Cartilage Lesions in Anterior Bony Impingement of the Ankle

Purpose: The aim of this study was to investigate the correlations between spur severity, clinical characteristics, and articular cartilage lesions in patients with anterior bony impingement. Methods: The study included 57 ankles in 57 patients (48 male and 9 female patients; age range, 15 to 59 years) who had undergone a spur resection for anterior impingement. We excluded spurs in patients with osteoarthritis with joint space narrowing. Spur severity was classified by use of the McDermott scale. The correlations between spur severity, clinical characteristics, and articular cartilage lesions were evaluated. Differences in the mean lengths of the tibial spurs were examined according to the presence or absence of tram-track lesions, spur fragmentation, and loose bodies. Results: The duration of pain, degree of sports activity, and presence of mechanical instability showed no relation to spur severity. Of the ankles, 28 (49.1%) were grade 1, 1 (1.8%) was grade 2, and 28 (49.1%) were grade 3. Cartilage lesions were present in 46 ankles (80.7%). Spur severity was correlated with the degree of cartilage lesions (Spearman rho = 0.30, P = .02). Grade 3 ankles had more spur fragmentation than grade 1 or 2 ankles. The mean length of the tibial spurs with tram-track lesions or spur fragmentation was longer than that without these lesions. Conclusions: The results suggest that cartilage lesions are present even in ankles with small spurs and that the degree of cartilage lesions increases as spurs become larger. Level of Evidence: Level IV, therapeutic case series.