Z Orthop Unfall 2018; 156(02): 160-167
DOI: 10.1055/s-0043-124597
Original Article/Originalarbeit
Georg Thieme Verlag KG Stuttgart · New York

Pain in Osteochondral Lesions of the Ankle – an Investigation Based on Data from the German Cartilage Registry (KnorpelRegister DGOU)

Article in several languages: English | deutsch
Daniel Körner
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
,
Philipp Kohler
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
,
Steffen Schröter
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
,
Aline Naumann
2   Institut für Klinische Epidemiologie und angewandte Biometrie, Universitätsklinikum Tübingen
,
Markus Walther
3   Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München-Harlaching, München
,
Philipp Niemeyer
4   Orthopädische Chirurgie München (OCM), München
5   Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg
,
Yannic Bangert
6   Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg
,
Matthias Aurich
7   Zentrum Orthopädie und Unfallchirurgie, Klinikum Ingolstadt GmbH, Ingolstadt
,
Atesch Ateschrang
1   Klinik für Unfall- und Wiederherstellungschirurgie, BG Unfallklinik Tübingen
› Author Affiliations
Further Information

Publication History

Publication Date:
17 April 2018 (online)

Abstract

Background The aim of the study was to investigate parameters influencing the preoperative pain intensity in patients with osteochondral lesions of the ankle. The evaluation covered patient-related parameters such as age, sex, body mass index (BMI), as well as defect-related parameters, such as localisation, size and stage (according to the classification of the International Cartilage Repair Society [ICRS] and the Berndt-Harty-Loomer classification). We also examined the correlation between the different surgical techniques and additional factors, such as debridement of an impingement or stabilisation of the ankle on the one hand, and the preoperative pain intensity on the other.

Material and Methods 259 patients with osteochondral lesions of the ankle were operated in 32 clinical centres between October 2014 and December 2016 and enrolled consecutively in the German Cartilage Registry (KnorpelRegister DGOU). 151 patients were available for analysis. The preoperative pain intensity was assessed at the time of surgery with online questionnaires, using the Numeric Rating Scale for pain (NRS).

Results The median preoperative pain intensity in the complete study population (n = 151) was 3 (range 0 – 10). There was no correlation between the age and the preoperative pain intensity (ρ = − 0.06). Further, there was not detected a difference between the two genders according to the preoperative pain intensity (p = 0.31). In female patients a higher BMI correlated with a higher preoperative pain intensity (ρ = 0.16). Within the group of patients with a solitary treated talus lesion there was no difference according to the preoperative pain intensity between the different localizations of the defect (medial vs. lateral talus) (p = 0.82). Within the group of patients with a solitary treated talus or tibia lesion there was no correlation between the defective area or the lesion stage according to the ICRS classification on the one hand, and the preoperative pain intensity on the other (ρ = 0.09, and ρ = 0.04, respectively). According to the Berndt-Harty-Loomer classification a higher lesion stage (stage four and five) was associated with a higher preoperative pain intensity (ρ = 0.13). There was no difference according to the preoperative pain intensity between the group of patients that received a debridement of a bony or soft tissue impingement in addition to the cartilage therapy and the group of patients without this kind of additional therapy (p = 0.10). Further, there was no difference according to the preoperative pain intensity between the group of patients that received a stabilisation of the ankle joint in addition to the cartilage therapy and the group of patients without a stabilisation procedure (p = 0.83).

Conclusion Osteochondral lesions of the ankle can be associated with a moderate and in some cases high pain intensity. In female patients a higher BMI is associated with a higher pain intensity. Further, a higher lesion stage according to the Berndt-Harty-Loomer classification is associated with a higher pain intensity, which highlights the clinical relevance of this classification.

