Treatments for Osteochondral Lesions of the Ankle: A Long Term Follow Up and Retrospective Clinical and Radiographic Evaluation of Pre and Postoperative Factors Influencing Prognosis (SS-71)

Abstract

Osteochondral lesions of the ankle result from rotational injuries of the ankle in athletes. The purpose of this study is to evaluate the results of arthroscopic treatment of ankle osteochondral lesions and to define the clinical and arthroscopic factors influencing prognosis. From 1993 to 2002 a total of 108 patients underwent 132 arthroscopic procedures for diagnosis and treatment of osteochondral lesions of the ankle. The evaluations included a pre and postoperative clinical scoring, radiographic evaluation including pre and postoperative anterior- posterior, lateral and mortise view of the ankle, as well as CT and MRI of the ankle. Operative techniques included: microfructures technique (81 patients), fixation of the lesions using polylactic acid “Biofix” rods (17 patients), diagnostic arthroscopy followed by cartilage lesions shaving (16 patients), retrograde drilling of the lesion to the subchondral bone (12 patients) bone graft filling of subchondral cysts (4 patients) osteochondral autografts (OATS 2 patients). Traumatic etiology of the lesions was found to be associated with postero-medial Talar lesions (p<0.003). No correlation was found between the x-ray CT findings and arthroscopic grading. Clinical improvements where found to correlate directly with CT grading (p<0.05). Lesions with sclerosis and or cyst on x-ray or CT before operation, appeared to have less clinical improvement with surgery (p<0.05). Ankle x-rays and CT plays a limited role in planing the intra-operative procedure. Findings like sclerosis and subchondral cyst carry less favorable prognosis, which is not reflected in the current classifications. Arthroscopy is a valuable tool for evaluation and treatment of ankle osteochondral lesions. The operative technique should be selected according to arthroscopic findings and the surgeon should be prepared to tailor the different types of treatment to each lesion.