for this meeting and opportunity, and to my co-authors for their excellent work. So we'll talk about osteochondral lesions of the talus and factors predictive of instability. So the integrity of articular cartilage in patients with osteochondral lesions of the talus certainly guides treatment, and the ability to accurately predict cartilage integrity in OLTs is certainly beneficial. So prior work at our institution has identified that age and cartilage integrity on MRI are strong predictors of intraoperative findings of cartilage integrity and OCD of the knee. So in this study, the purpose of the study was to evaluate the association of radiographic and MRI findings and articular cartilage integrity at the time of our ankle arthroscopy for OLTs. This was a single institution retrospective study of patients treated from 2010 to 2017. Patients were included if they were less than age 19 at time of surgery. They underwent operative treatment for an OLT, and they had a preoperative MRI still available for review. Demographics and intraoperative findings were recorded, and radiographic review was performed to document the fissile status of the distal tibia, OLT location, burnt and hardy stage. MRI review was then performed, again, to document the location of the OLT. The cartilage status is deemed by a musculoskeletal radiologist as intact or disrupted in the modified Kramer grade. In the results, there were 54 OLTs in 53 patients. The average age was 13.6 years. And fissile status was distributed differently in the patients with closed distal tibial fissus. The majority of the cartilage was deemed disrupted in patients with an open distal tibial fissus. The majority had intact cartilage. Location-wise, the majority were medial and posterior medial, as you would suspect. There was no difference between intact versus disrupted OLTs at the time of arthroscopy. We looked at additional variables, radiographic stage, MRI grade, and were both predictive at an increasing stage of cartilage disruption. When we looked at the results further, MRI assessment of cartilage integrity, MRI was 95% sensitive and 75% specific, overall with an accuracy of 89%. Eleven percent of cases were misclassified, and they did not correlate with the arthroscopic findings as shown in this image in which articular cartilage disruption was suggested on the MRI, but not complete disruption at arthroscopy. But among the 22 patients with open fissus, MRI to assess cartilage integrity was highly sensitive and specific, 92% sensitivity and 100% specific. When we used regression analysis to create a predictive model, we looked at MRI cartilage integrity. It showed good reliability with an area under the curve of 0.85. When we added fiseal status and or MRI grade, it did not statistically increase the area under the curve, but when adding radiographic stage, it certainly did to raise it to the excellent reliability of 0.95. So in conclusion, the ability to accurately predict cartilage integrity of OLTs certainly guides treatment and provides expectations for the patient and families. We found independent predictors of cartilage integrity at the time of arthroscopy or fiseal status, radiographic stage, MRI grade, and cartilage integrity as deemed on the MRI. Using a predictive model with MRI classification, radiographic stage showed the greatest diagnostic ability for correctly predicting cartilage integrity at the time of arthroscopy. Thank you.

osteochondral lesions of the talus

cartilage integrity

ankle arthroscopy

radiographic stage

MRI grade