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Yang L, Wang Q, Wang Y, Ding X, Liang H. Comparative clinical study of the modified Broström procedure for the treatment of the anterior talofibular ligament injury-outcomes of the open technique compared to the arthroscopic procedure. INTERNATIONAL ORTHOPAEDICS 2024; 48:409-417. [PMID: 37668726 PMCID: PMC10799830 DOI: 10.1007/s00264-023-05963-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To observe the clinical efficacy and safety of arthroscopic-modified Broström surgery for the treatment of anterior talofibular ligament injury. METHODS The clinical data of 51 cases with anterior talofibular ligament injury were retrospectively analyzed, in which 23 patients were treated by arthroscopic-modified Broström surgery (arthroscopic surgery group) and 28 patients were treated by open-modified Broström surgery (open surgery group). The time to surgery, hospital stay, visual analog scale (VAS) scores of ankle pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, and incidence rate of complications were compared between the two groups. RESULTS (1) General results: compared with open surgery group, arthroscopic surgery group had shorter time to surgery and hospital stay ((33.8 ± 6.7) min, (42.1 ± 8.5) min, t = 1.468, P = 0.001; (2.2 ± 1.4) d, (5.8 ± 1.6) d, t = 1.975, P = 1.975, P = 0.002). (2) VAS scores of ankle pain: there was an interaction effect between the time and group factors (F = 0.378, P = 0.018); overall, there was no statistically significant difference in VAS scores of ankle pain between the two groups, i.e., there was no grouping effect (F = 1.865, P = 0.163); there was statistically significant difference in VAS score of ankle pain at different time points before and after operation, i.e., there was a time effect (F = 1.675, P = 0.000); the VAS scores of ankle pain showed a decreasing trend with time in both groups, but the decreasing trend was not completely consistent between the two groups ((7.78 ± 1.23), (1.23 ± 1.24), (1.03 ± 0.35), (1.01 ± 0.28), F = 0.568, P = 0.000. (7.45 ± 1.43), (1.45 ± 1.87), (1.23 ± 0.55), (1.04 ± 0.37), F = 1.358, P = 0.000); there was no statistically significant difference in VAS score of ankle joint pain between the two groups six and 12 months before and after surgery (t = 2.987, P = 0.055; t = 1.654, P = 2.542; t = 0.015, P = 0.078); the VAS scores of ankle pain in the arthroscopic surgery group was lower than that in the open surgery group three months after operation (t = 1.267, P = 0.023). (3) AOFAS ankle and hindfoot scores: there was an interaction effect between time and grouping factors (F = 2.693, P = 0.027); overall, there was no statistically significant difference in the AOFAS ankle and hindfoot scores between the two groups, i.e., there was no grouping effect (F = 1.983, P = 0.106); there was statistically significant difference in the AOFAS ankle and hindfoot scores at different time points before and after surgery, i.e., there was a time effect (F = 34.623, P = 0.000); the AOFAS ankle and hindfoot scores of the two groups showed an increasing trend with time, but the increasing trend of the two groups was not completely consistent ((48.19 ± 12.89), (89.20 ± 8.96), (90.24 ± 7.89), (91.34 ± 9.67), F = 25.623, P = 0.000; (49.35 ± 13.28), (86.78 ± 12.34), (88.78 ± 9.78),(91.43 ± 7.98), F = 33.275, P = 0.000); there was no statistically significant difference in the AOFAS ankle and hindfoot scores between the two groups 12 months before/after surgery (t = 2.145,P = 0.056;t = 2.879,P = 0.389); compared with open surgery group, the arthroscopic surgery group had higher AOFAS ankle and hindfoot scores 3/6 months after surgery (t = 1.346, P = 0.014; t = 1.874, P = 0.028). CONCLUSION For the treatment of anterior talofibular ligament injury, arthroscopic surgery group is superior to open surgery group in ankle pain relief and functional recovery and has shorter operation time and hospital stay compared with open surgery group.
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Affiliation(s)
- LiLi Yang
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China.
| | - QingFu Wang
- Tendon Department of Traumatology The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - YuanLi Wang
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China
| | - XiaoFang Ding
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China
| | - Huan Liang
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China
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Mederake M, Hofmann UK, Ipach I. Arthroscopic modified Broström operation versus open reconstruction with local periosteal flap in chronic ankle instability. Arch Orthop Trauma Surg 2022; 142:3581-3588. [PMID: 33993359 PMCID: PMC9596524 DOI: 10.1007/s00402-021-03949-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/03/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The modified Broström operation (MBO) has found widespread use in the therapy of lateral chronic ankle instability (CAI). However, alternative surgical techniques like the open reconstruction using a periosteal flap (RPF) are still an important part of the surgical treatment of lateral CAI. Both procedures differ in terms of the reconstruction material used and the surgical procedure. Comparative studies on the surgical therapy of CAI are limited and generally refer to similar surgical procedures. Aim of this study was to compare the arthroscopic MBO and the RPF. MATERIALS AND METHODS We retrospectively analysed 25 patients with lateral CAI after a tear of the anterior talofibular ligament (ATFL). 14 patients received arthroscopic MBO and 11 patients received RPF. We compared the postoperative outcome between both groups with respect to subjective instability, the number of ankle sprains, pain, complications and follow-up operations as well as the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS Both surgical procedures resulted in a significant improvement in pain, in subjective instability, in the reduction in the frequency of ankle sprains and improvement in the AOFAS ankle-hindfoot score one year postoperatively. Three months postoperatively, the values for pain and instability of the MBO group were significantly better compared to the RPF. One year after the operation, these differences were evened out. Also in terms of complications and follow-up operations, no significant difference was found between the two procedures. CONCLUSIONS Both surgical procedures give very good results one year postoperatively in terms of pain, instability, function and complication rate. With significantly better results regarding pain and instability three months postoperatively, the MBO allows a faster recovery in patients operated with this technique.
