Masato Takao

➢ Ankle cartilage damage ranges from osteochondral lesions of the talus to end-stage osteoarthritis. End-stage ankle osteoarthritis has been associated with a health burden comparable with that of major chronic diseases such as congestive heart failure and kidney disease, while predominantly affecting young and active patients. ➢ Ankle osteoarthritis often has a posttraumatic nature, making it possible to study the long-term results of traumatic articular injuries and identify potential targets for early therapeutic interventions. ➢ The scientific literature has been predominantly focused on outcomes after surgical treatment of osteochondral lesions of the talus or osteoarthritis. However, evidence on nonoperative treatment has been limited and methodologically weak, with evidence for early interventions (e.g., lifestyle or biologicals) even more scarce. ➢ The greatest opportunity to improve long-term outcomes in ankle cartilage damage may be early recognition and early initiation of treatment.

Background: Although arthroscopic lateral ankle ligament repair for chronic lateral ankle instability (CLAI) is widely performed, the association between patient age and postoperative outcomes remains unclear. This study aimed to investigate the clinical outcomes of arthroscopic lateral ankle ligament repair across a broad age spectrum. Methods: We retrospectively reviewed 934 patients who underwent arthroscopic lateral ankle ligament repair for CLAI with a modified lasso-loop stitch using a suture anchor; all procedures were performed by a single surgeon. Patients were classified into 5 age groups: skeletally immature (SI; P < .001). Time to free gait ( P = .004), jogging ( P < .001), and return to full sports activities ( P < .001) differed significantly among groups; older patients tended to require longer recovery times. SI, AD, and YA groups demonstrated higher postoperative SAFE-Q scores than the EP group in several subscales, particularly in physical and social functioning. In contrast, no age-related differences were observed in the sports activity subscale. Conclusion: The association between age and postoperative outcomes after arthroscopic lateral ankle ligament repair varied across outcome domains. Younger patients demonstrated better outcomes in several functional subscales and achieved faster recovery milestones; however, advanced age alone should not be considered a contraindication to arthroscopic lateral ankle ligament repair. Level of Evidence: Level III, retrospective cohort study.

Introduction: Few reports described the effects and clinical outcomes of peroneal tendon pathologies in patients undergoing arthroscopic repair for lateral ankle instability.Methods: Patients were stratified into those who underwent arthroscopic ankle lateral ligament repair alone (Group N) and those who underwent arthroscopic ankle lateral ligament repair in combination with surgery for peroneal tendon pathologies (Group P). Group P was further divided into patients without peroneal tendon dislocation (Group PT) and those with peroneal tendon dislocation (Group PD). Arthroscopic ankle lateral ligament repair was performed first, followed by additional surgery for peroneal tendon pathology in Group P. Subjective clinical outcome scores were assessed preoperatively and at 2 years postoperatively using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q).Results: A total of 311 patients who met the inclusion and exclusion criteria were included in this study. There were 248 patients in Group N and 63 patients in Group P. Of the 63 patients in Group P, 46 were classified into Group PT and 17 into Group PD. In all groups, SAFE-Q scores significantly improved in all categories 2 years after surgery compared with preoperatively. At 2 years postoperatively, SAFE-Q scores showed statistically significant differences in all categories between Group P and Group N, Group PT and Group N, and Group PD and Group N (p < 0.0001), with Group N having higher scores.Conclusions: Although surgical treatment for lateral ankle instability associated with peroneal tendon pathologies was effective, the presence of peroneal tendon pathologies had a negative effect on the postoperative clinical outcomes of arthroscopic repair for lateral ankle instability.

Since the first total ankle arthroplasty (TAA) was performed in 1970, the number of TAA procedures for end-stage ankle osteoarthritis has gradually increased as an alternative to arthrodesis. There are two types of TAAs: mobile-bearing and fixed-bearing. Each has its own advantages and disadvantages, but both have evolved over time from the first generation to the fourth generation, with improvements addressing earlier limitations. Although fourth-generation TAAs were introduced to the market in the early 2010s and long-term outcomes remain uncertain, early reports have shown favorable survival rates of 92%-98% and significant improvements in functional and pain scores two years after surgery. The design of TAA devices has advanced through improvements in mechanisms, anatomical shapes, materials, and surgical approaches. These advancements have improved, and will continue to improve clinical outcomes and survival rates with each new generation.

