Chronic lateral ankle instability: The effect of intra-articular lesions on clinical outcome

Background: There has been no attempt to correlate the type and number of intra-articular lesions with the results of ligament reconstruction for chronic lateral ankle instability. Hypothesis: Certain intra-articular lesions affect the clinical outcome of ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Sixty-five ankles from 64 patients underwent a modified Broström operation for chronic lateral ankle instability with a mean follow-up of 28.7 months (range, 12-67). The results were assessed according to the Karlsson-Peterson Ankle Score. The type of intra-articular lesions and the association of clinical outcome were investigated using Pearson's correlation coefficient and multivariate logistic regression analysis. Results: The average Karlsson-Peterson Ankle Score was improved from 53 ± 14.63 preoperatively to 85.21 ± 11.97 at final follow-up (P <.001). Five different intra-articular lesions were described in 63 ankles (96.9%), and the ankle score negatively correlated with the number of lesions (r = -.604; P <.001). Multivariate logistic regression showed that syndesmosis widening (odds ratio, 11.1; 95% confidence interval: 2.2-55.4; P =.003), osteochondral lesions of the talus (odds ratio, 8.5; 95% confidence interval: 1.7-42.3; P =.008), and ossicles (odds ratio, 4.5; 95% confidence interval: 1.0-20.2; P =.046) are significant predictors of unsatisfactory results after ligament reconstruction. Conclusion: Arthroscopic diagnosis and treatment of intra-articular lesions associated with chronic lateral ankle instability is a safe and effective method. The presence of any combination of associated intra-articular lesions can result in a poor outcome.