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Rougereau G, Hassan SK, Valentin E, Jehan S, Bauer T, Baudrier N, Hardy A. Incidence of Septic Arthritis After Vancomycin Soaking of the Graft During Arthroscopic Anatomic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction. Orthop J Sports Med 2024; 12:23259671241228276. [PMID: 38444570 PMCID: PMC10913514 DOI: 10.1177/23259671241228276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 03/07/2024] Open
Abstract
Background Vancomycin soaking of the graft during arthroscopic anterior cruciate ligament reconstruction has been shown to be effective in reducing the rate of postoperative infection. Purpose/Hypothesis The present study aimed to (1) analyze the effect of vancomycin-soaked grafts during arthroscopic anatomic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) on the incidence of infection and (2) evaluate the influence of infection on functional outcomes and identify the risk factors of infection. It was hypothesized that vancomycin soaking of the graft would reduce the postoperative infection rate. Study Design Cohort study; Level of evidence, 3. Methods Consecutive patients at 2 centers who underwent ATFL/CFL reconstruction between December 2011 and July 2022 were included. All patients had undergone anterolateral arthroscopic debridement of the ankle and anatomic ATFL/CFL reconstruction with a gracilis tendon autograft. Vancomycin soaking of the graft was begun in both centers in January 2021. Complications, functional scores, return to sports (RTS) rates, and the level of return were compared between patients with and without vancomycin-soaked grafts and between patients with and without infection. Results Overall, 182 patients (48% men; mean age, 34 ± 11.9 years) were included, with a mean follow-up of 23 ± 16.1 months. The rate of postoperative infection was significantly lower in the group with vancomycin soaking versus without (0/92 [0%] vs 8/90 [8.9%]; P = .001). At the final follow-up, there were 26 complications (14.3%): 8 infections, 6 recurrent tears, and 12 peripheral neuropathies. The infections developed after a mean of 17 ± 11 days. The functional scores were excellent at the final follow-up (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Score, 86.5 ± 18.7; Karlsson score, 85 ± 18.3). Patients with infection had significantly decreased AOFAS scores (52.8 ± 27.6 vs 83.3 ± 21.5; P = .003), Karlsson scores (57 ± 27.7 vs 83.6 ± 20; P = .006), and RTS rates (25% vs 77%; P = .005) versus patients without infection. Conclusion Vancomycin-soaked grafts for arthroscopic anatomic ATFL/CFL reconstruction decreased the rate of postoperative infection. Infection led to a deterioration in results. Vancomycin-soaking of the graft did not have a negative effect on functional results.
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Affiliation(s)
- Grégoire Rougereau
- Hospital Ambroise Pare, APHP, Boulogne Billancourt, France
- Hospital Pitie Salpetriere, APHP, Paris, France
| | - Sammy Kassab Hassan
- Hospital Ambroise Pare, APHP, Boulogne Billancourt, France
- Hospital Pitie Salpetriere, APHP, Paris, France
| | | | - Sacha Jehan
- Hospital Ambroise Pare, APHP, Boulogne Billancourt, France
| | - Thomas Bauer
- Hospital Ambroise Pare, APHP, Boulogne Billancourt, France
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Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Vialle R, Langlais T, Hardy A. Biomechanical evaluation of the anterior talo-fibular and calcaneo-fibular ligaments using shear wave elastography in young healthy adults. Orthop Traumatol Surg Res 2024; 110:103647. [PMID: 37356798 DOI: 10.1016/j.otsr.2023.103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the stiffness of the anterior talo-fibular ligament (ATFL) and calcaneo-fibular ligament (CFL) using shear wave elastography (SWE) with the ankle in the neutral position and in varus, in young healthy adult volunteers. We also evaluated the reliability and reproducibility of the SWE measurements. HYPOTHESIS The stiffness of both ligaments increases with increasing ankle varus. SWE may be a reliable tool for evaluating the lateral collateral ligament complex of the ankle. MATERIAL AND METHODS We used SWE to evaluate both ankles of each of 20 healthy volunteers (10 females and 10 males). For each test, the foot was placed on a hinged plate and tested in the neutral position and in 15° and 30° of varus. Stiffness was evaluated based on shear wave velocity (SWV). RESULTS Stiffness of both the ATFL and CFL was minimal in the neutral position (2.06m/s and 3.43m/s, respectively). Stiffness increased significantly for both ligaments in 15° of varus (2.48m/s and 4.11m/s, respectively; p<0.0001) and was greatest in 30° of varus (3.15m/s and 4.57m/s, respectively; p<0.0001). ATFL stiffness was greater in males than in females in 15° (p=0.04) and 30° (p=0.02) of varus. For the CFL, in contrast, stiffness was not different between males and females. Stiffness of the ATFL and CFL was not associated with age, dominant side, height, or foot morphology. No correlations were found between stiffness of the two ligaments in any of the positions. Repeating each measurement three times produced excellent concordance for both ligaments in all three positions. CONCLUSION The ATFL and CFL are the main lateral stabilisers of the ankle, and each exerts a specific function. Their stiffness increases with the degree of varus. This study describes a protocol for evaluating ATFL and CFL density by SWE, which is a reliable and reproducible technique that provides a normal range. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grégoire Rougereau
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique adulte, hôpital de la Pitié-Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France.
| | - Thibault Marty-Diloy
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Marie Vigan
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Unité de recherche clinique, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphaël Vialle
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculosquelettiques, université de la Sorbonne, Paris, France
| | - Tristan Langlais
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique pédiatrique, hôpital des enfants, université de Toulouse, Purpan, Toulouse, France
| | - Alexandre Hardy
- Département de chirurgie orthopédique, clinique du sport, 75005 Paris, France
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Mellado-Romero MÁ, Guerra-Pinto F, Ojeda-Thies C, Arroyo-Hernández M, Abarquero-Diezhandino A, Ramos-Pascua L, Vilá-Rico J. Comparison of Direct Repair Versus Anatomic Graft Reconstruction of the Anterior Talofibular Ligament: A Biomechanical Cadaveric Study. J Foot Ankle Surg 2024; 63:36-41. [PMID: 37633486 DOI: 10.1053/j.jfas.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
The goal of our study is to compare the stability of the anatomic reconstruction of the anterior talofibular ligament (ATFL) with direct repair of the ATFL, in a cadaver model. We performed the following techniques in 18 cadaveric ankles: the intact ATFL was cut, after which a direct repair using 2 anchors was performed. The repair was sectioned, and anatomic reconstruction was then performed with a tendon autograft. We measured angular displacement in 3 anatomic planes (axial, coronal, sagittal) for each situation in response to the anterior drawer test (ADT), talar tilt test (TTT) and pivot test (PT), using a specifically constructed arthrometer. The sectioned ATFL was inferior to the intact ATFL in the axial plane with the ADT (p = .012), in the axial plane with the PT (p = .001) and in the axial and coronal planes with the TTT (p = .013 and p = .016, respectively). Direct anatomic repair was inferior to the intact ATFL in the axial plane upon the PT (p = .009). No differences could be found between anatomic graft reconstructions and the intact ATFL with any manoeuver, nor when comparing anatomic graft reconstruction and direct repair with 2 anchors. We were able to conclude that anatomic graft reconstruction of the ATFL reproduces angular stability of the native ligament in a cadaver model. While we could not detect if anatomic graft reconstruction was superior to direct repair, the latter proved to be less stable in the axial plane upon internal rotation (pivot test) versus the intact ATFL.
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Affiliation(s)
- María Ángela Mellado-Romero
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Francisco Guerra-Pinto
- Department of Orthopaedics of the Hospital de Sant'Ana, Parede, Portugal; Department of Orthopaedics of the Hospital da Cruz Vermelha, Lisbon, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Arroyo-Hernández
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Abarquero-Diezhandino
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Ramos-Pascua
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Vilá-Rico
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Thès A, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Elkaïm M, Boniface O, Guillo S, Bauer T, Lopes R. Five-year clinical follow-up of arthroscopically treated chronic ankle instability. Orthop Traumatol Surg Res 2023; 109:103649. [PMID: 37364821 DOI: 10.1016/j.otsr.2023.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Arthroscopic treatment of lateral ankle instability is a recent innovation. In 2014, a prospective study was initiated by the French Society of Arthroscopy demonstrating the feasibility, morbidity and short-term results of arthroscopic treatment of ankle instability. HYPOTHESIS The functional results of arthroscopic treatment of chronic ankle instability found after one year were maintained in the medium term. MATERIAL AND METHODS The prospective follow-up of the patients included in the initial cohort was continued. The Karlsson and AOFAS scores, as well as patient satisfaction, were assessed. The causes of failure underwent univariate and multivariate analyzes. The results of 172 patients were included (40.2% ligament repairs; 59.7% ligament reconstructions). The average follow-up was 5years. The average satisfaction was 8.6/10, the average Karlsson score was 85 points and the average AOFAS score was 87.5 points. The reoperation rate was 6.4% of patients. The failures were related to an absence of sports practice, a high BMI and female gender. A high BMI and the intense sports practice were associated to ligament repair failure. The absence of sports practice and the intraoperative presence of the anterior talofibular ligament were associated to ligament reconstruction failure. DISCUSSION Arthroscopic treatment of ankle instability confers high satisfaction in the medium term, as well as long-lasting results with a low reoperation rate. A more detailed evaluation of the failure criteria could help guide the choice of treatment between ligament reconstruction or repair. LEVEL OF EVIDENCE II.
