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

Ding-Yu Wang; Chen Jiao; Ying-Fang Ao; Jia-Kuo Yu; Qin-Wei Guo; Xing Xie; Lin-Xin Chen; Feng Zhao; Yan-Bin Pi; Nan Li; Yue-Lin Hu; Dong Jiang

doi:10.1177/2325967120922821

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. eCollection 2020 May.

Authors

Ding-Yu Wang¹, Chen Jiao¹, Ying-Fang Ao¹, Jia-Kuo Yu¹, Qin-Wei Guo¹, Xing Xie¹, Lin-Xin Chen¹, Feng Zhao¹, Yan-Bin Pi¹, Nan Li², Yue-Lin Hu¹, Dong Jiang¹

Affiliations

¹ Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, China.
² Research Center of Clinical Epidemiology, Peking University Third Hospital, Haidian, Beijing, China.

Abstract

Background: Osteochondral lesions (OCLs) and bony impingement are common secondary lesions of chronic lateral ankle instability (CLAI), but the risk factors that predict OCLs and bony impingement are unknown.

Purpose: To analyze the risk factors for the development of OCLs and osteophytes in patients with CLAI.

Study design: Case-control study; Level of evidence, 3.

Methods: Patients diagnosed with CLAI at our institution from June 2007 to May 2018 were enrolled. The assessed potential risk factors were age, sex, postinjury duration, body mass index, injury side, and ligament injury type (isolated anterior talofibular ligament [ATFL] injury, isolated calcaneofibular ligament [CFL] injury, or concomitant ATFL and CFL injuries). Univariate and multivariate logistic regression analyses were performed to evaluate the association between these factors and the presence of OCLs and osteophytes.

Results: A total of 1169 patients with CLAI were included; 436 patients (37%) had OCLs and 334 (31%) had osteophytes. The presence of OCLs was significantly associated with the presence of osteophytes (P < .001). Male sex and older age were significantly associated with the presence of OCLs in the medial and lateral talus. A postinjury duration of 5 years or longer was significantly associated with the presence of OCLs in the medial talus (odds ratio [OR], 1.532; 95% CI, 1.023-2.293; P = .038) but not in the lateral talus. ATFL and CFL injuries were both significantly associated with the presence of lateral OCLs. Risk factors for the presence of osteophytes were male sex, older age, postinjury duration 5 years or longer, and CFL injury. Patients with concomitant ATFL and CFL injuries were significantly more likely to have osteophytes than were patients with single-ligament injuries (P = .018).

Conclusion: Risk factors for OCLs and osteophytes were postinjury duration of 5 years or longer, older age, and male sex. ATFL injury was associated with the presence of lateral OCLs, whereas CFL injury was associated with the presence of lateral OCLs and osteophytes. Patients with these risk factors should be closely monitored and treated to reduce the incidence of ankle arthritis.

Keywords: chronic lateral ankle instability; osteochondral lesion; osteophytes; postinjury duration; risk factors.