Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2021; 12(9): 710-719
Published online Sep 18, 2021. doi: 10.5312/wjo.v12.i9.710
Correlation of stress radiographs to injuries associated with lateral ankle instability
Joshua W Sy, Andrew J Lopez, Gregory E Lausé, J Banks Deal, Michael B Lustik, Paul M Ryan
Joshua W Sy, Andrew J Lopez, Gregory E Lausé, J Banks Deal, Paul M Ryan, Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, HI 96859, United States
Michael B Lustik, Department of Statistics, Tripler Army Medical Center, Honolulu, HI 96859, United States
Author contributions: Sy JW performed the research; Lausé GE designed the research and contributed to the manuscript and analysis; Lopez AJ performed the research; Deal JB designed the research; Lustik MB performed the statistics review; Ryan PM supervised the report, finalized data analysis and wrote the manuscript.
Institutional review board statement: This study was reviewed by the Tripler Army Medical Center Institutional Review Board and found to be exempt from IRB review IAW 32 Code of Federal Regulation 219.104(d), category (4)(iii).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data.
Conflict-of-interest statement: None of the authors have a conflict of interest with the submitted study.
Data sharing statement: Please contact the corresponding author if access to the de-identified data is requested.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gregory E Lausé, MD, MS, Doctor, Department of Orthopaedic Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859, United States. gregory.e.lause.mil@mail.mil
Received: February 17, 2021
Peer-review started: February 17, 2021
First decision: May 3, 2021
Revised: May 17, 2021
Accepted: August 20, 2021
Article in press: August 20, 2021
Published online: September 18, 2021
Processing time: 209 Days and 5.2 Hours
ARTICLE HIGHLIGHTS
Research background

Once patients were diagnosed with instability based upon stress radiographs, the surgical procedure was delayed due to the need to obtain a magnetic resonance imaging in order to define which patients had associated conditions. Prior to this study, the surgeons involved felt that higher degrees on instability were associated with the incidence of associated conditions that could result from instability.

Research motivation

In general, we hoped to avoid a delay in treatment due to the need to obtain advanced imaging. We assumed that patients with higher degrees of instability would have osteochondral lesions or peroneal pathology and would require diagnostic arthroscopy or peroneal exploration while patients with a lesser degree of instability could be addressed with a limited surgical procedure focused on the lateral ligaments.

Research objectives

We aimed to determine a degree of instability that could predict the incidence of peroneal pathology or osteochondral defects.

Research methods

A retrospective analysis of patients who had previously been diagnosed with ankle instability was performed. We stratified the patients based upon their degree of instability as defined by stress radiographs and evaluated the incidence of peroneal pathology and osteochondral defects as related to the varying degrees of instability.

Research results

Increasing degrees of instability was associated with a statistically significant increased prevalence of peroneal pathology. An inverse relationship was found between increasing degrees of instability and the presence of osteochondral defects. While we did confirm the association of ligamentous instability to peroneal pathology and the inverse relationship found between osteochondral defects and instability, we did not find a degree of instability that was predictive of peroneal pathology or osteochondral defects.

Research conclusions

Stress radiographs were not found to be predictive of peroneal tendon pathology or osteochondral defects of the talus.

Research perspectives

This is only the second study to demonstrate an inverse relationship between ankle instability and osteochondral defects of the talus. This is a novel discovery, but the injury mechanism that leads to ligamentous instability without chondral injury is unclear. Potentially axial load injuries are more likely to result in chondral injuries as opposed to rotational injuries that may lead to ankle instability. Further work is required to better understand this injury pattern.