Location of Talar Osteochondral Defects in Chronic Lateral Ankle Instability in an Asian Population

Teo, Bryon Jun Xiong; Gatot, Cheryl; Cheng, Daryl Z.C.; Koo, Kevin

doi:10.1053/j.jfas.2021.01.001

Cited by 2 publications

(3 citation statements)

References 27 publications

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“…Arthroscopic joint debridement and microfracture are indicated for the management of limited (no more than 15 mm in diameter and 8 mm in depth) OLTs [ 21 , 22 ]. OLTs are commonly encountered in CLAI patients undergoing surgery and are mostly located over the centromedial portion and the anterolateral portion of the talus [ 23 , 24 ]. It is more likely that OLTs of the medial portion of the talus are present in patients with long-standing CLAI [ 25 ] and rotational instability of the ankle [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

Feng

Chen

et al. 2022

J Orthop Surg Res

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Background The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients. Methods This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups. Conclusion In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome. Level of Evidence Level III, a retrospective comparative study.

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Section: Discussionmentioning

confidence: 99%

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

Feng

Chen

et al. 2022

J Orthop Surg Res

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“…Over the past decades, surgical and scientific attention has been focused on medially located lesions of the talar dome. However, as we are aware of the fact that 24% of the OLTs are located on the lateral talar dome and that the laterally located OLTs are associated with chronic lateral ankle instability, there is a clinical need to present surgical techniques that are amenable and effective for laterally located OLTs [ 2 , 37 , 40 , 41 , 43 ]. Moreover, it is stated that concomitant lateral ankle instability is considered a negative prognostic factor regarding the clinical outcomes of surgical treatment of OLTs [ 17 , 20 , 27 ].…”

Section: Surgical Principle and Objectivementioning

confidence: 99%

“…The technique provides a natural scaffold, good quality cells, and growth factors, facilitating replacement of the complete osteochondral unit—a triad considered to be of vital importance in the treatment of these defects. Moreover, the technique can directly and simultaneously address (chronic) lateral ankle instability, which is a common concomitant diagnosis in painful osteochondral lesions of the talus [ 2 , 37 , 40 , 41 , 43 ].…”

Section: Surgical Principle and Objectivementioning

confidence: 99%

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for lateral osteochondral lesions of the talus: operative technique

Dahmen

Rikken

Kerkhoffs

et al. 2023

Oper Orthop Traumatol

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Objective To provide a natural scaffold, good quality cells, and growth factors to facilitate replacement of the complete osteochondral unit with matching talar curvature for large osteochondral lesions of the lateral talar dome. Indications Symptomatic primary and non-primary lateral osteochondral lesions of the talus not responding to conservative treatment. The anterior–posterior or medial–lateral diameter should exceed 10 mm on computed tomography (CT) for primary lesions; for secondary lesions, there are no size limitations. Contraindications Tibiotalar osteoarthritis grade III, malignancy, active infectious ankle joint pathology, and hemophilic or other diffuse arthropathy. Surgical technique Anterolateral arthrotomy is performed after which the Anterior TaloFibular Ligament (ATFL) is disinserted from the fibula. Additional exposure is achieved by placing a Hintermann distractor subluxating the talus ventrally. Thereafter, the osteochondral lesion is excised in toto from the talar dome. The recipient site is micro-drilled in order to disrupt subchondral bone vessels. Thereafter, the autograft is harvested from the ipsilateral iliac crest with an oscillating saw, after which the graft is adjusted to an exactly fitting shape to match the extracted lateral osteochondral defect and the talar morphology as well as curvature. The graft is implanted with a press-fit technique after which the ATFL is re-inserted followed by potential augmentation with an InternalBrace™ (Arthrex, Naples, FL, USA). Postoperative management Non-weightbearing cast for 6 weeks, followed by another 6 weeks with a walking boot. After 12 weeks, a computed tomography (CT) scan is performed to assess consolidation of the inserted autograft. The patient is referred to a physiotherapist.

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Location of Talar Osteochondral Defects in Chronic Lateral Ankle Instability in an Asian Population

Cited by 2 publications

References 27 publications

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) for lateral osteochondral lesions of the talus: operative technique

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