Treatment of the Unstable Ankle with an Osteochondral Lesion

Abstract

Background Few reports have studied the treatment of osteochondral lesions of the talus (OLTs) in the setting of lateral ankle instability. Hypothesis Arthroscopic treatment of an OLT and lateral ankle stabilization in the same sitting is safe and leads to reliable improvement of symptoms. Study Design Case series; Level of evidence, 4. Methods Of 37 patients who underwent concomitant treatment of an OLT and lateral ankle stabilization, 31 (84%) were evaluated at a mean of 7.3 years postoperatively. Patients were evaluated by physical examination, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, the modified Weber Scale, the Single Assessment Numeric Evaluation, the Berndt and Harty Scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Results The average postoperative ankle-hindfoot score was 89, the mean modified Weber score was 85, and the mean Single Assessment Numeric Evaluation was 86. In sum, 74% of patients had a good result on the Berndt and Harty Scale, 23% had a fair result, and 3% had a poor result. Of the short-form survey, the mean physical function score was 86.5, and the mean summary physical component score was 52.3. For the 13 patients for whom prospective ankle-hindfoot scores were available, a statistically significant improvement was seen, from 75 points preoperatively to 91 points postoperatively (P < .001). Conclusion Simultaneous arthroscopic treatment of an OLT and open lateral ankle stabilization is a safe and effective procedure. The presence of an osteochondral lesion had a negative effect on the overall result when compared to that of patients who underwent lateral ankle stabilization as an isolated procedure.