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Affiliation(s)
- André Thès
- Hôpital privé d'Eure-et-Loir, 2, rue Roland-Buthier, 28300 Mainvilliers, France
| | - Michael Andrieu
- Clinique Pont-de-Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France
| | - Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - François Molinier
- Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Marc Elkaïm
- Clinique Drouot sport, 20, rue Laffitte, 75009 Paris, France
| | - Olivier Boniface
- Clinique Générale-Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France
| | - Stéphane Guillo
- SOS Pied Cheville Bordeaux, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, groupe hospitalier universitaire Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Francophone Arthroscopic society (SFA), 15, rue Ampère, 92500 Rueil-Malmaison, France
| | - Ronny Lopes
- Francophone Arthroscopic society (SFA), 15, rue Ampère, 92500 Rueil-Malmaison, France; Santé atlantique (Pied Cheville Nantes Atlantique), avenue Claude-Bernard, 44800 Saint-Herblain, France.
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Le T, Liu H, Jenkins SM, Rayos del Sol S, Gardner BB, McGahan P, Chen J. Single Knotless Suture Anchor Repair of Anterior Talofibular Ligament Following Distal Fibula Nonunion Excision. Arthrosc Tech 2022; 11:e449-e455. [PMID: 35256990 PMCID: PMC8897637 DOI: 10.1016/j.eats.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023] Open
Abstract
Anterior talofibular ligament (ATFL) tear is the most common ankle ligament injury. This can lead to recurrent ankle instability, which is detrimental to ankle function and the patient's quality of life. Currently, several techniques have shown successful outcomes for ATFL repair. In this technical note, we describe an open ATFL repair using a single knotless suture anchor at the distal fibula location. This approach is rapid, equipment-efficient, and reproducible, while promising excellent results and high patient satisfaction by restoring ATFL anatomy.
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Affiliation(s)
| | | | - Sarah M. Jenkins
- Address correspondence to Sarah M. Jenkins, M.D., AO Sports, Advanced Orthopaedics and Sports Medicine, 450 Sutter St., San Francisco, CA 94108, U.S.A.
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Sánchez CA, Briceño I, Robledo J. Resultados de uma técnica modificada de reconstrução assistida por artroscopia para instabilidade lateral do tornozelo. Rev Bras Ortop 2022; 57:577-583. [PMID: 35966426 PMCID: PMC9365499 DOI: 10.1055/s-0041-1741446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022] Open
Abstract
Objective
The present study assesses the results of a minimally invasive surgical technique for acute and chronic ankle instability management.
Methods
The present case series study retrospectively evaluated 40 patients undergoing arthroscopic-assisted percutaneous ankle ligament reconstruction from 2013 to 2019.
Results
The present study included 17 males and 23 females with an average age of 38.3 years old. Postintervention follow-up using American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scores identified improvement of > 30 points in function and pain control. The most frequently occurring associated injuries were osteochondral (35%). No patient required reintervention or had infection during follow-up.
Conclusion
The technique in the present study is easy and achieves satisfactory results for function and pain control.
Level of Evidence
IV.
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Affiliation(s)
- Carlos A. Sánchez
- Departamento de Ortopedia e Traumatologia, Pontificia Universidad Javeriana, Bogotá, D.C., Colômbia
| | - Ignacio Briceño
- Departamento de Ortopedia e Traumatologia, Pontificia Universidad Javeriana, Bogotá, D.C., Colômbia
| | - Jaime Robledo
- Departamento de Ortopedia e Traumatologia, Hospital Universitario San Ignacio, Bogotá, D.C., Colômbia
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Lambert LA, Mangwani J, Davies MB, Molloy AP, Mason LW. The lateral transligamentous approach to the talar dome. Foot Ankle Surg 2021; 27:767-771. [PMID: 33153917 DOI: 10.1016/j.fas.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/11/2020] [Accepted: 10/03/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Anatomic reduction of talar body fractures is critical in restoring congruency to the talocrural joint. Previous studies have indicated 43% talar body access with a single incision and without malleolar osteotomy. The aim of this study was to investigate the percentage talar body exposure when using the lateral transligamentous approach. METHODS The lateral transligamentous approach to the talus was undertaken in 10 fresh frozen cadaveric specimens by surgeons inexperienced in the approach following demonstration of the technique. An incision was made on the anterolateral aspect of the ankle augmented by the removal of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) from their fibular insertions. A bone lever was then placed behind the lateral aspect of the talus and levered forward with the foot in equinus and inversion. A mark was made on the talar dome where an instrument could be placed 90 degrees to the talar surface. The talus was subsequently disarticulated and high-resolution images were taken of the talar dome surface. The images were overlain with a reproducible nine-grid division. Accessibility to each zone within the grid was documented using the mark made on the talar surface. ImageJ software was used to calculate the surface area exposed with each approach. RESULTS The mean percentage area of talar dome available through the transligamentous approach was 77.3% (95% confidence interval 73.3, 81.3). In all specimens the complete lateral talar process was accessible, along with the lateral and dorsomedial aspect of the talar neck. This approach gives complete access to Zones 1, 2, 3, 5 & 6 with partial access to Zones 4, 8 & 9. CONCLUSION The lateral transligamentous approach to the talus provides significantly greater access to the talar dome as compared to standard approaches. The residual surface area that is inaccessible with this approach is predominantly within Zones 4,7 and 8, the posteromedial corner. LEVEL OF CLINICAL EVIDENCE V.
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Affiliation(s)
- Laura-Ann Lambert
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
| | - Jitendra Mangwani
- Leicester Royal Infirmary, Leicester, United Kingdom; University of Leicester, Leicester, United Kingdom
| | - Mark B Davies
- Northern General Hospital, Sheffield, United Kingdom
| | - Andrew P Molloy
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Lyndon W Mason
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
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Lopes R, Andrieu M, Molinier F, Colin F, Morin V. PT4: New arthroscopic technique for isolated reconstruction of the anterior talofibular ligament using a quadrupled plantaris tendon. Orthop Traumatol Surg Res 2021; 107:102995. [PMID: 34198006 DOI: 10.1016/j.otsr.2021.102995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 02/03/2023]
Abstract
The strategy for surgical treatment of chronic ankle instability is becoming increasingly refined. In instances of isolated symptomatic non-repairable anterior talofibular ligament (ATFL) injury, there is a surgical indication for isolated ATFL reconstruction. However, we feel that the typical gracilis tendon graft is not always appropriate. Interest in using the plantaris tendon as a graft has picked up since a biomechanics study found the tensile strength of a quadrupled plantaris tendon is comparable to that of the ATFL. Here, we describe an original arthroscopic technique for isolated ATFL reconstruction using a quadrupled plantaris tendon (PT4) graft.
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Affiliation(s)
- Rony Lopes
- Clinique Brétéché, 3, rue de la Béraudière, 44000 Nantes, France; Santé Atlantique, Avenue Claude Bernard, 44800 Saint-Herblain, France.
| | - Mickaël Andrieu
- Clinique du Pont de Chaume, 330 Avenue Marcel Unal, 82017 Montauban cedex, France
| | | | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis Mouillard, 66000 Perpignan, France
| | - Vincent Morin
- Clinique Médipôle de Savoie, 300, Avenue des Massettes, 73190 Challes-les-Eaux, France
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Pereira BS, Andrade R, Espregueira-Mendes J, Marano RPC, Oliva XM, Karlsson J. Current Concepts on Subtalar Instability. Orthop J Sports Med 2021; 9:23259671211021352. [PMID: 34435065 PMCID: PMC8381447 DOI: 10.1177/23259671211021352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.
