Concomitant chronic lateral ankle instability affects postoperative functional outcomes in patients with osteochondral lesions of the talus, but does not affect cartilage repair after restoration of ankle stability

Jiayao Zhang; Wufeng Cai; Xiumei Zhao; Yiyuan Sun; Yiteng Zhang; Wenjing Ma; Jian Li; Chenghao Zhang; Qi Li

doi:10.1016/j.arthro.2024.12.025

Concomitant chronic lateral ankle instability affects postoperative functional outcomes in patients with osteochondral lesions of the talus, but does not affect cartilage repair after restoration of ankle stability

Arthroscopy. 2024 Dec 26:S0749-8063(24)01089-2. doi: 10.1016/j.arthro.2024.12.025. Online ahead of print.

Authors

Jiayao Zhang¹, Wufeng Cai¹, Xiumei Zhao², Yiyuan Sun³, Yiteng Zhang⁴, Wenjing Ma¹, Jian Li¹, Chenghao Zhang¹, Qi Li⁵

Affiliations

¹ Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China.
² Operating Room, Department of Anesthesiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University.
³ Day Surgery Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
⁴ Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
⁵ Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, China; Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China. Electronic address: liqi_sports@scu.edu.cn.

PMID: 39732209
DOI: 10.1016/j.arthro.2024.12.025

Abstract

Purpose: To investigate the effect of concomitant chronic lateral ankle instability (CLAI) on postoperative clinical outcomes in patients with osteochondral lesions of the talus (OLTs).

Methods: Patients who underwent surgery for OLTs between January 2018 and May 2022 were retrospectively evaluated. OLT procedures involved debridement, microfracture, or bone grafting, while concomitant CLAI underwent lateral ligament repair or reconstruction. Functional assessments included the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), and Tegner Score, with a minimum follow-up of 24 months. Cartilage repair was evaluated using the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores based on postoperative MRI. Additionally, multiple linear regression analysis was performed to explore the effects of potential factors, and Spearman correlation coefficients (r_s) were calculated to assess the relationship between these factors and outcome scores.

Results: A total of 85 patients were included, with 39 in OLT group and 46 in OLT with CLAI group. The mean follow-up times were 46.95±17.00 months (range, 24-76 months) and 41.80±15.10 months (range, 24-76 months), respectively (P=0.347). Compared to OLT group, OLT with CLAI group showed lower postoperative AOFAS and FAOS scores, with a significantly smaller overall improvement in AOFAS scores (p<0.05). There was no significant difference between the groups in the number of patients achieving the minimal clinically important difference (MCID) in functional scores. Multiple linear regression analysis showed that CLAI surgery negatively affected postoperative AOFAS and FAOS scores (std β=-0.344, p=0.001; std β=-0.332, p=0.001), with Spearman analysis indicating a moderate correlation (r_s=-0.442, p<0.001; r_s=-0.339, p=0.002). There were no significant differences observed between groups in terms of MOCART 1 or MOCART 2.0 scores (MOCART 1.0, 61.52±12.38 vs. 65.89±14.47; MOCART 2.0, 68.70±16.53 vs. 73.75±14.76; P>0.05), and multiple linear regression as well as Spearman analysis did not yield positive results.

Conclusion: Concomitant CLAI had lower postoperative functional outcomes in OLT patients, but no impact on cartilage repair was observed after restoration of ankle stability.

Level of evidence: Retrospective comparative study; Level of evidence, III.

Keywords: ankle; chronic lateral ankle instability; functional outcome; osteochondral lesions of the talus; surgery.