The Incidence of Osteochondral Lesions after Isolated Syndesmotic Injury: A Systematic Review and Meta-Analysis

Category: Ankle Introduction/Purpose: To determine the incidence of osteochondral lesions of the ankle (as well as their location and size) incidence after isolated syndesmotic injuries. Methods: A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. Two authors separately and independently screened the search results and conducted the quality assessment using the MINORS criteria. Available full-text studies published in English, Dutch and German were eligible for inclusion. OCL incidence as well as location after isolated syndesmotic injuries were extracted from the original articles and subsequently pooled. Whenever possible, OCL incidence per syndesmotic timing (Acute/subacute/chronic) was calculated, pooled and compared with a random effects model. Results: Nine articles were included with 694 syndesmotic injuries. Overall (O)CL incidence was 21.6% (95% CI 18.7 - 24.8%). This rate was 15.9% (95% CI 12.2 - 20.4), 11.4% (95% CI 5.9 - 21.0), and 54.2% (95% CI 44.2-63.8) for the acute, sub-acute, and chronic isolated syndesmotic group, respectively, thereby showing a significant difference in incidence rate between the acute and chronic syndesmotic injuries group (p<0.05). Concerning overall (O)CL incidence, 74.6% (95% CI 65.9 - 81.2) of the lesions were located on the talar dome and 16.7% (95% CI 10.9 - 24.6%) of the lesions were located on the distal tibia (p<0.05). (O)CL size was not reported in any of the studies. Concerning location difference between the acute and chronic group, the incidence of talar (O)CLs was higher in the acute group than in the chronic group (100% 95% CI 93.9 - 100% vs. 46.8% 95% CI 33.3 - 60.8%.) (p<0.05). Conclusion: This meta-analysis showed that (osteo)chondral lesions of the ankle are frequently associated with isolated syndesmotic injuries. (O)CL incidence was significantly higher in the chronic isolated syndesmotic injuries group compared to the acute group (54% versus 16%). The vast majority of (O)CLs were located on the talar dome.