Incidence of Occult Chondral Lesions in Weber C Ankle Fractures in Athletes and Their Effect on Time to Return to Play

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1 Incidence of Occult Chondral Lesions in Weber C Ankle Fractures in Athletes and Their Effect on Time to Return to Play Jefferson B. Sabatini M.D. 1, Kyle T. Aune M.P.H. 2, Norman E. Waldrop III M.D. 3 1 University of Alabama at Birmingham, Department of Surgery, Division of Orthopedic Surgery, Birmingham, Alabama 2 The American Sports Medicine Institute, Birmingham, Alabama 3 Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama

2 NO CONFLICT TO DISCLOSE Incidence of Occult Chondral Lesions in Weber C Ankle Fractures in Athletes and Their Effect on Time to Return to Play Jefferson B. Sabatini M.D., Kyle T. Aune M.P.H., Norman E. Waldrop III M.D. Our disclosures are in the Final AOFAS Mobile App. We have no potential conflicts with this presentation.

3 Background Ankle injuries account for 15-25% of sports related injuries 1,3-5 While most ankle injuries are isolated to the soft tissues, ankle fractures are a source of significant morbidity resulting in extended loss of playing time. Despite anatomical surgical reconstruction, many athletes continue to experience pain and swelling that interferes with their ability to play 2,12 Residual problems are thought to be related to occult intraarticular injuries such as cartilage or ligament disruption, and the presence of loose bodies. 8,14 Previous studies have reported occult chondral lesions (OCL) to occur as frequently as 20-79% in acute ankle fractures sustained in the general population. 6-9,11 Severity of cartilage injury has been shown to correlate with the distance from the syndesmosis 6,12

4 Purpose Examine the prevalence of intra-articular injuries found at the time of operative fixation of Weber C fibula fractures in competitive athletes, and to characterize effect, If any, on time to return to play

5 Methodology Retrospective case-control study 13 competitive athletes Weber C ankle fractures only Arthroscopy at time of initial fixation Microfracture/Drilling of OCLs Fixation of ankle fracture/syndesmosis Detailed aggressive rehab protocol

6 Results OCLs: 5/13 patients (38.5%) had total of 6 lesions 5 medial talus, one posteromedial tibial plafond Syndesmosis disruption: 13/13 (100%) Deltoid disruption: 10/13 patients (76.9%) Loose bodies: 6/13 (46.2%) 100% patients with OCL

7 Results Time to Return to Play Weeks Overall OCL No OCL Deltoid Injury No Deltoid Injury High School College

8 Results 2 football players were fixed by outside physician without arthroscopy Unable to return to play after 6 and 8 months respectively due to residual pain and swelling Workup revealed full thickness OCD and loose body Patients underwent arthroscopic microfracture and loose body removal Returned to play 10.9 and 16 weeks after arthroscopy

9 Discussion Prevalence of 38.5% OCLs in Weber C ankle fractures consistent with reported literature 6,8-9 Overall time of 14.5 weeks before to return to play shorter than previously reported 2,10 No statistically significant differences in time to return to play between groups Cannot determine if acute OCL intervention makes a functional difference without outcome scores 11,13 Future aims: Prospective study with outcome data and longer follow up Ankle arthroscopy before Weber C fixation in conjunction with an aggressive rehabilitation protocol may lead to earlier return to sport and improved outcomes with deceased residual problems

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