Osteochondral lesions of talus associated with ankle fractures.
BACKGROUND
Residual ankle pain and stiffness is not uncommon after ankle fractures. Proposed etiologies include ligamentous instability, joint arthrosis and osteochondral injuries. We studied the incidence of osteochondral lesions of the talus (OCLT) with various ankle fracture patterns and assessed their impact on functional outcome.


METHODS
Preoperative MRI of 153 patients with ankle fractures who underwent operative fixation was studied. Ligamentous structures around the ankle and OCLT were assessed by MRI. The OCLT was graded as follows: 0, normal; 1, hyperintense but morphologically intact cartilage; 2, fibrillations or fissures not extending into the bone; 3, cartilage flap or bone exposed; 4, loose undisplaced fragment; 5, displaced fragments. Functional outcome was assessed using Foot and Ankle Outcome Scoring (FAOS) at a minimum of 6 months. Outcome between the OCLT and non OCLT group with similar fracture pattern was compared using Fischer's exact test.


RESULTS
There were 26 (17%) associated OCLT; four grade I, five grade II, one grade III, eight grade IV, and eight grade V lesions. Three were associated with supination adduction, 21 with supination external rotation injuries and two with pronation external rotation injuries. In the OCLT and the non OCLT group, the average symptom score, pain score, activities of daily living score, sports/recreation score and quality of life score was 80, 72, 79, 45, 50 and 73, 73, 79, 60, 45, respectively. There was no statistically significant difference between the two groups (p > 0.1).


CONCLUSIONS
Osteochondral lesions were frequently associated with ankle fractures; however they had no significant impact on the functional outcome when associated with ankle fractures.
Boraiah
Sreevathsa
S
New York Medical College, Westchester Medical Center, Orthopaedics, Orthopaedic Trauma Service, 520 East 70th street, New York, NY 10021, USA. bsreevathsa@rediffmail.com
Paul
Omesh
O
Parker
Robert J
RJ
Miller
Anna N
AN
Hentel
Keith D
KD
Lorich
Dean G
DG
D000203:Activities of Daily Living; D016512:Ankle Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D002358:Cartilage, Articular / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013628:Talus / Q000000981:diagnostic imaging / Q000293:injuries*