Arthroscopic findings and treatment of maisonneuve fracture complex

• Main Authors: Lukas Fraissler, Georg Mattiassich, Lars Brunnader, Lukas A. Holzer
• Format: Article
• Language: English
• Published: BMC 2021-09-01
• Series: BMC Musculoskeletal Disorders
• Subjects: Maisonneuve fracture; Tibio-fibular instability; Syndesmotic rupture; Ankle arthroscopy; Osteochondral lesion; Cartilage lesion
• Online Access: https://doi.org/10.1186/s12891-021-04713-8

Abstract Background The Maisonneuve fracture complex (MFC) is a well-known lower leg injury. However, the optimal treatment is still not clear and there is limited data on concomitant injuries of cartilage. Therefore, the aim of our study was to report the incidence of incidental cartilage injuries and their management in arthroscopic treatment of MFC. Patients and methods Between February 2018 and February 2021 all patients presenting with MFC in our department were treated with diagnostic ankle arthroscopy and percutaneous syndesmotic screw or suture-endobutton fixation. In case of instable cartilage, it was debrided and according to the International Consensus Meeting on Cartilage Repair of the Ankle, in grade IV lesions < 10 mm or < 100 mm2 area the subchondral bone was microfractured. Results Eighteen patients, 16 male and two female, with a mean age of 48.1 years, were included. In all cases, instability of the distal tibiofibular articulation was confirmed arthroscopically. Injuries of the cartilage were found in 56% of the cases and in 31% of the patients surgical intervention was required. In three talar and one tibial lesion additional arthroscopic bone marrow stimulation with microfracture of the subchondral bone was performed. Conclusions Ankle arthroscopy is a helpful method to guide fibular reduction and to detect and address associated cartilage injuries. Due to the high rate of chondral lesions, addressing these arthroscopically may contribute to better postoperative results. Level of evidence IV