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Affiliation(s)
- Bruno S. Pereira
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Hospital Privado de Braga, Lugar da Igreja Nogueira, Braga,
Portugal
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports,
University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto,
Porto, Portugal
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- School of Medicine, Minho University, Braga, Portugal
- 3B’s–PT Government Associate Laboratory, Braga/Guimarães,
Portugal
- 3B’s Research Group– Biomaterials, Biodegradables and Biomimetics,
University of Minho, Headquarters of the European Institute of Excellence on Tissue
Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
| | | | - Xavier Martin Oliva
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Orthopedic Surgery Department, Clínica Ntra. Sra. Del Remei,
Barcelona, Spain
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Sweden
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Giunta JC, Toschi B, Moroney P, Tourné Y. Assessment of Evertor Strength Following Inferior Extensor Retinaculum Flap Ligamentoplasty in Patients With Chronic Lateral Ankle Instability. J Foot Ankle Surg 2021; 60:30-35. [PMID: 33214099 DOI: 10.1053/j.jfas.2020.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/10/2019] [Accepted: 04/29/2020] [Indexed: 02/03/2023]
Abstract
The primary aim of our study was to evaluate the strength of ankle evertor muscles in patients who have undergone a lateral ankle ligamentoplasty (which combined tensioning of the primary ligament group and reinforcing it with a pediculated extensor retinaculum flap), using 2 measurement systems (isokinetic and the functional weightbearing test [MyoLux). Our hypothesis was the strength of evertor muscles on the treated side was comparable to that of the contralateral healthy side. This prospective study included 23 patients who had chronic ankle instability and underwent an inferior extensor retinaculum flap ligamentoplasty. Clinical and functional results were assessed using the American Orthopaedic Foot & Ankle Society and Karlsson scores. The evertor muscle strength was analyzed, in both treated and healthy contralateral ankles, using isokinetic testing (gold standard) - an open kinetic chain test and a functional closed kinetic chain test (MyoLux). Data were interpreted using the Stata 14.0 software. The American Orthopaedic Foot & Ankle Society score was 88.1 ± 4.5, and the Karlsson score was 89.6 ± 4.0. Isokinetic tests did not show any significant difference between the treated ankles and the healthy one. Functional tests measuring inversion control at the ankle did not demonstrate any functional differences between the 2 ankles. As confirmed by good functional scores and the lack of difference in evertor muscle strength, this study reports that the inferior extensor retinaculum flap ligamentoplasty is a satisfactory treatment of chronic ankle instability. In addition, the MyoLux is a reliable and effective test to properly assess proprioception at the ankle.
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Affiliation(s)
- Jean-Charles Giunta
- Orthopaedic Surgeon, Service de Chirurgie Orthopédique et de Traumatologie du Sport, Urgences, Hôpital Sud, CHU de Grenoble, Echirolles, France.
| | - Benjamin Toschi
- Physiotherapist and Associate Registrar, Laboratoire de Physiologie de l'Exercice (E.A. 4338), Département des Sciences et Techniques des Activités Physiques et Sportives (STAPS), Université de Savoie, France
| | - Paul Moroney
- Orthopedic Surgeon and Foot and Ankle Specialist, Mater Misericordiae University Hospital, Cappagh National Orthopaedic Hospital, Sports Surgery Clinic Santry, Beacon Hospital, Ireland
| | - Yves Tourné
- Orthopedic Surgeon, Institut Grenoblois du Pied et de la Cheville-Centre Ostéo-Articulaire Clinique des Cèdres, Echirolles, France
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11
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A four-step approach improves long-term functional outcomes in patients suffering from chronic ankle instability: a retrospective study with a follow-up of 7-16 years. Knee Surg Sports Traumatol Arthrosc 2021; 29:1612-1616. [PMID: 33242132 DOI: 10.1007/s00167-020-06368-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the present study was to assess the long-term outcomes of the treatment of chronic ankle instability (CAI) with a four-step protocol. METHODS Fifty-four patients with isolated anterior talo-fibular ligament (ATFL) lesion suffering from CAI who underwent surgical treatment between 2000 and 2009 were assessed. All the patients underwent a four-step protocol including synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and nonweightbearing. Median age at surgery was 31.6 years (18-48). Patients were examined preoperatively and at follow-up. Clinical assessment included the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and objective examination comprehending range of motion (ROM) and manual laxity tests. RESULTS AOFAS (preoperative, 64.8; postoperative, 92.4; p < 0.001) and Karlsson-Peterson score (preoperative, 62.5; postoperative, 88.8; p < 0.001) significantly improved after a median 11 years follow-up (7-16 years). Similarly median Tegner activity level significantly increased at follow-up compared to pre-operatory status (6.0 and 4.0 respectively, p < 0.001). Objective examination documented a statistically significant improvement in terms of ankle stability compared to pre-operative manual laxity tests, with negative anterior drawer test observed in 48 (88.9%) patients (p < 0.001). Sagittal ROM was full in 50 patients (92%). Nine patients had subsequent ankle sprains (15.6%), two patients required further surgery, while seven were treated conservatively. No major complications were reported. CONCLUSION Satisfying subjective and objective clinical outcomes in selected patients with isolated ATFL lesion suffering from CAI were reported with a treatment protocol including arthroscopic synovectomy, debridement of ATFL remnants, capsular shrinkage, and immobilization. These findings are of clinical relevance because they provide a suitable minimally invasive method for the treatment of mild to moderate ankle instability. LEVEL OF EVIDENCE Level IV.
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12
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Sigonney F, Lopes R, Bouché PA, Kierszbaum E, Moslemi A, Anract P, Stein A, Hardy A. The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproducible scale to quantify psychological readiness before returning to sport after ankle ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:4003-4010. [PMID: 32356045 PMCID: PMC7669765 DOI: 10.1007/s00167-020-06020-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/21/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE Chronic ankle instability is the main complication of ankle sprains and requires surgery if non-operative treatment fails. The goal of this study was to validate a tool to quantify psychological readiness to return to sport after ankle ligament reconstruction. METHODS The form was designed like the anterior cruciate ligament-return to sport after injury scale and "Knee" was replaced by the term "ankle". The ankle ligament reconstruction-return to sport after injury (ALR-RSI) scale was filled by patients who underwent ankle ligament reconstruction and were active in sports. The scale was then validated according to the international COSMIN methodology. The AOFAS and Karlsson scores were used as reference questionnaires. RESULTS Fifty-seven patients (59 ankles) were included, 27 women. The ALR-RSI scale was strongly correlated with the Karlsson score (r = 0.79 [0.66-0.87]) and the AOFAS score (r = 0.8 [0.66-0.87]). A highly significant difference was found in the ALR-RSI between the subgroup of 50 patients who returned to playing sport and the seven who did not: 68.8 (56.5-86.5) vs 45.0 (31.3-55.8), respectively, p = 0.02. The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.92; 95% CI [0.86-0.96]). CONCLUSION The ALR-RSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after ankle ligament reconstruction. This scale may help to identify athletes who will find sport resumption difficult. LEVEL OF EVIDENCE III.
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Affiliation(s)
- François Sigonney
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Ronny Lopes
- Orthopaedic Department, Pied Cheville Nantes Atlantique (Santé Atlantique Et Clinique Bretéché), Nantes, France
| | - Pierre-Alban Bouché
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Elliott Kierszbaum
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Aymane Moslemi
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Philippe Anract
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Alexandra Stein
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Alexandre Hardy
- Clinique du Sport, 36 boulevard Saint-Marcel, 75005, Paris, France
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13
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Kanzaki N, Chinzei N, Yamashita T, Kumai T, Kuroda R. A Novel Technique of Arthroscopic Ankle Lateral Ligament Repair Using a Knotless Suture Anchor. Orthop J Sports Med 2020; 8:2325967120962079. [PMID: 33225007 PMCID: PMC7658529 DOI: 10.1177/2325967120962079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Although arthroscopic lateral ligament repair (ALLR) with suture anchors for chronic lateral ankle instability has become widely accepted, some complications have been reported as well. Establishment of a new technique is essential for better clinical outcomes after ALLR. Purpose To report a novel technique and good clinical results of ALLR using a knotless suture anchor. Study Design: Case series; Level of evidence, 4. Methods: We examined 30 patients (16 men and 14 women) who underwent ALLR. The mean age of the patients was 30.0 years, and the average period of postoperative monitoring was 21 months. The Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale was used for clinical evaluation postoperatively, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for patient-reported results. Surgical complications were also examined. Results: The JSSF ankle-hindfoot scale showed a significant improvement from preoperatively to follow-up (from 72.1 to 96.1; P < 0.001), and the SAFE-Q was significantly improved in all subscales (pain and pain-related, physical function and daily living, social function, shoe-related, and general health and well-being; P < 0.004 for all). Complications included residual joint pain due to remaining osteophytes in 1 case, scar pain of the accessory anterolateral portal in 2 cases, and positive Tinel sign indicative of superficial peroneal nerve irritation at the anterolateral portal in 1 case. Conclusion: The clinical results of the novel ALLR technique were overall satisfactory. Knot-related complications, one of the main reasons for postoperative complications, were reduced by using a knotless suture anchor.
