Cartilage Lesions and the Development of Osteoarthritis After Internal Fixation of Ankle Fractures

Stutkens, Sjoerd A.; Knupp, Markus; Horisberger, Monika; Lampert, Christoph; Hintermann, Beat
February 2010
Journal of Bone & Joint Surgery, American Volume;Feb2010, Vol. 92-A Issue 2, p279
Academic Journal
Background: The role of the location and severity of the initial cartilage lesions associated with an ankle fracture in the development of posttraumatic osteoarthritis has not been established, to our knowledge. Methods: We performed a long-term follow-up study of a consecutive, prospectively included cohort of 288 ankle fractures that were treated operatively between June 1993 and November 1997. Arthroscopy had been performed in all cases in order to classify the extent and location of cartilage damage. One hundred and nine patients (47%) were available for follow-up after a mean of 12.9 years. The main outcome parameters were the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score for clinical evaluation and a modified Kannus osteoarthritis score for radiographic assessment of the development of posttraumatic osteoarthritis. Results: Cartilage damage anywhere in the anklejointwas associated with a suboptimal clinical outcome (odds ratio, 5.0 [95% confidence interval = 1.3 to 20.1]; p = 0.02) and with a suboptimal radiographic outcome (odds ratio = 3.4 [95% confidence interval = 1.0 to 11.2]; p = 0.04). An association was also found between the development of clinical signs of osteoarthritis and a deep lesion (>50% of the cartilage thickness) on the anterior aspect of the talus (odds ratio = 12.3 [95% confidence interval = 1.4 to 108.0]; p = 0.02) and a deep lesion on the lateral aspect of the talus (odds ratio = 5.4 [95% confidence interval = 1.2 to 23.5]; p = 0.02). A deep lesion on the medial malleolus was associated with the development of clinical signs of osteoarthritis (odds ratio = 5.2 [95% confidence interval = 1.9 to 14.6]; p <0.01) and radiographic signs of osteoarthritis (odds ratio = 2.9 [95% confidence interval = 1.1 to 7.9]; p = 0.03) of osteoarthritis. There was no significant correlation between cartilage lesions on the fibula and the long-term outcome. Conclusions: Our findings show that initial cartilage damage seen arthroscopically following an ankle fracture is an independent predictor of the development of posttraumatic osteoarthritis. Specifically, lesions on the anterior and lateral aspects of the talus and on the medial malleolus correlate with an unfavorable clinical outcome.


Related Articles

  • Artroscopía de tobillo: Análisis de indicaciones y resultados. Serie de 17 casos consecutivos. Cedeño, Mónica Álvarez; Rojas, Carlos Juárez; Parra, Mónica León; Cázares, René Ochoa // Acta Ortopedica Mexicana;nov/dic2003, Vol. 17 Issue 6, p265 

    We studied 17 consecutive ankle arthroscopies with a follow up of 3 to 60 months, and evaluated indications and results of the procedure. All the arthroscopies were performed by several orthopedic surgeons. All of the arthroscopies were made with no skeletal traction. The functional tests before...

  • Distribution and Progression of Chondrocyte Damage in a Whole-Organ Model of Human Ankle Intra-Articular Fracture. Tochigi, Yuki; Buckwalter, Joseph A.; Martin, James A.; Hillis, Stephen L.; Peng Zhang; Vaseenon, Tanawat; Lehman, Abigail D.; Brown, Thomas D. // Journal of Bone & Joint Surgery, American Volume;3/16/2011, Vol. 93-A Issue 6, p533 

    Background: Despite the best current treatments, intra-articular fractures commonly cause posttraumatic osteoarthritis. In this disorder, death and dysfunction of chondrocytes associated with acute cartilage injury presumably plays an important role in triggering the pathomechanical cascade that...

  • Arthroscopic findings of Kienböck's disease. Tatebe, Masahiro; Hirata, Hitoshi; Shinohara, Takaaki; Yamamoto, Michiro; Okui, Nobuyuki; Kurimoto, Shigeru; Imaeda, Toshihiko // Journal of Orthopaedic Science;Nov2011, Vol. 16 Issue 6, p745 

    Purpose: Kienböck's disease affects the lunate bone, and osteoarthritic changes progress as the disease advances; however, relatively few studies have reported the arthroscopic findings of Kienböck's disease, and these reports have been in small populations. The purpose of this study was...

  • Implantation of rAAV5-IGF-I Transduced Autologous Chondrocytes Improves Cartilage Repair in Full-thickness Defects in the Equine Model. Ortved, Kyla F; Begum, Laila; Nixon, Alan J; Mohammed, Hussni O // Molecular Therapy;Feb2015, Vol. 23 Issue 2, p363 

    Cartilage injury often precipitates osteoarthritis which has driven research to bolster repair in cartilage impact damage. Autologous chondrocytes transduced with rAAV5-IGF-I were evaluated in chondral defects in a well-established large animal model. Cartilage was harvested from the talus of 24...

  • Articular cartilage: structure, injuries and review of management. Abhijit M. Bhosale; James B. Richardson // British Medical Bulletin;Sep2008, Vol. 87 Issue 1, p77 

    : Introduction Chondral and osteochondral injuries are commonly seen in todays clinical practice. Articular cartilage provides an ultimate low-friction gliding surface, which none of the artificial constructs have been able to replace successfully. Retrospective review of the knee arthroscopies...

  • Browser's notes.  // Skeletal Radiology;Dec2010, Vol. 39 Issue 12, p1263 

    No abstract available.

  • The High Variability in Sizing Knee Cartilage Defects. Siston, Robert A.; Geier, David; Bishop, Julie Y.; Jones, Grant L.; Kaeding, Christopher C.; Granger, Jeffery F.; Skaife, Tyler; May, Megan; Flanigan, David C. // Journal of Bone & Joint Surgery, American Volume;1/2/2013, Vol. 95-A Issue 1, p70 

    Background: Articular cartilage defects of the knee are commonly encountered during arthroscopic examination and are believed to be a precursor to osteoarthritis. While a variety of surgical treatments exist, the defect size, specifically the cross-sectional area, has historically been used as a...

  • down to the bone. Alper, Joe // Health (Time Inc. Health);Nov/Dec2000, Vol. 14 Issue 9, p60 

    Provides information on the use of carticel for the treatment of torn or mangled cartilage. Information on osteoarthritis; Remedies for mild and advance cases of mangled cartilage; Surgeries involved in carticel treatment.

  • Modern Operative Treatment of Malleolar Fractures and Associated Consequences (Review). Gorbatov, R. O.; Pavlov, D. V.; Malyshev, E. E. // Medical Technologies in Medicine / Sovremennye Tehnologii v Medi;2015, Vol. 7 Issue 2, p153 

    The review covers the current state of the problem of operative treatment of malleolar fractures and the associated consequences. Various methods used in osteosynthesis of the malleolus were analyzed. The main criteria of the favorable arrangement of the fractured bone fragments for malleolus...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics