Concomitant osteochondral lesion of the talus in ankle instability: Utilizing clinical presentation to guide imaging decision

Low ankle sprains are a prevalent issue, often involving the anterior talofibular ligament. While there is increased attention placed on ligamentous injuries in ankle sprains, concomitant cartilaginous injuries are frequently overlooked. This article aims to [1] evaluate the significance of magnetic resonance imaging in anterior talofibular ligament injuries to detect concurrent osteochondral lesions of the talus as well as other associated ligamentous injuries; [2] determine the importance of clinical presentation and its association with the risk of concomitant osteochondral lesions in anterior talofibular ligament injuries. We conducted a retrospective analysis of 129 patients who underwent anterior talofibular ligament reconstruction, reviewing patient data to assess the incidence of osteochondral lesions of the talus and associated ligamentous injuries. Clinical presentations were then reviewed to identify signs and symptoms associated with the occurrence of osteochondral lesions of the talus. The results indicated that calcaneofibular ligament was most injured in association with anterior talofibular ligament injuries (69.52%; n=73). Furthermore. 31.78% (n=41) of patients with anterior talofibular ligament injuries had concurrent osteochondral lesion of the talus. Analysis on clinical presentation revealed statistical significance (p<.001) between patients that had ankle joint line tenderness lasting for more than 6 weeks and the occurrence of osteochondral lesions of the talus. This study concludes that magnetic resonance imaging could be beneficial in anterior talofibular ligament injuries with patients exhibiting persistent joint line tenderness to evaluate for osteochondral lesions to ensure a comprehensive pre-operative assessment.