athletes, main sports being soccer (49%) and rugby (14%). The main subjective complaint was exertion ankle pain (93%). Effusion (75%) and joint line tenderness on palpation (92%) were the most common clinical findings. The duration from injury to arthroscopy for 58/61 cases was 7 months (5.7–7.9). 3/61 cases were referred within 3 weeks from injury. There were in total 75 cartilage lesions. Of these, 52 were located on the Talus dome, 17 on the medial malleolus and 6 on the Tibia plafond. Of the Talus dome injuries 18 were anteromedial, 14 anterolateral, 9 posteromedial, 3 posterolateral and 8 affecting mid talus. 50% were grade 4 lesions, 13.3% grade 3, 16.7% grade 2 and 20% grade 1. MRI had been performed pre operatively in 26/61 (39%) and 59% of these had been interpreted as normal. Detection rate of cartilage lesions was only 19%, but subchondral oedema was present in 55%. At clinical follow up average 24 months after surgery (10–48 months), 73% were playing at pre-injury level. The average return to that level of sports after surgery was 16 weeks (3–32 weeks). However 43% still suffered minor symptoms.ConclusionArthroscopy should be considered early when an athlete presents with exertion ankle pain, effusion and joint line tenderness on palpation after a previous sprain. Conventional MRI is not reliable for detecting isolated cartilage lesions, but the presence of subchondral oedema should raise such suspicion.
Highlights
Ankle sprains are common in sports and can sometimes result in a persistent pain condition.Purpose: Primarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes
Arthroscopy should be considered early when an athlete presents with exertion ankle pain, effusion and joint line tenderness on palpation after a previous sprain
While there are accurate clinical tests to evaluate complete ligament ruptures after sprains, associated cartilage injuries are challenging to diagnose, due to the vague nature of their symptoms as stated in the literature, [2] and are often missed [3]. In contact sports such as professional soccer and rugby, the "sprain" mechanism so often referred to can be challenged since it is often blurred in a tackle, which may well involve direct impact from the opponent's leg, shoe or studs. This has not been systematically studied, but was seen in some of the present cases, occurring during games which were filmed by Sky Sports, videos brought by the Team medics
Summary
Ankle sprains are common in sports and can sometimes result in a persistent pain condition.Purpose: Primarily to evaluate clinical symptoms, signs, diagnostics and outcomes of surgery for symptomatic chondral injuries of the talo crural joint in athletes. While there are accurate clinical tests to evaluate complete ligament ruptures after sprains, associated cartilage injuries are challenging to diagnose, due to the vague nature of their symptoms as stated in the literature, [2] and are often missed [3]. In contact sports such as professional soccer and rugby, the "sprain" mechanism so often referred to can be challenged since it is often blurred in a tackle, which may well involve direct impact from the opponent's leg, shoe or studs. To our knowledge there is no corresponding study on the ankle
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