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Affiliation(s)
- Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuaki Chinzei
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Kobe, Japan
| | - Takahiro Yamashita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tsukasa Kumai
- Faculty of Sports Sciences, WASEDA University, Saitama, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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14
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Johns WL, Walley KC, Seedat R, Jackson B, Boukhemis K, Gonzalez T. Tranexamic Acid Use in Foot and Ankle Surgery. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420975419. [PMID: 35097417 PMCID: PMC8564923 DOI: 10.1177/2473011420975419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is a potential role for tranexamic acid (TXA) use in foot and ankle procedures; however, the benefits of this intervention have not been fully elucidated. The purpose of this study was to explore the safety, outcomes, and medical complication profile of the use of intravenous TXA in patients undergoing foot and ankle surgery. Methods: A prospective study with retrospective review of 241 patients undergoing elective and traumatic foot and ankle procedures was performed. One gram of intravenous (IV) TXA was administered prior to incision. Patients were followed and evaluated for medical comorbidities, intraoperative blood loss, wound complication, superficial and deep infections, hematoma formation, medical complications, 30-day hospital readmission rate, and return visits to the emergency department or urgent care setting prior to first postoperative visit. Descriptive statistics were used for subgroup analysis. Mean postoperative follow-up was 4.5 months. Results: Estimated blood loss in all cases was less than 20 mL. There was 1 case of superficial cellulitis (1/241, 0.4%), 1 deep infection after Achilles tendon repair (1/241, 0.4%), 4 cases of delayed wound healing (4/241, 1.6%), 1 instance of deep vein thrombosis (1/241, 0.4%), and 2 cases of postoperative pulmonary embolism (2/241, 0.8%). There were no instances of postoperative hematoma formation. There were no additional recorded thromboembolic events. There were no adverse drug reactions. There were no 30-day hospital readmissions or return visits to the emergency department or urgent care setting before the first postoperative visit. In a subgroup analysis, there was no significant difference in wound complications or infections between nondiabetics and diabetics (P > .05) and traumatic and nontraumatic cases (P > .05). Conclusions: The use of IV TXA in foot and ankle surgeries was associated with low risk of wound complications, infections, hematoma formation, thromboembolic events, and overall complication rates with minimal side effect profile. Perioperative tranexamic acid use may prove to be beneficial in foot and ankle surgery patients but especially in higher-risk patients such as those with diabetes, trauma, and those that are immunocompromised. Level of Evidence: Level IV, case series.
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Affiliation(s)
- William L Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Raees Seedat
- Virginia Commonwealth University, School of Medicine, Richmond, VA, USA
| | - Benjamin Jackson
- University of South Carolina, School of Medicine, Columbia, SC, USA
| | | | - Tyler Gonzalez
- University of South Carolina, School of Medicine, Columbia, SC, USA
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15
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Feng SM, Sun QQ, Wang AG, Chang BQ, Cheng J. Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium- and Long-Term Functional Follow-Up. Orthop Surg 2020; 12:505-514. [PMID: 32124530 PMCID: PMC7189041 DOI: 10.1111/os.12651] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium‐ and long‐term follow‐up. Methods From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles, 25 right ankles) aged between 21 and 56 years, with an average age of 32.17 ± 6.35 years, presenting with CLAI, was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07 ± 13.29 months. All patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair of ATFL, with the fixation of one to two anchors. Pre‐ and post‐operative visual analogue scales (VAS), the American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation. Results The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average of 51.25 ± 11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve, blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77 ± 1.36 days. All patients were followed for 24 to 45 months, averaging 33.16 ± 10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow‐up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12 ± 0.13, the AOFAS score increased to 92.53 ± 4.87, and the KAFS score increased to 93.36 ± 6.15. All the follow‐up indexes were significantly different from those before surgery. Conclusion Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable medium‐ and long‐term effect.
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Affiliation(s)
- Shi-Ming Feng
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China.,Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Qing-Qing Sun
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China
| | - Ai-Guo Wang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China.,Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Bu-Qing Chang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China
| | - Jian Cheng
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China
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16
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Evaluation modalities for the anatomical repair of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:163-176. [PMID: 31646350 DOI: 10.1007/s00167-019-05755-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/07/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Several evaluation modalities are reported in the literature dealing with the operative treatment of chronic ankle instability (CAI) both to establish the CAI diagnosis leading to the surgical indication and to assess the effectiveness of ankle stabilisation procedure. The purpose of this study is to present an overview of the pre- and postoperative evaluation modalities reported in the literature dealing with CAI operative treatment. The comprehensive analysis of the different modalities chosen by researchers is expected to suggest critical points in current evaluation ability of CAI surgical treatment. METHODS Systematic review of the literature on surgical treatment of CAI through anatomic procedures. Pubmed, Embase and Cochrane electronic databases were analysed, from 2004 to 2018. RESULTS One-hundred-and-four studies met inclusion in this systematic review. 88 out of 104 studies analysed preoperative mechanical laxity of the ankle to depict the ligamentous insufficiency related to the subjective feeling of functional instability. Stress radiographs and manual stress examination of the ankle were the two most common modalities to evaluate joint laxity, reported in 67 and 53 studies, respectively. Clinical Outcome Measurement Scales (COMs) is the most common evaluation modality (102 out of 104 studies) to assess CAI surgical outcome. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS) and the Karlsson score are the most frequent COMs, reported in the 66% and 33%, respectively of the included literature. The radiographic analysis of ankle laxity after stabilisation procedures is the second most frequent postoperative evaluation modality, reported in 55 out 104 studies. CONCLUSIONS There is a lack of standardization among researchers related to both the criteria to establish the CAI diagnosis leading to the surgical indication and the modality chosen to evaluate the effectiveness of surgical treatment. Future standardization of evaluation modalities in the CAI population is desirable to increase consistency of reported data. LEVEL OF EVIDENCE Level IV, review of level I, II, III and IV studies.
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17
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Endoscopic anatomic ligament reconstruction is a reliable option to treat chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:86-92. [PMID: 31728603 DOI: 10.1007/s00167-019-05793-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/06/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Anatomic reconstruction of the anterior talofibular ligament and calcaneofibular ligament is a valid treatment of chronic hindfoot instability. The purpose of this study was to investigate the outcomes of this procedure performed by an all-inside endoscopic technique. METHODS This study is a retrospective evaluation of a prospective database. Subjects were all patients who underwent an endoscopic lateral ligament reconstruction between 2013 and 2016. All patients had symptoms of ankle instability with positive manual stress testing and failed nonoperative treatment during at least 6 months. At final follow-up the outcome was assessed using the visual analogue score (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Karlsson-Peterson scores. RESULTS After an average follow-up of 31.5 ± 6.9 months, all patients reported significant improvement compared to their preoperative status. The preoperative AOFAS score improved from 76.4 ± 15 to 94.7 ± 11.7 postoperatively (p = 0.0001). The preoperative Karlsson-Peterson score increased from 73.0 ± 16.0 to 93.7 ± 10.6 postoperatively (p = 0.0001). The VAS score improved from 1.9 ± 2.5 to 0.8 ± 1.7 (p < 0.001). Two patients had complaints of recurrent instability. CONCLUSION Endoscopic ligament reconstruction for chronic lateral ankle instability is a safe procedure and produces good clinical results with minimal complications. In addition, the endoscopic approach allows an assessment of the ankle joint and treatment of associated intra-articular lesions. LEVEL OF EVIDENCE II.
