Risk Factors for Osteochondral Lesions and Osteophytes in Chronic Lateral Ankle Instability: A Case Series of 1169 Patients

SLR - February 2021 - Laura B. Adler

Reference: Wang DY, Jiao C, Ao YF, Yu JK, Guo QW, Xie X, Chen LX, Zhao F, Pi YB, Li N, Hu YL, Jiang D. Risk Factors for Osteochondral Lesions and Osteophytes in Chronic Lateral Ankle Instability: A Case Series of 1169 Patients. Orthop J Sports Med. 2020 May 26;8(5):2325967120922821. doi: 10.1177/2325967120922821. PMID:32518802; PMCID: PMC7252382.

Level of Evidence: III 

Scientific Literature Review 

Reviewed By: Laura B. Adler, DPM
Residency Program: Presbyterian St. Luke’s Hospital – Denver, CO

Podiatric Relevance: Ankle sprain is a very common injury with the potential of developing into chronic lateral ankle instability in up to 40 percent of those affected. Over time, these patients’ symptoms may worsen as secondary lesions develop including osteochondral lesions (OCLs), loose bodies, and osteophytes, leading to osteoarthritis of the ankle joint. Secondary lesions are associated with worse outcomes following surgery in comparison with patients without these. This study aimed to assess risk factors for development of OCLs and osteophytes in patients with chronic lateral ankle instability (CLAI). The authors hypothesized that the risk of developing secondary lesions increased with increasing time post injury.

Methods: This is a case-control study performed on patients diagnosed with CLAI at one institution from June 2007 to May 2018. Inclusion criteria included those with available surgical records, history of at least one serious ankle sprain, ankle instability > six months, feeling of instability and/or recurrent sprain, and injury of the lateral ankle ligaments (ATFL and/or CFL). Patients were excluded if they had a history of fracture requiring surgery or surgery in either lower extremity, acute injury to the other distal extremity within three months and other neuromuscular diseases affecting lower extremities. One thousand one hundred sixty-nine patients were included. Osteochondral lesions and osteophytes were evaluated using arthroscopy. Univariate and multivariate regression analyses were done to assess for any association between age, sex, post injury duration, body mass index (BMI) and ligaments injured with the development of OCLs and osteophytes.

Results: Four hundred thirty-six (37percent) patients had OCLs. Univariate analysis demonstrated several factors significantly associated with OCLs including; male sex, older age, overweight or obese (BMI 23 to <25 or >25 kg/m2 ), and post injury duration greater than or equal to two years. Multivariate analysis identified male sex and older age as risk factors for OCLs. ATFL and CFL injuries were associated with lateral OCLs. Osteophytes were found in 334 (31 percent) patients. Univariate analysis identified risk factors for osteophytes as male sex, older age, overweight or obese, post injury duration greater than or equal to two years, and both ATFL and CFL injuries. Multivariate analysis similarly identified male sex, and older age as risk factors for osteophytes in addition to post injury duration great than five years and CFL injury. OCLs were significantly associated with the presence of osteophytes (P <.001).

Conclusions: This study helped identify patient risk factors for developing OCLs and osteophytes in patients with CLAI. Male sex, older age, obesity, longer post injury duration and ATFL and CFL injuries were identified. Lateral OCLs were associated with ATFL and CFL injuries and the presence of osteophytes was associated with CFL injury. This study highlights risk factors for secondary lesions which may progress to end-stage arthritis. This paper may help guide treatment in patients following injury as it suggests that those with the identifiable risk factors should be followed closely. These results also serve as a tool to further educate our patients with CLAI.