 
  • References/Literatur

  • 1 DiGiovanni BF, Fraga CJ, Cohen BE. et al. Associated injuries found in chronic lateral ankle instability. Foot Ankle Int 2000; 21: 809-815
  • 2 Valderrabano V, Wiewiorski M, Frigg A. et al. [Chronic ankle instability]. Unfallchirurg 2007; 110: 691-699 quiz 700
  • 3 Lee M, Kwon JW, Choi WJ. et al. Comparison of outcomes for osteochondral lesions of the talus with and without chronic lateral ankle instability. Foot Ankle Int 2015; 36: 1050-1057
  • 4 Lee J, Hamilton G, Ford L. Associated intra-articular ankle pathologies in patients with chronic lateral ankle instability: arthroscopic findings at the time of lateral ankle reconstruction. Foot Ankle Spec 2011; 4: 284-289
  • 5 Laffenetre O. Osteochondral lesions of the talus: current concept. Orthop Traumatol Surg Res 2010; 96: 554-566
  • 6 OʼLoughlin PF, Heyworth BE, Kennedy JG. Current concepts in the diagnosis and treatment of osteochondral lesions of the ankle. Am J Sports Med 2010; 38: 392-404
  • 7 Talusan PG, Milewski MD, Toy JO. et al. Osteochondritis dissecans of the talus: diagnosis and treatment in athletes. Clin Sports Med 2014; 33: 267-284
  • 8 Anderson DV, Lyne ED. Osteochondritis dissecans of the talus: case report on two family members. J Pediatr Orthop 1984; 4: 356-357
  • 9 Hammett RB, Saxby TS. Osteochondral lesion of the talus in homozygous twins – the question of heredity. Foot Ankle Surg 2010; 16: e55-e56
  • 10 Woods K, Harris I. Osteochondritis dissecans of the talus in identical twins. J Bone Joint Surg Br 1995; 77: 331
  • 11 Berndt AL, Harty M. Transchondral fractures (osteochondritis dissecans) of the talus. J Bone Joint Surg Am 1959; 41-A: 988-1020
  • 12 Loomer R, Fisher C, Lloyd-Smith R. et al. Osteochondral lesions of the talus. Am J Sports Med 1993; 21: 13-19
  • 13 Hepple S, Winson IG, Glew D. Osteochondral lesions of the talus: a revised classification. Foot Ankle Int 1999; 20: 789-793
  • 14 Mintz DN, Tashjian GS, Connell DA. et al. Osteochondral lesions of the talus: a new magnetic resonance grading system with arthroscopic correlation. Arthroscopy 2003; 19: 353-359
  • 15 Giannini S, Buda R, Faldini C. et al. Surgical treatment of osteochondral lesions of the talus in young active patients. J Bone Joint Surg Am 2005; 87 (Suppl. 02) 28-41
  • 16 Bruns J, Habermann CR, Petersen JP. [Osteochondritis dissecans of the talus – a critical review]. Z Orthop Unfall 2016; 154: 199-216
  • 17 van Dijk CN, Reilingh ML, Zengerink M. et al. Osteochondral defects in the ankle: why painful?. Knee Surg Sports Traumatol Arthrosc 2010; 18: 570-580
  • 18 Hawker GA, Mian S, Kendzerska T. et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63 (Suppl. 01) 240-252
  • 19 Johnson C. Measuring pain. Visual analog scale versus numeric pain scale: What is the difference?. J Chiropr Med 2005; 4: 43-44
  • 20 Gerbershagen HJ, Rothaug J, Kalkman CJ. et al. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth 2011; 107: 619-626
  • 21 van Dijk JFM, van Wijck AJM, Kappen TH. et al. Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: a cross-sectional study. Int J Nurs Stud 2012; 49: 65-71
  • 22 van Dijk JFM, Kappen TH, Schuurmans MJ. et al. The relation between patientsʼ NRS pain scores and their desire for additional opioids after surgery. Pain Pract 2015; 15: 604-609
  • 23 Boonstra AM, Stewart RE, Koke AJA. et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol 2016; 7: 1466
  • 24 Klammer G, Maquieira GJ, Spahn S. et al. Natural history of nonoperatively treated osteochondral lesions of the talus. Foot Ankle Int 2015; 36: 24-31
  • 25 Claassen H, Schicht M, Paulsen F. Impact of sex hormones, insulin, growth factors and peptides on cartilage health and disease. Prog Histochem Cytochem 2011; 45: 239-293
  • 26 Zengerink M, Struijs PAA, Tol JL. et al. Treatment of osteochondral lesions of the talus: a systematic review. Knee Surg Sports Traumatol Arthrosc 2010; 18: 238-246
  • 27 Elias I, Zoga AC, Morrison WB. et al. Osteochondral lesions of the talus: localization and morphologic data from 424 patients using a novel anatomical grid scheme. Foot Ankle Int 2007; 28: 154-161
  • 28 Hembree WC, Wittstein JR, Vinson EN. et al. Magnetic resonance imaging features of osteochondral lesions of the talus. Foot Ankle Int 2012; 33: 591-597