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18
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Ventura A, Legnani C, Corradini C, Borgo E. Lateral ligament reconstruction and augmented direct anatomical repair restore ligament laxity in patients suffering from chronic ankle instability up to 15 years from surgery. Knee Surg Sports Traumatol Arthrosc 2020; 28:202-207. [PMID: 30377717 DOI: 10.1007/s00167-018-5244-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the present study was to compare the outcomes of patients who underwent augmented direct anatomical repair using a Broström-Gould procedure with those who underwent lateral ligament reconstruction using a split peroneus brevis tendon for the treatment of chronic ankle instability. METHODS Forty patients aged 18-40 years underwent surgical treatment for chronic lateral ankle instability between 1997 and 1998: 20 patients underwent direct anatomical repair using Broström-Gould procedure (Group A); 20 patients underwent lateral tenodesis using a split peroneus brevis tendon (Group B). Median age at surgery was 22.6 years (range 18-40). Patients were assessed pre-operatively and 15 years after surgery with functional assessment including AOFAS scale, Karlsson-Peterson score, Tegner activity level, Sefton stability scale, and objective examination comprehending ROM, anterior drawer sign and talar tilt test. Telos Stress equipment was used for pre- and post-operative radiographic laxity testing. RESULTS No major complications were reported. Mean overall AOFAS, Karlsson-Peterson and Tegner scores significantly increased at follow-up compared to pre-operatory status, although no statistically significant differences concerning these variables were reported between the two groups. Sagittal ROM was full in 36 patients: 4 subjects in the Group B experienced 5 degrees dorsiflexion limitation compared to the contralateral side. Patients treated with lateral tenodesis reported a statistically significant reduction in the values of radiographic anterior talar translation (1.4 mm, SD: 0.9) compared to patients in Group A (5.7 mm, SD: 1.1, p < 0.001). CONCLUSION Augmented direct anatomical repair and lateral tenodesis provide satisfying long-term outcomes in terms of subjective and objective parameters up to 15 years from surgery in patients with chronic ankle instability without leading to significant artrhitic changes. Objectively, lateral tenodesis appears to improve more effectively restoration of laxity; the reduced ROM reported in 20% of patients did not considerably affect the overall functional outcome. LEVEL OF EVIDENCE Comparative case series, Level III.
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Affiliation(s)
- Alberto Ventura
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy
| | - Claudio Legnani
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy.
| | - Costantino Corradini
- ASST Gaetano Pini, 1st University Division of Orthopaedics and Traumatology, Milan, Italy
| | - Enrico Borgo
- IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy
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19
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Song Y, Li H, Sun C, Zhang J, Gui J, Guo Q, Song W, Duan X, Wang X, Wang X, Shi Z, Hua Y, Tang K, Chen S. Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data. Orthop J Sports Med 2019; 7:2325967119873852. [PMID: 31579683 PMCID: PMC6757505 DOI: 10.1177/2325967119873852] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered. Purpose: To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI. Study Design: A consensus statement of the Chinese Society of Sports Medicine. Methods: A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized. Results: A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded. Conclusion: This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.
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Affiliation(s)
- Yujie Song
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Chao Sun
- Beijing Tongren Hospital, Beijing, China
| | - Jian Zhang
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Jianchao Gui
- Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China
| | - Qinwei Guo
- Peking University Third Hospital, Beijing, China
| | - Weidong Song
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaojun Duan
- Southwest Hospital Affiliated to Army Medical University, Chongqing, China
| | - Xiaoqin Wang
- Huashan Hospital Fudan University, Shanghai, China
| | | | - Zhongming Shi
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | | | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Kanglai Tang
- Southwest Hospital Affiliated to Army Medical University, Chongqing, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
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20
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Krähenbühl N, Weinberg MW, Davidson NP, Mills MK, Hintermann B, Saltzman CL, Barg A. Currently used imaging options cannot accurately predict subtalar joint instability. Knee Surg Sports Traumatol Arthrosc 2019; 27:2818-2830. [PMID: 30367197 DOI: 10.1007/s00167-018-5232-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/17/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To give a systematic overview of current diagnostic imaging options and surgical treatment for chronic subtalar joint instability. METHODS A systematic literature search across the following sources was performed: PubMed, ScienceDirect, and SpringerLink. Twenty-three imaging studies and 19 outcome studies were included. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS 2) tool was used to assess the methodologic quality of the imaging articles, while the modified Coleman Score was used to assess the methodologic quality of the outcome studies. RESULTS Conventional radiographs were most frequently used to assess chronic subtalar joint instability. Talar tilt, anterior talar translation, and subtalar tilt were the three most commonly used measurement methods. Surgery often included calcaneofibular ligament reconstruction. CONCLUSION Current imaging options do not reliably predict subtalar joint instability. Distinction between chronic lateral ankle instability and subtalar joint instability remains challenging. Recognition of subtalar joint instability as an identifiable and treatable cause of ankle pain requires vigilant clinical investigation. LEVEL OF EVIDENCE Systematic Review of Level III and Level IV Studies, Level IV.
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Affiliation(s)
- Nicola Krähenbühl
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Maxwell W Weinberg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nathan P Davidson
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N. 1900 E. #1A071, Salt Lake City, UT, 84132, USA
| | - Beat Hintermann
- Department of Orthopaedics, Kantonsspital Baselland, Rheinstrasse 26, 4410, Liestal, Switzerland
| | - Charles L Saltzman
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
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21
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Dromzée E, Granger B, Rousseau R, Steltzlen C, Stolz H, Khiami F. Long-Term Results for Treatment of Chronic Ankle Instability With Fibular Periosteum Ligamentoplasty and Extensor Retinaculum Flap. J Foot Ankle Surg 2019; 58:674-678. [PMID: 30962108 DOI: 10.1053/j.jfas.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Indexed: 02/03/2023]
Abstract
Long-term results of anatomic reconstruction for chronic ankle instability are good, but no study has shown the results of fibular periosteum ligamentoplasty associated with extensor retinaculum flap at long-term follow-up. To demonstrate the efficacy of fibular periosteum ligamentoplasty and extensor retinaculum flap in chronic lateral instability, 40 patients underwent surgery for ankle instability. Thirty-three (82.5%) patients were reviewed, with a median follow-up duration of 8.2 (range 4 to 13) years. Functional results were assessed using the Karlsson score. Static and dynamic x-ray images were realized to measure varus tilt and anterior drawer, and osteoarthritis was evaluated with the van Dijk classification. The median Karlsson score was 95 (range 80 to 100). The mean decrease in varus laxity was 11° (range 0 to 18) and in anterior drawer was 1 (range -8 to 4) mm. At the last follow-up visit, 3 (7.5%) patients showed an evidence of osteoarthritis according to the preoperative criteria of the van Dijk classification (grade 2) and 6 (15%) patients had radiologic changes, without narrowing of the joint space (grade 1). Studies that have a follow-up time >5 years are rare. This study shows that despite the excellent control of ankle laxity, severe radiographic changes (grade 2) continue to evolve in the long term. This study indicates a good long-term outcome but suggests the need to monitor the occurrence of osteoarthritis over the long term.
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Affiliation(s)
- Eric Dromzée
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, University Hospital of Geneva, Geneva, Switzerland
| | - Benjamin Granger
- Biostatician, Department of Biostatistics, Public Health and Medical Information, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Rousseau
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Camille Steltzlen
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hadrien Stolz
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, University Hospital of Geneva, Geneva, Switzerland
| | - Frédéric Khiami
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Tourné Y, Peruzzi M. Lateral collateral ligament repair. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:169-179. [DOI: 10.1007/s00064-019-0599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lopes R, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Thès A, Elkaïm M, Boniface O, Guillo S, Bauer T. Arthroscopic treatment of chronic ankle instability: Prospective study of outcomes in 286 patients. Orthop Traumatol Surg Res 2018; 104:S199-S205. [PMID: 30245066 DOI: 10.1016/j.otsr.2018.09.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is the main complication of ankle sprains and requires surgery if non-operative treatment fails. Surgical ankle stabilisation techniques can be roughly classified into two groups, namely, repair involving retensioning and suturing of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) and reconstruction using a tendon graft. Arthroscopic repair and reconstruction techniques for CAI have been introduced recently. The objective of this prospective multicentre study was to assess the feasibility, morbidity, and short-term outcomes of these arthroscopic ankle-stabilisation techniques. MATERIAL AND METHODS Consecutive patients scheduled for arthroscopic treatment of CAI were included prospectively. Of the 286 included patients, 115 underwent ligament repair and 171 ligament reconstruction. Mean follow-up was 9.6 months (range, 6-43 months). We recorded the AOFAS and Karlsson scores, patient satisfaction, complications, and time to return to sports. RESULTS The overall patient satisfaction score was 8.5/10. The AOFAS and Karlsson scores improved significantly between the pre- and postoperative assessments, from 62.1 to 89.2 and from 55 to 87.1, respectively. These scores were not significantly different between the groups treated by repair and by reconstruction. Neurological complications occurred in 10% of patients and consisted chiefly in transient dysesthesia (with neuroma in 3.5% of patients). Cutaneous or infectious complications requiring surgical revision developed in 4.2% of patients. DISCUSSION Arthroscopic treatment is becoming a method of choice for patients with CAI, as it allows a comprehensive assessment of the ligament lesions, the detection and treatment of associated lesions, and repair or reconstruction of the damaged ligaments. These simple, reliable, and reproducible arthroscopic techniques seem as effective as conventional surgical techniques. The rate of cutaneous complications is at least halved compared to open surgery. CONCLUSION Arthroscopic ankle stabilisation repair and reconstruction techniques hold considerable promise but require further evaluation to better determine the indications of repair versus reconstruction and to obtain information on long-term outcomes.
