Prognosis of Medial Gutter Osteoarthritis Combined with Chronic Ankle Instability

Abstract

Category: Ankle Arthritis Introduction/Purpose: Although the frequent intraarticular pathologies associated with recurrent ankle sprains are well known, informations regarding treatment method for arthritic changes in the medial gutter are still insufficient. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following modified Broström procedure and arthroscopic debridement in the middle-aged patients. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after surgical treatment. All patients showed medial joint space narrowing of Takakura stage 2. The clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final followup, respectively (P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.5 points (P < .001), 8 patients (36.4%) complained of discomfort at gait with considerable pain ≥ 4 points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression in arthritis stage. Conclusion: Modified Broström procedure concomitant with arthroscopic debridement for medial gutter osteoarthritis secondary to chronic ankle instability is not effective enough to treat the medial ankle pain and functional impairment. Alternative treatment strategies for middle-aged cohort with arthritic changes are needed to improve the clinical outcomes and to prevent a progressive osteoarthritis.