Today I'll discuss our study entitled validation of the foot and ankle outcome score or FAOS score for osteochondral lesions of the ankle. These are relevant disclosures. Osteochondral lesions of the ankle joint are a commonly occurring injury that are typically managed with surgical intervention. However, no patient reported outcome measurement tool has been validated for osteochondral lesions of the ankle joint to date. The foot and ankle outcome score or FAOS score is a subjective clinical scoring system that has been validated for a litany of foot and ankle orthopedic pathologies, but not for osteochondral lesions of the ankle. So, the purpose of our study was to attempt to validate the FAOS score for osteochondral lesions of the ankle. The psychometric properties of construct and content validity, test-retest reliability, and responsiveness will be evaluated. A retrospective chart review for patients who visited a single institution between 2008 and 2014 was conducted. Both FAOS and SF-12 scores were administered to these patients both preoperatively and postoperatively. The inclusion criteria included patients who were at least 18 years of age and patients who underwent surgical management of an ankle osteochondral lesion. We excluded anyone who had an incomplete FAOS or SF-12 score and who had a concomitant ankle pathology. So, construct validity was assessed by administering the FAOS and SF-12 score two weeks preoperatively. We assessed and attempted to identify any floor and ceiling effects. Content validity was assessed by administering questionnaires to the patients. Fourteen patients received this questionnaire two weeks preoperatively and six patients received this questionnaire four weeks postoperatively. Reliability was assessed by completing the FAOS score at two discrete preoperative time points, typically between two to four weeks of an interval between completing the questionnaires. Responsiveness was measured by comparing the preoperative FAOS score with the postoperative FAOS score. We found that all five FAOS subscales demonstrated moderate correlation with the three SF-12 physical health domains. We found that no floor nor ceiling effects were found. We found that all domains met the threshold for acceptable content validity. The quality of life and function in sports items received the highest relevant scores from this patient cohort. All FAOS subscales demonstrated acceptable test-retest reliability. High FAOS responsiveness to changes in this cohort were found. There are numerous limitations and potential confounders in our study. This study involved a single patient population, recruitment from one institution, and retrospective patient identification through the registry. It may not have captured the full cohort of patients seen and treated for ankylo-osteochondral lesions. It was not possible to determine precisely what degree of improvement between preoperative FAOS scores and postoperative FAOS scores is clinically meaningful. Radiographic grading and condition severity were not correlated with FAOS scores in order to obtain a pure characterization of the instrument in evaluating ankylo-osteochondral lesions. In summary, we found that the FAOS score is a valid, reliable, and responsive patient-reported outcome scale for osteochondral lesions in the ankle. FAOS scores may be more useful for patients with ankle pathologies, particularly ankle osteochondral lesions, compared to foot pathologies, given its superiority regarding the ADL subscale, the sports and recreational activities subscale, and the lack of floor and ceiling effects. We endorse the use of the FAOS score in evaluating ankle osteochondral lesions in both the research and clinical setting and consider it a useful patient-reported, self-administered instrument following surgical intervention.

validation

Foot and Ankle Outcome Score

FAOS

osteochondral lesions

ankle