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Affiliation(s)
- Ronny Lopes
- Polyclinique de l'atlantique (PCNA), avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Michael Andrieu
- Clinique Pont-de-Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France
| | - Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - François Molinier
- Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - André Thès
- Hôpital privé d'Eure-et-Loir, 2, rue Roland-Buthier, 28300 Mainvilliers, France; Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, AP-HP, groupe hospitalier universitaire Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Elkaïm
- Clinique de Tournan, 2, rue Jules-Lefebvre, 77220 Tournan-en-Brie, France
| | - Olivier Boniface
- Clinique Générale-Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France
| | - Stéphane Guillo
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, AP-HP, groupe hospitalier universitaire Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Sperati G, Ceri L. Hemi-Castaing ligamentoplasty for the surgical treatment of chronic lateral ankle instability in young athletes: our 7 years experience. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 90:141-145. [PMID: 30715013 PMCID: PMC6503395 DOI: 10.23750/abm.v90i1-s.7828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Abstract
Background and aim of the work: in this study we report our 7-years experience (from January 2011 to December 2017) of 35 patients with chronic lateral ankle instability treated with the Hemi-Castaing reconstruction procedure, all performed in our clinic. Methods: thirty-five patients (F12-M23; median age around 31 yrs, range 18-52 yrs). All patients used to practice amateur sports at competitive level. The procedures were performed in 19 cases on the right ankle whereas in 16 cases on the left ankle. The average follow-up was 54.2 months. Results: of the 35 patients included in our study, all of them were able to practice sport as the same level as before from 80 to 100 days after intervention. Optimal functional results were achieved in all patients and no further episodes of ankle sprain occurred. All patients rated their outcome as good/excellent. No intra-operative complications were observed, whereas we noticed a case of surgical wound dehiscence after surgery. The Hemi-Castaing procedure provided a high lateral ankle stability, with excellent clinical and functional results. In our study, no significant difference in evertor strength was found according to side, and there was no significant change in E/I ratio. Moreover, joint position sense was not impaired. Conclusion. According to us, this surgical technique is efficient and safe, providing remarkable outcomes in the treatment of chronic lateral ankle instability. (www.actabiomedica.it)
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Affiliation(s)
- Gianluca Sperati
- Unit of Orthopaedics and Traumatology, "Prof Nobili" Private Hospital, Castiglione dei Pepoli, Bologna, Italy.
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Noailles T, Lopes R, Padiolleau G, Gouin F, Brilhault J. Non-anatomical or direct anatomical repair of chronic lateral instability of the ankle: A systematic review of the literature after at least 10 years of follow-up. Foot Ankle Surg 2018; 24:80-85. [PMID: 29409255 DOI: 10.1016/j.fas.2016.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 07/11/2016] [Accepted: 10/27/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A lateral ankle sprain is one of the most frequent reasons for consultation at the emergency trauma unit. Numerous surgical procedures have been described with long-term outcomes that differ. HYPOTHESIS The long-term results of anatomical repair of the anterior talofibular ligament (ATFL) and the calcaneofibular (CFL) ligament are better, with less secondary radiological osteoarthritis than non-anatomical repair. MATERIALS AND METHODS A review of the literature after a minimum follow-up of 10 years was performed to analyze the clinical and radiological results of direct anatomical repair (Broström, Duquennoy) and non-anatomical repair (Watson Jones, Evans, Castaing). Thirteen articles were selected. RESULTS Eight hundred and one ankles were evaluated after a mean follow-up of 15.3 years. The functional outcome was better after anatomical repair but with recurrent instability. Loss of range of motion and secondary osteoarthritis was more frequent after non-anatomical repair. CONCLUSION Anatomical repair of the lateral collateral ligament of the ankle resulted in a better functional outcome and less secondary osteoarthritis than non-anatomical repair. STUDY DESIGN Review of the literature; level of proof IV.
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Affiliation(s)
- Thibaut Noailles
- Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44000 Nantes, France.
| | - Ronny Lopes
- Clinique Brétéché, 3 rue de la Béraudière, 44000 Nantes, France
| | - Giovanni Padiolleau
- Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - François Gouin
- Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Jean Brilhault
- Université F. Rabelais & C.H.R.U Tours, 1 Hôpital Trousseau, 37044 Tours Cedex 09, France.
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Abstract
Participation in sports activity has increased significantly during the last several decades. This phenomenon has exposed orthopedic sports medicine surgeons to new challenges regarding the diagnosis and management of common sport-related injuries. Arthroscopy is becoming more commonly used in many of the surgical procedures for these injuries and carries the risk of complications. Wound and nerve complications make up the bulk of complications in most procedures. This article describes these complications associated with the common surgical procedures related to foot and ankle sport-related injuries and how to address and prevent them.
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Lopes R, Noailles T, Brulefert K, Geffroy L, Decante C. Anatomic validation of the lateral malleolus as a cutaneous marker for the distal insertion of the calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 2018; 26:869-874. [PMID: 27497693 DOI: 10.1007/s00167-016-4250-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE An anatomic study was performed to confirm whether the lateral malleolus could serve as a simple and reproducible anatomic reference for the distal insertion of the calcaneofibular ligament (CFL). METHODS Dissection was performed after placement of a Kirschner wire to simulate the calcaneal tunnel for the distal insertion of the CFL. The skin was penetrated 1 cm distal and posterior to the tip of the lateral malleolus. The main information recorded was the distance from the Kirschner wire to the centre of the distal insertion of the CFL. Other elements were noted (characteristics of the CFL, distance between the distal insertion of the CFL-peroneal tubercle, nerve or tendon injuries). RESULTS Thirty ankles were dissected. The mean distance from the Kirschner wire to the centre of the distal insertion of the CFL was 2.4 ± 1.8 mm. Only one case of peroneal injury was noted. The sural nerve was usually located a mean 1.8 ± 1.1 mm from the Kirschner wire. The posterior tibial vascular pedicle was a mean 27.8 ± 3.5 mm from the point of exit of the Kirschner wire. CONCLUSION Using the lateral malleolus as the cutaneous reference for the distal insertion of the CFL seems to be more reliable than the pure arthroscopic technique. This study describes a percutaneous technique to obtain a calcaneal tunnel for distal insertion of the CFL. The sural nerve is at the greatest risk of injury with this technique and requires careful subcutaneous incision to prevent injury. This new percutaneous technique is less invasive than a purely arthroscopic technique and more accurately identifies the location of the tunnel. It can be used to do calcaneal tunnel in clinical practice during anatomic ligament reconstruction for chronic ankle instability.
