According to a new study, by midterm follow-up, there is usually no discernible clinical difference between patients treated with a single-stage approach and patients treated with a staged surgery approach for chronic lateral ankle instability with osteochondral lesions of the talus.
Ways to Approach Osteochondral Lesions and Ankle Instability
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The researchers did note, however, that patients who’d had a single-stage surgery had better clinical outcomes at the short-term follow-up.
“There is controversy about whether treatment of chronic lateral ankle instability with osteochondral lesions of the talus can be performed concurrently,” they wrote.
The study, “Outcomes of Single-Stage Versus Staged Treatment of Osteochondral Lesions in Patients With Chronic Lateral Ankle Instability: A Prospective Randomized Study,” was published online on February 4, 2022 in the Orthopaedic Journal of Sports Medicine.
The researchers wanted to understand better the midterm results of arthroscopic treatment of chronic lateral ankle instability combined with osteochondral lesions of the talus using different surgical techniques.
They hypothesized that both single-stage and staged treatment approaches would have similar outcomes.
Overall, there were 103 patients included in the study. They all underwent arthroscopic microfracture surgery and an open modified Broström-Gould procedure for ligament repair between January 2015 and December 2016.
The patients were randomly assigned to either staged group or a single-stage group. The staged group first underwent arthroscopic debridement of the osteochondral lesion of the talus and microfracture. Then after 4 to 6 months of rehabilitation, they had modified Broström-Gould ligament repair. The single-stage group had both procedures at the same time.
Final follow-up data was possible for 98 of the 103 patients—50 patients in the single-stage group and 48 patients in the staged group.
The median lesion size was 0.72 cm2 (interquartile range [IQR], 0.5-1.12 cm2) in the single-stage group and 0.84 cm2 (interquartile range [IQR], 0.7-1.05 cm2) in the staged group. At 12-month follow-up, the single-stage group had a higher median Karlsson-Peterson score (79 [IQR, 70-95] vs. 76 [IQR 65-80] for staged; p = .024) and median American Orthopaedic Foot & Ankle Society score (85 [IQR, 76-89] vs. 79.5 [IQR, 76-89] vs.79.5 [IQR, 70-87] for staged; p = .045).
At 24-month follow-up, the median difference in the Karlsson-Peterson score for single-stage versus staged surgery was 2 points (95% CI, -2 to 5 points), and the confidence interval was greater than the predefined value.
“At midterm follow-up, there was no clinical difference between single-stage versus staged surgery to treat chronic lateral ankle instability with osteochondral lesions of the talus. Single-stage surgery achieved better clinical outcomes than staged surgery at short-term follow-up,” the researchers wrote.
The study authors included Yu Wei, Xing Yun, Zhuo Zhang, M.D., Wei Qi, M.D., and Min Wei, M.D., of the Fourth Medical Center of Chinese PLA General Hospital and Jianing Song of Beijing Rehabilitation Hospital of Capital Medical University.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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