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20-11-2023 | Pathology | Arthroscopy and Sports Medicine

Relationship between pain and intra-articular pathology in patients with chronic lateral ankle instability

Authors: Tomoyuki Nakasa, Yasunari Ikuta, Junichi Sumii, Akinori Nekomoto, Shingo Kawabata, Nobuo Adachi

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2024

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Abstract

Purpose

Repeated ankle sprains can lead to chronic lateral ankle instability (CLAI). It is unclear whether CLAI causes pain unless complicated by intra-articular lesions. This study aimed to analyze the characteristics of pain and the relationship between pain and intra-articular pathology in patients with CLAI.

Materials and methods

Fifty-three ankles in 46 patients with CLAI who had undergone surgery were retrospectively reviewed. The self-administered foot evaluation questionnaire (SAFE-Q) was given to patients the day before surgery. Intra-articular lesions were assessed using arthroscopy and magnetic resonance imaging (MRI). In addition, the Hounsfield Unit (HU) on computed tomography (CT) of the medial gutter was measured. The relationship between pain and intra-articular findings was also analyzed.

Results

The pain and pain-related scores in the SAFE-Q were significantly correlated with synovitis in 96.3% (rs = – 0.532). HU ratios in the tibia and talus were also significantly correlated with pain (rs = – 0.603, – 0.534, respectively). The arthroscopic synovitis score and HU ratios in patients with high pain scores were significantly higher than those in patients with low pain scores. Forty ankles (75.5%) had synovitis and articular cartilage injuries were observed in 22 ankles (41.5%). Patients with fluid collection or bone marrow lesions (BML) scored significantly lower in pain than those without, but there was no significant difference between patients with and without cartilage injury. Multiple regression analysis revealed that a high synovitis score and HU ratio of the talus were significantly associated with high pain.

Conclusions

Intra-articular lesions such as synovitis and BML were associated with pain in patients with CLAI. Osteosclerotic changes in the medial gutter also induced ankle pain, indicating that osteoarthritic changes had already begun. Therefore, lateral ankle ligament injuries after ankle sprain should be appropriately treated to avoid secondary degenerative changes.

Level of evidence

4.
Literature
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go back to reference Harrington KD (1979) Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Jt Surg Am 61(3):354–361CrossRef Harrington KD (1979) Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. J Bone Jt Surg Am 61(3):354–361CrossRef
Metadata
Title
Relationship between pain and intra-articular pathology in patients with chronic lateral ankle instability
Authors
Tomoyuki Nakasa
Yasunari Ikuta
Junichi Sumii
Akinori Nekomoto
Shingo Kawabata
Nobuo Adachi
Publication date
20-11-2023
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 2/2024
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-023-05123-2

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