Original Article With Video Illustration
Cartilage Lesions in Anterior Bony Impingement of the Ankle

https://doi.org/10.1016/j.arthro.2009.11.021Get rights and content

Purpose

The aim of this study was to investigate the correlations between spur severity, clinical characteristics, and articular cartilage lesions in patients with anterior bony impingement.

Methods

The study included 57 ankles in 57 patients (48 male and 9 female patients; age range, 15 to 59 years) who had undergone a spur resection for anterior impingement. We excluded spurs in patients with osteoarthritis with joint space narrowing. Spur severity was classified by use of the McDermott scale. The correlations between spur severity, clinical characteristics, and articular cartilage lesions were evaluated. Differences in the mean lengths of the tibial spurs were examined according to the presence or absence of tram-track lesions, spur fragmentation, and loose bodies.

Results

The duration of pain, degree of sports activity, and presence of mechanical instability showed no relation to spur severity. Of the ankles, 28 (49.1%) were grade 1, 1 (1.8%) was grade 2, and 28 (49.1%) were grade 3. Cartilage lesions were present in 46 ankles (80.7%). Spur severity was correlated with the degree of cartilage lesions (Spearman ρ = 0.30, P = .02). Grade 3 ankles had more spur fragmentation than grade 1 or 2 ankles. The mean length of the tibial spurs with tram-track lesions or spur fragmentation was longer than that without these lesions.

Conclusions

The results suggest that cartilage lesions are present even in ankles with small spurs and that the degree of cartilage lesions increases as spurs become larger.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

The data from a clinical database were evaluated for 351 consecutive patients (364 ankles) who had undergone an arthroscopic examination for chronic ankle pain between January 2004 and January 2009. We excluded patients who had spurs with joint space narrowing, because articular cartilage lesions were obvious in these cases. Patients were also excluded if their spurs were associated with cartilage changes, including an osteochondral lesion of the talus (OCL), inflammatory arthropathy, and

Results

The relation between the McDermott scale and clinical characteristics is shown in Table 1. The duration of pain, degree of sports activity, and presence of instability showed no relation to spur severity. According to the McDermott scale, 28 ankles (49.1%) were grade 1, 1 (1.8%) was grade 2, and 28 (49.1%) were grade 3. Cartilage lesions were present in 46 ankles (80.7%); these were mainly located in the anterior half of the talar dome, corresponding to the mediolateral location of the tibial

Discussion

It has been suggested that anterior spurs of the ankle are associated with cartilage lesions.7, 9, 10 Although arthroscopic findings for ABI have been documented, there is no report regarding the correlation of spur severity with the degree of cartilage lesions in ABI.

We used plain lateral and mortise radiographs to assess spur severity,7, 14, 16 because talar spurs are often not visualized on lateral radiographs. Although 3-dimensional CT has proved to be an excellent tool to clarify the shape

Conclusions

The results of this study suggest that cartilage lesions are present even in ankles with small spurs and that the degree of cartilage lesions increases as spurs become larger.

References (20)

There are more references available in the full text version of this article.

The authors report no conflict of interest.

Note: To access the video accompanying this report, visit the July issue of Arthroscopy at www.arthroscopyjournal.org.

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