Associated Injuries Found in Chronic Lateral Ankle Instability

Abstract

Sixty-one patients underwent a primary ankle lateral ligament reconstruction for chronic instability between 1989 and 1996. In addition to the ligament reconstruction, all patients had evaluation of the peroneal retinaculum, peroneal tendon inspection by routine opening of the tendon sheath, and ankle joint inspection by arthrotomy. A retrospective review of the clinical history, physical exam, MRI examination, and intraoperative findings was conducted on these 61 patients. The purpose was to determine the type and frequency of associated injuries found at surgery and during the preoperative evaluation. At surgery no patients were found to have isolated lateral ligament injury. Fifteen different associated injuries were noted. The injuries found most often by direct inspection included: peroneal tenosynovitis, 47/61 patients (77%); anterolateral impingement lesion, 41/61 (67%); attenuated peroneal retinaculum, 33/61 (54%); and ankle synovitis, 30/61 (49%). Other less common but significant associated injuries included: intra-articular loose body, 16/61 (26%); peroneus brevis tear, 15/61 (25%); talus osteochondral lesion, 14/61 (23%); medial ankle tendon tenosynovitis, 3/61 (5%). The findings of this study indicate there is a high frequency of associated injuries in patients with chronic lateral ankle instability. Peroneal tendon and retinacular pathology, as well as anterolateral impingement lesions, occur most often. A high index of suspicion for possible associated injuries may result in more consistent outcomes with nonoperative and operative treatment of patients with chronic lateral ankle instability.

Is MRI Adequate to Detect Lesions in Patients with Ankle Instability?

“…The low detection rate for chondral lesions was similar to that found previously with preoperative MRI in a study of athletes with symptomatic ankle lesions, where chondral lesions were detected in five of 26 patients (19%). Other investigators have reported a higher detection rate of chondral lesions on preoperative MRI, with 11 of 14 (79%) chondral lesions observed [2]. However, in that study, ankle exploration was performed without arthroscopy through an anterolateral incision.…”

“…A specialized musculoskeletal radiologist may have access to various imaging sequences and may have an extensive background in reading images of musculoskeletal tissue. The high MRI detection accuracy rate in a previous study may be partly attributable to the fact that 60% of the MRIs in that study were performed at the host institution with access to a musculoskeletal radiologist [2].…”

“…Chondral lesions, peroneal tears, and other disorders occur relatively frequently in patients with chronic ankle instability [2,7,9,20]. These associated lesions may be an important potential cause of long-term problems [7,10,15,19,24], and appropriate treatment depends on accurate diagnosis.…”

“…Although many patients are successfully treated nonoperatively, residual problems may occur [4,8]. Twenty to 40% of patients with chronic instability have associated disorders, such as chondral lesions of the talus, peroneal tears, or loose bodies [2,3,7]. These lesions may contribute to morbidity after an ankle sprain [7,10,19,24].…”

“…One way to identify concomitant disorders is to obtain preoperative MRI. A previous report noted MRI accuracy of 80% in detecting talus osteochondral lesions and peroneal brevis tendon tears [2], but another study reported MRI detected cartilage lesions in only five of 26 (19%) patients with lesions confirmed at surgery [18]. Often patients arrive for surgical consultation with MR images obtained and read at outside institutions, which may add additional variability to the scenario.…”