High prevalence of intra-articular lesions identified by arthroscopy during syndesmotic screw removal after ankle fracture fixation

Abstract

Objective: To determine the prevalence of intra-articular lesions and evaluate syndesmotic stability using ankle arthroscopy performed at the time of syndesmotic screw removal in patients with surgically treated Weber B and C ankle fractures. Methods: A prospective observational study was conducted, including patients with unstable ankle fractures classified as Weber B or C who underwent open reduction and internal fixation with syndesmotic screw placement. Ankle arthroscopy was performed during routine syndesmotic screw removal 6–8 weeks after the index procedure. Arthroscopic findings, including chondral lesions of the talar dome, synovitis, intra articular fibrosis, meniscoid lesions, loose bodies, and syndesmotic instability, were recorded. Chondral lesions were classified according to the Outerbridge classification. Results: Twenty-two patients were included in the study. Arthroscopic evaluation revealed chondral lesions of the talar dome in 16 patients (72.7%), synovitis in 17 patients (77.3%), and diffused intra-articular fibrosis in 20 patients (90.9%). Residual syndesmotic instability was identified in two patients (9.1%). Most chondral lesions were classified as Outerbridge grade II or III. No statistically significant association was identified between mechanism of injury and arthroscopic findings. Conclusion: Arthroscopy evaluation during syndesmotic screw removal revealed a high prevalence of intra-articular lesions following ankle fracture fixation. Arthroscopic evaluation may therefore represent a valuable diagnostic and therapeutic adjunct for identifying intra-articular lesions that may contribute to persistent postoperative symptoms. Level of Evidence IV; Prospective Observational Study.