Osteochondral Pathology

Guhl, James F.; Parisien, J. Serge

doi:10.1007/0-387-21546-8_7

Cited by 8 publications

(10 citation statements)

References 6 publications

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“…Our prospective study demonstrates a similar high percentage of good, and excellent results (91%) with only two patients having a fair result. Guhl [6] believed that the term meniscoid should be abandoned, and synovial impingement lesion should be used instead because of the synovitis, and fibrosis, but in our patients we had four patients with a meniscoid like lesion on the anterolateral aspect of the ankle, and the patients were relieved after excision, and debridement of the lesion.…”

Section: Discussionmentioning

confidence: 99%

“…The anterolateral talar dome extrudes anteriorly with dorsiflexion resulting in impingement. The differential diagnosis of chronic ankle pain, and the other conditions causing pain at the anterolateral region of the ankle should be ruled out [5][6][7]. Arthroscopy of the ankle joint is a useful method for confirming the diagnosis of the anterolateral impingement of the ankle, and for treatment of patients who do not respond to conservative measures [8].…”

Section: Introductionmentioning

confidence: 99%

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Treatment of anterolateral impingements of the ankle joint by arthroscopy

Hassan

2007

Knee Surg Sports Traumatol Arthr

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Impingement syndromes of the ankle joint are among the most common intraarticular ankle lesions. Soft tissue impingement lesions of the ankle usually occur as a result of synovial, or capsular irritation secondary to traumatic injuries, usually ankle sprains, leading to chronic ankle pain. The aim of this prospective study was to evaluate arthroscopic debridement of an anterolateral soft tissue impingement of the ankle. During the period between October 2000 and February 2004, 23 patients with residual complaints after an ankle sprain were diagnosed as anterolateral impingement of the ankle, and were treated by arthroscopic debridement. At a minimum of 6 months follow up, patients were asked to complete an American orthopaedic foot and ankle society (AOFAS) ankle and hind foot score. The average follow-up was 25 months (range 12-38). The average pre-operative patient assessed AOFAS score was 34 (range 4-57). At the end of follow-up the mean AOFAS score was 89 (range 60-100). In terms of patient satisfaction 22 patients said they would accept the same arthroscopic procedure again for the same complaints. At the end of follow-up, 7 patients had excellent results, and 14 patients had good results while two patients had fair results. We believe that arthroscopic debridement of the anterolateral impingement soft tissues are a good, and effective method of treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of anterolateral impingements of the ankle joint by arthroscopy

Hassan

2007

Knee Surg Sports Traumatol Arthr

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“…However, if the incidence of ankle sprains approaches 27000 per day, why then do only a few patients suffer chronically? Guhl believes that synovial impingement emanates from the synovial recess located above the lateral talomalleolar joint in the distal tibiofibular joint [18]. Shonholtz [44] described a meniscold structure consisting of torn and fibrosed fibres of the capsule and ligaments, as well as chronic synovial tissue.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic treatment of antirior synovitis of the ankle in athletes

Jerosch

Steinbeck

Schröder

et al. 1994

Knee Surg, Sports traumatol, Arthroscopy

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In a retrospective study we analysed the results of arthroscopic treatment of anterior synovitis of the ankle in 35 athletes. Five athletes additionally suffered from anterior osteophytes, and three presented with an anterolateral plica. Their average age was 25 years (SD 8.3), and the follow-up interval was 32.4 months (SD 19.4). Eight patients suffered from additional hyperlaxity of the ankle joint. At the time of follow-up, the patients were examined clinically as well as radiologically. The results were scored according to an ankle index containing the criteria pain, function, athletic activity, walking aids, range of motion and swelling. During surgery a partial synovectomy was performed and removal of anterior osteophytes or anterolateral plica as necessary. The overall score increased non-significantly from 66.2 preoperatively to 78.7 postoperatively (P > 0.05). Comparing the different criteria, the score parameter pain significantly increased after arthroscopy. All other parameters (function, athletic activity, walking aids, range of motion, swelling) showed only slight changes in this patient group. Athletes with a hypermobile joint showed worse results compared with the others. Even after surgery we documented severe restriction concerning athletic activity. Only 9 patients performed their activities at their previous level, 19 had reduced their activity level, and 7 had discontinued their athletic activity. In 6 cases we found temporary iatrogenic neurological damage. Regarding the uncertain clinical outcome and the documented high risk for neurovascular complication, patient selection for arthroscopic partial synovectomy in the athletic population should be extremely carefully performed.(ABSTRACT TRUNCATED AT 250 WORDS)

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“…The limited number of patients is due to the fact that this approach requires adopting highly selective indications as criteria for patient selection. Osteochondral talar dome lesions are strictly related to soft tissue pathology, and they may coexist because of the mechanism of injury [16,28]. Arthroscopic microfracturing itself could be insufficient for the treatment of sportsrelated OCLs of the ankle since usually the presence of cartilage damage implies concomitant involvement of the lateral ligament complex.…”

Section: Discussionmentioning

confidence: 99%

Treatment of post-traumatic osteochondral lesions of the talus: a four-step approach

Ventura

Terzaghi

Legnani

et al. 2012

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this retrospective study was to assess the treatment of post-traumatic osteochondral lesions (OCLs) of the ankle with a four-step protocol.MethodsThirty-eight patients with at least one MRI-documented OCL of the ankle were treated from 2004 to 2010. Median age at surgery was 39 years (range: 18–52). Mean lesion size was 1.0 cm2 (SD: 0.2). All patients underwent a four-step surgical procedure including synovectomy, debridement and microfractures of the OCL, capsular shrinkage, and bracing and non-weightbearing for 21 days. Clinical assessment included objective examination, the AOFAS ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and Sefton articular stability scale. MRI scans were taken 18 months after surgery in all patients.ResultsFollow-up examination at an average of 4 years (SD: 1.1) after surgery showed significant improvement of all variables compared to pre-operative values (P < 0.05). Most patients rated their outcome as good/excellent. MRI scans taken 18 months after surgery documented completely repaired lesion in 27 ankles, slight bone marrow oedema with partially repaired defect in 9 patients, and visible defect in 2 ankles.ConclusionBased on the present results, we propose a comprehensive four-step protocol as a safe and clinically effective treatment option in patients with post-traumatic OCLs of the ankle.Level of evidenceRetrospective case series, Level IV.

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Osteochondral Pathology

Cited by 8 publications

References 6 publications

Treatment of anterolateral impingements of the ankle joint by arthroscopy

Treatment of anterolateral impingements of the ankle joint by arthroscopy

Arthroscopic treatment of antirior synovitis of the ankle in athletes

Treatment of post-traumatic osteochondral lesions of the talus: a four-step approach

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