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Affiliation(s)
- Moritz Mederake
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Ulf Krister Hofmann
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany
| | - Ingmar Ipach
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany
- Orthopädie Straubing, Stadtgraben 1, 94315, Straubing, Germany
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Hou ZC, Su T, Ao YF, Hu YL, Jiao C, Guo QW, Ren S, Li N, Jiang D. Arthroscopic modified Broström procedure achieves faster return to sports than open procedure for chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:3570-3578. [PMID: 35419704 DOI: 10.1007/s00167-022-06961-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the clinical outcomes, rate of return to sports, postural control, and muscle strength between the arthroscopic and open modified Broström procedure for chronic lateral ankle instability (CLAI) patients. METHODS From September 2018 to April 2019, 70 patients diagnosed with CLAI were prospectively included with arthroscopic modified Broström procedure (n = 36) and open modified Broström procedure (n = 34). They were evaluated at five time points (preoperation and 3 months, 6 months, 1 year and 2 years postoperatively). The main results examined the rate of return to sports, American Orthopaedic Foot and Ankle Society Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS), centre of pressure (COP) excursion velocity, time to boundary (TTB), plantar pressure, isokinetic muscle strength and complications. RESULTS Compared with the open group, the arthroscopic group demonstrated a significantly shorter period of return to the preinjury sport (13.2 ± 2.4 weeks vs. 18.7 ± 3.1 weeks, P = 0.023) and a higher early sport ratio (80.6 vs. 61.8%, P = 0.011) combined with better FAAM sports and AOFAS at 3 months and 6 months postoperatively and VAS at 3 months postoperatively. In addition, better anterior-posterior postural control stability, less time to peak force under lateral hindfoot and better dorsiflexion strength were shown in the arthroscopic group at 6 months postoperatively. No significant difference was found in clinical scores, posture control or muscle strength at the 1- or 2-year follow-up between the two groups. CONCLUSIONS Shorter period and higher rates of return to sport activities and better clinical scores, posture control and muscle strength were achieved in the arthroscopic group at 6 months postoperatively, and no clinical differences were found between arthroscopic and open modified Broström procedure 1 year or 2 years postoperatively. Arthroscopic modified Broström procedure is a reliable procedure for CLAI injuries with the demand for fast exercise recovery. CLINICAL REGISTRATION ChiCTR1900023999. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Zong-Chen Hou
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Tong Su
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Ying-Fang Ao
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Yue-Lin Hu
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Chen Jiao
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Qin-Wei Guo
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Shuang Ren
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Dong Jiang
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China.
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Luo Y, Lin S, Kong L, Jin Y, Wang R, Zhang Y, Li B, Chen B. The clinical outcomes of surgical treatment for chronic ankle instability by anatomical reconstruction of the anterior talofibular ligament with autologous half-bundle peroneal longus tendon: A retrospective study. Front Surg 2022; 9:926825. [PMID: 35990101 PMCID: PMC9388904 DOI: 10.3389/fsurg.2022.926825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022] Open
Abstract
The anterior talofibular ligament is the weakest and most vulnerable lateral ligament to be injured, and it can replace anatomical position through anatomical reconstruction. The purpose of this study is to evaluate clinical outcomes after an autologous half-bundle peroneus longus tendon anatomical reconstruction. We conducted a retrospective analysis by enrolling 34 patients [22 male and 12 female, median age 21 (range 19–26) years] with anterior talofibular ligament injury from January 2018 to March 2020. All patients underwent a ligament anatomical reconstruction operation with autologous half-bundle peroneus longus tendon and followed up with an average time of 16.21 ± 3.20 (range 12–24) months, with no loss of patients to follow-up during the study period. The American Orthopedic Foot, Ankle Society Score (AOFAS), Visual Analogue Score (VAS), and Anterior Tibiotalar Translation were used to assess the curative effect. All the indexes were compared between the preoperative and at the final follow-up to discover the related statistical differences. The AOFAS score improved significantly from an average preoperative score of 56.91 ± 3.79 to 94.12 ± 2.51 at the final followed-up (p < 0.001). Meanwhile, the pre-operation VAS pain score decreased from 5.94 ± 1.32 to 1.71 ± 0.87 (p < 0.001). Additionally, the Anterior tibiotalar translation decreased from 16.40 ± 1.85 to 5.20 ± 0.57 mm at the final followed-up (p < 0.001). The anterior drawer test was negative for all patients after the operation. Considering the outcomes, we concluded that anatomical reconstruction of the anterior talofibular ligament with autologous half-bundle peroneal longus tendon was a proper and safe procedure for chronic lateral ankle instability, and it had good clinical results and minimal complications.