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Affiliation(s)
- R Lopes
- Department of Orthopaedic Surgery, Breteche Clinic, 3 rue de la Béraudière, 44000, Nantes, France.
| | - T Noailles
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - K Brulefert
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - L Geffroy
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - C Decante
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
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Vuurberg G, Pereira H, Blankevoort L, van Dijk CN. Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc 2018; 26:2183-2195. [PMID: 29138918 PMCID: PMC6061442 DOI: 10.1007/s00167-017-4730-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/25/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the best surgical treatment for chronic ankle instability (CAI) a systematic review was performed to compare the functional outcomes between various surgical stabilization methods. METHODS A systematic search was performed from 1950 up to April 2016 using PubMed, EMBASE, Medline and the Cochrane Library. Inclusion criteria were a minimum age of 18 years, persistent lateral ankle instability, treatment by some form of surgical stabilization, described functional outcome measures. Exclusion criteria were case reports, (systematic) reviews, articles not published in English, description of only acute instability or only conservative treatment, medial ankle instability and concomitant injuries, deformities or previous surgical treatment for ankle instability. After inclusion, studies were critically appraised using the Modified Coleman Methodology Score. RESULTS The search resulted in a total of 19 articles, including 882 patients, which were included in this review. The Modified Coleman Methodology Score ranged from 30 to 73 points on a scale from 0 to 90 points. The AOFAS and Karlsson Score were the most commonly used patient-reported outcome measures to assess functional outcome after surgery. Anatomic repair showed the highest post-operative scores [AOFAS 93.8 (SD ± 2.7; n = 119); Karlsson 95.1 (SD ± 3.6, n = 121)], compared to anatomic reconstruction [AOFAS 90.2 (SD ± 10.9, n = 128); Karlsson 90.1 (SD ± 7.8, n = 35)] and tenodesis [AOFAS 86.5 (SD ± 12.0, n = 10); Karlsson 85.3 (SD ± 2.5, n = 39)]. Anatomic reconstruction showed the highest score increase after surgery (AOFAS 37.0 (SD ± 6.8, n = 128); Karlsson 51.6 (SD ± 5.5, n = 35) compared to anatomic repair [AOFAS 31.8 (SD ± 5.3, n = 119); Karlsson 40.9 (SD ± 2.9, n = 121)] and tenodesis [AOFAS 19.5 (SD ± 13.7, n = 10); Karlsson 29.4 (SD ± 6.3, n = 39)] (p < 0.005). CONCLUSION Anatomic reconstruction and anatomic repair provide better functional outcome after surgical treatment of patients with CAI compared to tenodesis reconstruction. These results further discourage the use of tenodesis reconstruction and other non-anatomic surgical techniques. Future studies may be required to indicate potential value of tenodesis reconstruction when used as a salvage procedure. Not optimal, but the latter still provides an increase in functional outcome post-operatively. Anatomic reconstruction seems to give the best results, but may be more invasive than anatomic repair. This has to be kept in mind when choosing between reconstruction and repair in the treatment of CAI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- G. Vuurberg
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - H. Pereira
- Centro Hospitalar Póvoa de Varzim – Vila do Conde, Póvoa de Varzim, Portugal ,ICVS/3B’s—PT Government Associated Laboratory, University of Minho, Braga, Guimarães, Portugal ,Ripoll y De Prado Sports Clinic: Murcia-Madrid—FIFA Medical Center of Excellence, Madrid, Spain
| | - L. Blankevoort
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - C. N. van Dijk
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands ,Ripoll y De Prado Sports Clinic: Murcia-Madrid—FIFA Medical Center of Excellence, Madrid, Spain
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Yasui Y, Murawski CD, Wollstein A, Kennedy JG. Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures. Knee Surg Sports Traumatol Arthrosc 2017; 25:1908-1915. [PMID: 27311448 DOI: 10.1007/s00167-016-4207-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/08/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Over 50 % of the patients with chronic lateral ankle instability present with some degree of intra-articular pathology. To date, no consensus regarding the concomitant ankle arthroscopy procedures along with ankle ligament procedures has been reached. The purpose of current study was to investigate reoperation rates and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures. METHODS Reoperations and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures were investigated using the PearlDiver Patient Record Database (PearlDiver Technologies, Inc.; Fort Wayne, IN, USA) between 2007 and 2011. Ankle ligament procedures, including ligament repair and reconstruction, and ankle arthroscopic procedures were investigated as primary surgery. Subsequently, the reoperation procedures, including ankle ligament procedures, arthroscopic procedures, autologous osteochondral transplantation, and ankle arthrodesis, as well as wound complications and nerve injury following primary ankle ligament procedures were identified. RESULTS In 8014 patients receiving ligament repair, the arthroscopic group had a significantly higher reoperation rate in comparison with the non-arthroscopic group (8.8 vs. 6.5 %, odds ratio: 1.1, [p < 0.01], 95 % confidence interval (CI) 1.2-1.7). However, the non-arthroscopic group included 29 open arthrodesis procedures following the primary surgery, whereas arthroscopic group had none. Of the 8055 patients who received a ligament reconstruction, there was no significant difference in reoperation rate between the groups (5.9 vs. 5.9 %, odds ratio: 1.0, [n.s], 95 % CI 0.8-1.2). As seen in the ligament repair group, the non-arthroscopic group had a 4.9 % rate of ankle arthrodesis as a secondary procedure. Arthroscopic group had a significantly lower rate of wound dehiscence following ankle ligament procedures than non-arthroscopic group. CONCLUSION Concomitant ankle arthroscopy procedures performed with ankle ligament procedures did not decrease the rate of reoperation. However, there was a lower incidence of ankle arthrodesis and a lower rate of wound complications in the arthroscopic group when compared to those in non-arthroscopic group. Based on the results of the study, which analysed 16.069 patients, concomitant ankle arthroscopy is recommended. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Youichi Yasui
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Christopher D Murawski
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adi Wollstein
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John G Kennedy
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
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Vuurberg G, Veen OC, Pereira H, Blankevoort L, van Dijk CN. Tenodesis reconstruction in patients with chronic lateral ankle instability is associated with a high risk of complications compared with anatomic repair and reconstruction: a systematic review and meta-analysis. J ISAKOS 2017. [DOI: 10.1136/jisakos-2016-000121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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All-arthroscopic anatomical reconstruction of anterior talofibular ligament using semitendinosus autografts. INTERNATIONAL ORTHOPAEDICS 2017; 41:975-982. [DOI: 10.1007/s00264-017-3410-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/20/2017] [Indexed: 12/26/2022]
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Tourné Y, Mabit C. Lateral ligament reconstruction procedures for the ankle. Orthop Traumatol Surg Res 2017; 103:S171-S181. [PMID: 27871968 DOI: 10.1016/j.otsr.2016.06.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/05/2016] [Accepted: 06/10/2016] [Indexed: 02/02/2023]
Abstract
Capsule/ligament lesions of the lateral compartment of the ankle lead to lateral laxity, which is a prime contributor to chronic ankle instability. Lateral ligament reconstruction stabilizes the joint. Exhaustive preoperative clinical and paraclinical work-up is essential. The present article classifies, presents and criticizes the main techniques in terms of long-term stabilization and reduction of osteoarthritis risk. Anatomic ligament repair with reinforcement (mainly extensor retinaculum) or anatomic ligament reconstruction are the two recommended options. Non-anatomic reconstructions using the peroneus brevis should be abandoned. Arthroscopy is increasingly being developed, but results need assessment on longer follow-up than presently available. Postoperative neuromuscular reprogramming is fundamental to optimal recovery. Finally, the concept of complex ankle instability is discussed from the diagnostic and therapeutic points of view. The various forms of ligament reconstruction failure and corresponding treatments are reported.
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Affiliation(s)
- Y Tourné
- Centre ostéo-articulaire des Cèdres, 5, rue des Tropiques, Parc Galaxie-Sud, 38130 Échirolles, France.
| | - C Mabit
- Service de chirurgie orthopédique et traumatologique, CHU Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France; Laboratoire d'anatomie, faculté de médecine, 2, rue Dr-Marcland, 87025 Limoges, France
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Arthroscopic anatomical reconstruction of the lateral ankle ligaments: A technical simplification. Orthop Traumatol Surg Res 2016; 102:S317-S322. [PMID: 27692587 DOI: 10.1016/j.otsr.2016.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/20/2016] [Indexed: 02/02/2023]
Abstract
Anatomical reconstruction of the lateral ankle ligaments has become a pivotal component of the treatment strategy for chronic ankle instability. The recently described arthroscopic version of this procedure is indispensable to ensure that concomitant lesions are appropriately managed, yet remains technically demanding. Here, we describe a simplified variant involving percutaneous creation of the calcaneal tunnel for the distal attachment of the calcaneo-fibular ligament. The rationale for this technical stratagem was provided by a preliminary cadaver study that demonstrated a correlation between the lateral malleolus and the distal footprint of the calcaneo-fibular ligament. The main objectives are simplification of the operative technique and decreased injury to tissues whose function is crucial to the recovery of proprioception.
