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Arthroscopic Findings in Chronic Lateral Ankle Instability

Do Focal Chondral Lesions Influence the Results of Ligament Reconstruction?

Ryuzo Okuda, MD^*,, Mitsuo Kinoshita, MD, Junichi Morikawa, MD, Toshito Yasuda, MD and Muneaki Abe, MD

From the Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan, and the Department of Orthopedic Surgery, Ikoma General Hospital, Nara, Japan

^* Address correspondence to Ryuzo Okuda, MD, Department of Orthopedic Surgery, Osaka Medical College, 2–7 Daigaku-machi Takatsuki 569-8686, Osaka, Japan (e-mail: ort071{at}poh.osaka-med.ac.jp).

Background: There are few studies that have assessed the influence of focal chondral lesions on the results of ligament reconstruction for chronic lateral ankle instability.

Hypothesis: Focal chondral lesions do not influence the results of ligament reconstruction.

Study Design: Case series; Level of evidence, 4.

Methods: Arthroscopic examination of the ankle was performed on 30 consecutive patients immediately before ligament reconstruction using the palmaris longus tendon. Clinical assessment was performed using the Karlsson scoring scale. A radiologic assessment was performed on stress radiographs of the ankle. Preoperative anteroposterior and lateral weightbearing radiographs of the ankle did not show any joint space narrowing in any ankle. The mean duration of follow-up was 38 months.

Results: On arthroscopy, focal chondral lesions were found in 19 ankles (63%). Chondral lesions were located on the medial side of the tibial plafond in 13 ankles (43%), on the lateral side in 2 ankles (7%), on the lateral side of the talar dome in 3 ankles (10%), and on the medial side in 9 ankles (30%). Postoperative mean Karlsson scores in patients without chondral lesions and in those with chondral lesions were 99.1 and 98.4 points, respectively. Postoperative mean talar tilt angles in patients without chondral lesions and in those with chondral lesions were 5.9° and 4.7°, respectively. There were no significant differences in the clinical and radiologic results between patients with chondral lesions and those without chondral lesions.

Conclusions: Reconstruction of the lateral ligament can be successful regardless of the presence of focal chondral lesions in patients with chronic lateral ankle instability when preoperative weightbearing radiographs of the ankle do not show any joint space narrowing.

Key Words: ankle • lateral ligament • instability • arthroscopic • chondral lesion • ligament reconstruction

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