Pilot study to evaluate the relationship between type, location and depth of osteochondral lesions of the talus and...

Ankle sprains are a common musculoskeletal injury, with 10-30% of cases potentially progressing to chronic lateral ankle instability. In this context, a higher prevalence of talar osteochondral lesions (TOLs) has been observed. This study aims to confirm the association between chronic lateral ankle instability and TOLs, while also evaluating lesion location, severity, and morphology based on the Raikin, ICRS, and Hepple classifications.

A multicenter, cross-sectional, observational study was conducted in 7 Spanish hospitals. Patients with MRI-confirmed TOLs were included and subsequently evaluated arthroscopically. Clinical, morphological, and topographic variables were collected. The integrity of the anterior talofibular ligament (ATFL) was assessed through arthroscopy and clinical testing to determine the presence of chronic lateral ankle instability. Lesions were classified using the Hepple, Raikin, and ICRS systems.

Among the 42 patients with TOLs, those with recurrent ankle sprains, positive anterior drawer test, and positive talar tilt test showed significantly more severe lesions (p<0.05). Although ATFL rupture was more frequent in patients with severe lesions, this finding did not reach statistical significance. As a secondary finding, medial osteochondral involvement was more common in female patients (p=0.006), and patients without ATFL rupture exhibited a significantly larger chondral surface area affected (p<0.05).

This study demonstrates a statistically significant association between chronic lateral ankle instability and TOL severity, particularly in patients with recurrent sprains and positive clinical tests. Interestingly, greater chondral surface involvement was found in patients without ATFL rupture. A higher frequency of medial lesions was observed in women, though no clear correlation with lesion severity was identified.