Purpose Platelet-rich plasma (PRP) is a promising treatment for enhancing the outcomes of bone marrow stimulation for osteochondral lesions of the talus (OLT) and has demonstrated efficacy in alleviating symptoms due to its biological properties. However, the role of leukocyte concentration in PRP remains unclear, particularly regarding cartilage regeneration. This study aimed to compare the clinical outcomes and time to return to activity between leukocyte-poor PRP (LP-PRP) and leukocyte-rich PRP (LR-PRP) in OLT surgery. Methods Data from 29 patients with ≥ two year follow-up were retrospectively reviewed: 18 who received LP-PRP and 11 who received LR-PRP with OLT surgery. The study assessed the timeline of return to activity and Self-Managed Foot Evaluation Questionnaire (SAFE-Q) scores preoperatively and at three months, six months, and two years postoperatively. Results The LP-PRP group resumed jogging and sports significantly earlier than the LR-PRP group (P = 0.03, P < 0.01). No patients in either group experienced complications. Both groups showed improved SAFE-Q scores at six months, but at two years, the LP-PRP group maintained significantly higher scores compared to their preoperative levels, whereas the LR-PRP group showed declines in some domains. Conclusion LP-PRP enabled an earlier return to sports compared with LR-PRP. Additionally, LP-PRP maintained good clinical scores two years after surgery. In contrast, the LR-PRP group showed some decline from their early postoperative peak, although absolute scores remained above preoperative levels. These findings suggest that LP-PRP may be an effective adjuvant treatment for OLT surgery. Level of evidence III.

Purpose: The primary purpose of this study was to evaluate the prevalence of increased lateral ankle laxity (ILAL) in adolescent male soccer players. The secondary purpose was to investigate functional ankle impairments and muscle strengths related to chronic lateral ankle instability (CLAI). Methods: The anterior talofibular ligament (ATFL) lengths of adolescent male soccer players were measured in the stress and non‐stress positions using ultrasonography. The ATFL ratio, the ratio of stress ATFL length to non‐stress ATFL length, was calculated as an indicator of lateral ankle laxity. The Cumberland Ankle Instability Tool (CAIT), Ankle Instability Instrument (AII) and static balance tests were used to assess functional ankle impairments related to CLAI. Isometric hip abduction and ankle eversion muscle strengths, and ankle dorsiflexion angle were also evaluated. Results: One hundred twenty ankles from 60 male soccer players (mean age, 16.4 ± 0.7 years; mean duration of playing soccer, 9.8 ± 2.4 years) were included. ILAL was detected in 63.3% (38/60) of soccer players; 28 with ipsilateral ILAL (group I) and 10 with bilateral ILAL (group Bi). Seventeen participants (28.3%; 10 from group I, 3 from group Bi, and 4 from those without ILAL) showed a CAIT score of ≤24, and 5 (8.3%; 4 from group I and 1 from group Bi) showed an AII score of ≥5. The eversion muscle strength of the ankle with ILAL was significantly weaker than the contralateral side in group I ( p = 0.006). Conclusion: ILAL was detected in approximately two‐thirds of adolescent male soccer players with relatively low CAIT and AII scores. In addition, the eversion muscle strength of the ankle with ILAL was significantly weaker than that of the contralateral side in subjects with ipsilateral ILAL. These findings suggest the possible importance of preventive interventions for soccer players with ILAL. Level of Evidence: Level III.

Background: There are few reports on the intra- and interobserver agreement and parameters for the diagnostic accuracy of ultrasound (US) imaging for chronic lateral ankle instability (LAI). The purpose of this study was to investigate the reliability and validity of US imaging for identifying anterior talofibular ligament (ATFL) remnants in patients with LAI. Methods: A total of 547 ankles from 406 patients underwent surgery for LAI between 2019 and 2022. If ligament fibers remained in US images, they were evaluated as positive. If the ligament was not visualized, it was evaluated as negative. Two observers performed repeated measurements. Arthroscopic findings were considered the “gold standard” for validity and diagnostic test accuracy purposes. The intra- and interobserver agreements and parameters for diagnostic accuracy, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative US imaging as intraoperative arthroscopic findings were used as reference standards. Results: The intraobserver agreement was substantial, with an agreement of 98.54% and a kappa coefficient of 0.76. The interobserver agreement was also substantial, with an agreement of 98.72% and a kappa coefficient of 0.75. The sensitivity, specificity, and accuracy of preoperative US imaging were 98.7%, 100%, and 98.7%, respectively. The PPV and NPV of US imaging were 100% and 61.1%, respectively. In the arthroscopic evaluation of the 7 cases in which US imaging showed false negative results, the ATFL ruptured at the fibular attachment and ran in contact with the talus. Conclusion: A US examination finding of an intact ATFL is highly likely to be correct. An US examination finding of a ruptured ATFL can be false and may require arthroscopic confirmation.