One in five talar osteochondral lesions had hidden syndesmotic instability

Design

Single-centre retrospective cohort

Population

175 patients undergoing ankle arthroscopy for osteochondral lesions of the talus

Primary outcome

Arthroscopically confirmed occult syndesmotic instability

Effect

20.6% prevalence; BMI OR 1.81 (95% CI 1.42 to 2.31)

A single-centre review of 175 patients undergoing ankle arthroscopy for osteochondral lesions of the talus found that 36 (20.6%) had syndesmotic instability on arthroscopic probing that had not been diagnosed beforehand.

Higher BMI was independently associated with occult instability (OR 1.81 per unit, 95% CI 1.42 to 2.31), with a suggested cut-off of 25.6 kg/m². The authors also identified osteophytes and hypertrophy of Bassett's ligament as associated features on imaging and arthroscopy.

The practical point is to probe the syndesmosis routinely during arthroscopy for talar lesions, especially in heavier patients, because unrecognised instability may explain persistent symptoms after cartilage repair. The findings are exploratory and need external validation.

• Assess syndesmotic stability arthroscopically in every ankle arthroscopy for an osteochondral lesion of the talus.
• Higher BMI was associated with occult instability in this series.
• Consider unrecognised syndesmotic instability when symptoms persist after talar cartilage surgery.
• Preoperative imaging alone missed these cases, so arthroscopic probing matters.

Why it matters

A fifth of patients may carry a second, untreated problem that could undermine cartilage repair.

Don't overread it

This retrospective single-centre study shows association only and has not been externally validated.

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