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Affiliation(s)
- Yeqiang Luo
- Department of Orthopedics, General Hospital of Southern Theater Command, The first School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shanghui Lin
- Department of Orthopedics, General Hospital of Southern Theater Command, The first School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Lingchuang Kong
- Department of Orthopedics, General Hospital of Southern Theater Command, The first School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yan Jin
- Department of Orthopedics, General Hospital of Southern Theater Command, The first School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Renkai Wang
- Department of Orthopedics, General Hospital of Southern Theater Command, The first School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ying Zhang
- Department of Orthopedics, General Hospital of Southern Theater Command, The first School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Baofeng Li
- Department of Orthopedics, General Hospital of Southern Theater Command, The first School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Correspondence: Baofeng Li Bei Chen
| | - Bei Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Correspondence: Baofeng Li Bei Chen
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Potocnik P, Toepfer A. [43/m-occasional ankle sprain and symptoms of muscle fatigue : Preparation for the medical specialist examination: part 67]. DER ORTHOPADE 2021; 50:188-193. [PMID: 33709177 DOI: 10.1007/s00132-021-04084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- P Potocnik
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Schweiz.
| | - A Toepfer
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Schweiz
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Zhi X, Lv Z, Zhang C, Kong C, Wei S, Xu F. Does arthroscopic repair show superiority over open repair of lateral ankle ligament for chronic lateral ankle instability: a systematic review and meta-analysis. J Orthop Surg Res 2020; 15:355. [PMID: 32843055 PMCID: PMC7448467 DOI: 10.1186/s13018-020-01886-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background There is still no definite consensus on whether arthroscopic repair shows superiority over open repair for chronic lateral ankle instability. We conducted a systematic review and meta-analysis of the current comparative studies to make a generalized analysis. Methods PubMed, Embase, and Web of Science databases were searched from inception to April 2020. Included studies were assessed by the level of evidence and quality of evidence (Cochrane Handbook or MINORS). The process of data extraction was conducted by two independent authors. The comparative results of clinical outcomes, stress radiographic outcomes, and complication rates between two groups were pooled. Statistical analysis was performed using STATA. Results Nine comparative studies for a total of 473 patients (250 arthroscopic repair, 223 open repair) were included. For the clinical outcomes, a significant difference was found in favor of arthroscopic repair with regard to AOFAS scores (MD 0.32, 95% CI 0.12 to 0.53, I2 = 7.7%, P = .370) and VAS scores (MD − 0.30, 95% CI − 0.54 to − 0.05, I2 = 48.3%, P = .102). No significant difference was found regarding to stress radiographic outcomes. Importantly, the total complication rate (RR 0.88, 95% CI 0.51 to 1.49, I2 = 0%, P = .957) as well as nerve complication rate (RR 1.21, 95% CI 0.53 to 2.75, I2 = 0%, P = .975) of arthroscopic repair group is not significantly different to that of open repair group. Conclusions Arthroscopic repair for lateral ankle instability shows excellent clinical results comparable to open repair. Especially, arthroscopic repair might alleviate more pain due to the minimally invasive procedure. Patients receiving arthroscopic repair do not result in a higher total complication rate and nerve injury rate.
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Affiliation(s)
- Xiaosong Zhi
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, PR China
| | - Zhuman Lv
- Center for Stem Cells and Medicine, Department of Cell Biology, Navy Medical University (Second Military Medical University, previously), Shanghai, PR China
| | - Chen Zhang
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, PR China
| | - Changwang Kong
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, PR China
| | - Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, PR China.
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), No. 627, Wuluo Road, Wuhan, 430030, Hubei Province, PR China.
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Fehske K, Lukas C. [Ligamentous ankle injury: an underestimated trauma?]. SPORTVERLETZUNG-SPORTSCHADEN 2020; 34:147-152. [PMID: 32823343 DOI: 10.1055/a-1201-6162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ligamentous injuries of the ankle joint are among the most common injuries in sports, with landing on the opponent's foot or direct contact counting among the most common injury mechanisms. Initial measures most notably include a clinical examination, supplemented by X-rays, sonography or MRI as required. In most cases, conservative treatment is the treatment of choice. At the beginning, pain and swelling have to be reduced. Then function must be regained before patients may return to sports after a return-to-play test. Some injury patterns are more complex with concomitant injuries, and despite all the success of conservative treatment, certain cases remain the preserve of surgery. Not only the downtime of athletes, the severity of long-term damage and chronic functional limitations, but also the associated costs for treatment suggest the recommendation that ankle joint injuries should not be underestimated and adequate treatment should be selected.
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Affiliation(s)
- Kai Fehske
- Universitätsklinikum Würzburg Zentrum Operative Medizin/Zentrum Innere Medizin, Würzburg
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