title: Clinical characteristics of early-stage osteonecrosis of the ankle and treatment outcomes.
abstract: BACKGROUND
  The purposes of this study were to describe the clinical manifestations of osteonecrosis involving the distal tibia and talus, to identify risk factors associated with the disease, and to evaluate the efficacy of percutaneous drilling for the treatment of ankles with early-stage symptomatic osteonecrosis.
  
  
  METHODS
  One hundred and one ankles in seventy-three patients with symptomatic osteonecrosis of the talus and/or distal tibia treated with percutaneous drilling were identified. There were eighty-one ankles in fifty-nine patients treated only at our institution and twenty ankles in fourteen patients with a failed prior core decompression at outside institutions. The parameters evaluated included demographics, disease characteristics, clinical outcomes including the American Orthopaedic Foot & Ankle Society score, Short-Form-36 scores, University of California Los Angeles activity scores, and visual analog scale pain scores, and radiographic outcomes at a mean follow-up duration of five years (range, two to nine years).
  
  
  RESULTS
  Eighty-five ankles had isolated talus osteonecrosis, eleven ankles had involvement of the distal tibia and talus, and five ankles had isolated distal tibial disease. Twenty-nine patients (40%) had initially presented with symptomatic osteonecrosis of another joint, most commonly the knee (37%), the hip (29%), and the shoulder (25%). The most common identifiable risk factors included chronic corticosteroid use (49.3%), alcohol abuse (35.6%), tobacco use (29%), and hypertension (20.5%). Overall, 83% of ankles did not demonstrate further disease progression after the procedure. There were significant improvements (p < 0.05) in clinical and patient-reported outcomes after surgical treatment. The presence of human immunodeficiency virus and sickle cell disease was associated with a higher odds ratio of disease progression to joint collapse.
  
  
  CONCLUSIONS
  Osteonecrosis of the distal tibia and talus was usually part of multifocal disease, and concurrent knee osteonecrosis was more common than hip osteonecrosis. The results of the present study suggest that early-stage ankle osteonecrosis can be treated successfully with percutaneous drilling.
authors.affiliation: Seton Hall University, School of Health and Medical Sciences, 400 South Orange Avenue, South Orange Village, NJ 07079.
authors.forename: Kimona
authors.initials: K
authors.lastname: Issa
authors.affiliation: SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation, 450 Clarkson Avenue, Box 30, Brooklyn, NY 11203.
authors.forename: Qais
authors.initials: Q
authors.lastname: Naziri
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont: mmont@lifebridgehealth.org; rhondamont@aol.com.
authors.forename: Bhaveen H
authors.initials: BH
authors.lastname: Kapadia
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont: mmont@lifebridgehealth.org; rhondamont@aol.com.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Lamm
authors.affiliation: The Johns Hopkins Medical Institution, 733 North Broadway, Baltimore, MD 21287.
authors.forename: Lynne C
authors.initials: LC
authors.lastname: Jones
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD 21215. E-mail address for M.A. Mont: mmont@lifebridgehealth.org; rhondamont@aol.com.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000843:Ankle Joint / Q000601:surgery; D001858:Bone Nails; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000473:pathology / Q000601:surgery*; D011182:Postoperative Care; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D013628:Talus / Q000473:pathology / Q000601:surgery*; D013977:Tibia / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult