Incidence of concomitant chondral/osteochondral lesions in acute ankle fractures and their effect on clinical outcome: a systematic review and meta-analysis

Abstract

Introduction Despite successful osteosynthesis, some patients report residual symptoms after ankle fractures. One of the reasons behind the postoperative complaints might be traumatic concomitant chondral lesions (CL) and/or osteochondral lesions (OCL) within the ankle joint. The study aims to systematically review the incidence of CL and/or OCL in ankle fractures and to assess their effect on the clinical outcome. Materials and methods This work was conducted according to PRISMA checklists. A systematic literature search was performed using following keywords: “Ankle Fractures” OR “Trimalleolar Fracture” OR “Bimalleolar Fracture” OR “Maisonneuve fracture” OR “Malleolus Fracture” AND “Cartilage” OR “Cartilage Diseases” OR “Cartilage, Articular” OR “chondral” up to March 2020. The identified articles were analysed to determine the incidence of CL and/or OCL. Included studies in the meta-analysis assessed possible cartilage damage through arthroscopy or MRI immediately after traumatic ankle fractures and described the postoperative clinical outcome. Results The search identified a total of 111 publications; 19 described the incidence of CL and/or OCL after ankle fractures; six met the criteria to be included in the meta-analysis: five (n = 293) diagnosed CL and/or OCL through arthroscopy during ORIF and one study (n = 153) used preoperative MRI. The clinical outcome was evaluated in four studies (n = 177) using AOFAS score and in two (n = 269) using FAOS score. The mean incidence of arthroscopically detected CL and/or OCL was 65 ± 21% [95% CI 53.9 to 76.72]. The cumulative meta-analysis sample size comprised a total of 400 Patients (170 with and 230 without CL and/or OCL) available for a mean follow-up of 23.9 ± 11.5 months [95% CI 11.79 to 36.07]. The average age was 44.3 ± 5.5 years [95% CI 38.57 to 50.13]. The meta-analysis revealed a mean AOFAS score of 91.2 ± 4.8 [95% CI 83.53 to 98.93] with versus 94.4 ± 4.7 [95% CI 86.81 to 102.07] without CL and/or OCL (p = 0.15) and a mean FAOS score of 73.2 ± 11.31 [95% CI − 28.44 to 174.85] with versus 79.0 ± 18.4 [95% CI − 86.77 to 244.87] without CL and/or OCL (p = 0.18). Conclusions CL and/or OCL appear very frequently after ankle fractures. A tendency towards a favourable short- to mid-term clinical outcome was noticed in ankle fractures without CL and/or OCL, however without reaching statistical significance. Level of evidence Level I.

Effect of infrared irradiation combined with mannitol and kinesiology tape on postoperative swelling and pain in patients with a periarticular ankle fracture

“…8 While other scholars also reported that the peak of swelling occurred 1-3 days after the operation of periarticular ankle fracture, and the swelling of the affected part would produce negative impacts on the speed of wound healing and local blood circulation of the skin, reducing the effect of fracture healing, and lowing the quality of life of patients. 9 Treatment of patients with a periarticular ankle fracture…”

Arthroscopically assisted versus open reduction internal fixation for ankle fractures: a systematic review and meta-analysis

“…Intra-articular disorders such as ligament disruptions or chondral lesions could be identified and treated in ankle fractures with arthroscopy [ 6 ]. According to a meta-analysis, chondral or osteochondral injuries were found in 65% of patients with ankle fractures [ 7 ]. For this reason, arthroscopically assisted reduction and internal fixation (ARIF) were proposed to treat ankle fractures.…”

A Multi-Disciplinary MRI Assessment May Optimize the Evaluation of Chondral Lesions in Acute Ankle Fractures: A Prospective Study

“…The reported incidence of CLs in acute ankle fractures in the literature shows a very broad range of discrepancy. A somewhat more accurate estimation of this incidence was described in a meta-analysis by Darwich et al [14], where a mean value of 58 ± 25% (17-100) was observed, based on 19 included studies [1,[9][10][11][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. The incidence, however, varies widely according to the diagnostic method.…”

“…The incidence, however, varies widely according to the diagnostic method. In the same meta-analysis [14], the mean incidence was 65 ± 21% in the 16 studies [1,10,11,15,16,[18][19][20][21][22][24][25][26][27][28][29] where arthroscopy was used as diagnostic method and decreased to 19 ± 5% (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) in the only two available studies [9,17] where magnetic resonance imaging (MRI) was the diagnostic tool. The first MRI-based study [17] included 21 prospectively examined patients and reported an incidence of CL of 33%.…”