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Matheny LM, Johnson NS, Liechti DJ, Clanton TO. Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction. Am J Sports Med 2016; 44:1301-8. [PMID: 26920434 DOI: 10.1177/0363546515627817] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have compared outcomes of Broström-Gould repair and allograft reconstruction. HYPOTHESIS/PURPOSE The purpose of this study was to compare outcomes and revision rates after Broström-Gould lateral ankle ligament repair versus anatomic allograft reconstruction in patients with lateral ankle instability. The hypothesis was that patients who underwent lateral ankle ligament repair would have outcomes and revision rates similar to those of patients who underwent anatomic allograft reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All patients who underwent surgical repair or reconstruction of the anterior talofibular ligament and/or the calcaneofibular ligament by a single surgeon between September 2009 and February 2013 were included in this study. Patients completed a subjective questionnaire at minimum 2 years after ankle surgery. Outcomes measures included the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Lysholm score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, Tegner activity scale, and patient satisfaction with outcome. Detailed surgical data and intraoperative findings were documented at the time of surgery. All data were collected prospectively and reviewed retrospectively. RESULTS A total of 86 patients were included in this study: 45 men and 41 women (mean age, 38 years; range, 19-68 years) with a mean body mass index of 26.5 (range, 17.5-47.1). There were 61 (71%) patients in the repair cohort and 25 (29%) in the reconstruction cohort. There was no significant difference in age or sex between cohorts. Seventy-six (88%) patients had minimum 2-year follow-up (mean follow-up, 3.0 years; range, 2.0-5.3 years). There was no significant difference in FADI (87 vs 91; P = .553), AOFAS (77 vs 82; P = .372), Lysholm score (83 vs 87; P = .110), Tegner activity scale (6 vs 4; P = .271), patient satisfaction (9 vs 10; P = .058), WOMAC (8 vs 5; P = .264), or Short Form-12 PCS (51.3 vs 54.6; P = .169) or MCS (54.8 vs 51.5; P = .239) score between the repair cohort and the reconstruction cohort, respectively. No patient in either cohort underwent revision lateral ligament surgery. CONCLUSION When compared with lateral ankle repair, anatomic allograft reconstruction produced similarly favorable outcomes, including high patient satisfaction, high function and activity levels, and no revision surgeries in either cohort.
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Affiliation(s)
- Lauren M Matheny
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Nicholas S Johnson
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Daniel J Liechti
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Thomas O Clanton
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
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Baray AL, Philippot R, Neri T, Farizon F, Edouard P. The Hemi-Castaing ligamentoplasty for chronic lateral ankle instability does not modify proprioceptive, muscular and posturographic parameters. Knee Surg Sports Traumatol Arthrosc 2016; 24:1108-15. [PMID: 26410098 DOI: 10.1007/s00167-015-3793-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 09/10/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE The Hemi-Castaing ligamentoplasty uses a powerful dynamic stabilizer of the ankle which is the peroneus brevis tendon. To our knowledge, there is no study available evaluating the effects of this type of surgery on proprioceptive, muscular and posturographic parameters. METHODS This case-control study included 39 subjects divided into two groups: the operated (n = 24) and the control group (n = 15). All subjects underwent a clinical, proprioceptive and isokinetic assessment using a CON-TREX dynamometer, and a postural evaluation using the Win-Posturo force platform. RESULTS At a mean period of 23 (SD 5.4) post-operative months, the Karlsson ankle functional score was 84.2 (SD 23.8) and the AOFAS score was 88.1 (SD 16.2). The mean ankle joint position error for operated ankles was from 1.9° (SD 0.9) at 10° of inversion range of motion to 2.5° (SD 1.7) at 20°. It was similar to that achieved in the control group ranging from 2.2° (SD 1) at 10° to 2.3° (SD 1.3) at 20°. No significant loss of ankle eversion strength could be observed after ligamentoplasty. Ankle eversion/inversion ratio when tested under all velocities and contraction modes failed to reveal any statistical difference between the operated and healthy ankles in the patient group, neither between the patient and control groups. CONCLUSIONS This surgical technique achieved excellent functional outcomes. It did not impair the agonist/antagonist balance of ankle muscles, and use of half the peroneus brevis tendon did not lessen the eversion strength. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- Anne-Laure Baray
- Department of Orthopaedic and Trauma Surgery, University Hospital Center of Saint-Etienne, Hôpital Nord Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - Rémi Philippot
- Department of Orthopaedic and Trauma Surgery, University Hospital Center of Saint-Etienne, Hôpital Nord Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.,Laboratory of Exercise Physiology (LPE EA 4338), Lyon University, Saint-Étienne, France
| | - Thomas Neri
- Department of Orthopaedic and Trauma Surgery, University Hospital Center of Saint-Etienne, Hôpital Nord Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France
| | - Frédéric Farizon
- Department of Orthopaedic and Trauma Surgery, University Hospital Center of Saint-Etienne, Hôpital Nord Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.,Laboratory of Exercise Physiology (LPE EA 4338), Lyon University, Saint-Étienne, France
| | - Pascal Edouard
- Laboratory of Exercise Physiology (LPE EA 4338), Lyon University, Saint-Étienne, France.,Sports Medicine Unit, Department of Clinical and Exercise Physiology, University Hospital Center of Saint-Etienne, 42055, Saint-Étienne, France
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Guillo S, Cordier G, Sonnery-Cottet B, Bauer T. Anatomical reconstruction of the anterior talofibular and calcaneofibular ligaments with an all-arthroscopic surgical technique. Orthop Traumatol Surg Res 2014; 100:S413-7. [PMID: 25454336 DOI: 10.1016/j.otsr.2014.09.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 02/02/2023]
Abstract
Arthroscopy is becoming an essential tool for the treatment of chronic lateral ankle instability. It allows the surgeon to determine which ligaments are injured and choose the most appropriate surgical repair technique, and also to assess and treat any associated injuries. Several arthroscopic techniques for lateral ankle ligament repair have recently been developed. As a consequence, it may be possible to carry out complete lateral ligament reconstruction with an all-arthroscopic procedure. Such an arthroscopic lateral ankle ligament reconstruction technique is described in this article.
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Affiliation(s)
- S Guillo
- Clinique du sport, Bordeaux-Mérignac, France
| | - G Cordier
- Clinique du sport, Bordeaux-Mérignac, France
| | - B Sonnery-Cottet
- Centre orthopédique Santy, hôpital privé Jean-Mermoz, Lyon, France
| | - T Bauer
- Service de chirurgie orthopédique et traumatologique, hôpital universitaire Ambroise-Paré, (AP-HP), hôpitaux universitaires Paris-Île-de-France Ouest, Boulogne-Billancourt, France.
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Baray AL, Philippot R, Farizon F, Boyer B, Edouard P. Assessment of joint position sense deficit, muscular impairment and postural disorder following hemi-Castaing ankle ligamentoplasty. Orthop Traumatol Surg Res 2014; 100:S271-4. [PMID: 25155092 DOI: 10.1016/j.otsr.2014.02.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hemi-Castaing ligamentoplasty is a treatment for chronic ankle instability, accused of weakening a powerful stabilizing muscle: the peroneus brevis. OBJECTIVES To assess proprioceptive and muscular impairment following hemi-Castaing and impact on postural control. METHODOLOGY A retrospective series of 21 patients underwent clinical (Karlsson, AOFAS) and proprioceptive assessment with isokinetic assessment (evertors and invertors) on a Con-Trex dynamometer and postural assessment on a Win-Posturo force platform, at a minimum 6 months postsurgery. RESULTS At a mean 18 months' follow-up, mean Karlsson score was 84 and AOFAS score 88. Ankle joint position sense error was less on the operated than on the healthy side. Evertor strength deficit with respect to the healthy side was 4.7% (ns) at 30°/s and 5.7% (ns) at 120°/s in concentric mode and 6.6% (ns) in excentric mode. After surgery, the evertor/invertor ratio was >1 (in favor of the evertors). Postural values were significantly higher for the operated ankle. DISCUSSION-CONCLUSION Hemi-Castaing ligamentoplasty provided excellent clinical and functional results. It did not disturb the agonist/antagonist balance of the ankle muscles, and harvesting a half peroneus brevis did not impair evertor isokinetic force. Joint position sense was not impaired; indeed, deficits with respect to the contralateral side showed improvement. LEVEL OF EVIDENCE Retrospective study.
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Affiliation(s)
- A L Baray
- Service de Chirurgie Orthopédique et Traumatologique, CHU Saint-Etienne, Hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
| | - R Philippot
- Service de Chirurgie Orthopédique et Traumatologique, CHU Saint-Etienne, Hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France; Laboratoire de Physiologie de l'Exercice (LPE EA 4338), Université de Lyon, 42023 Saint-Etienne, France
| | - F Farizon
- Service de Chirurgie Orthopédique et Traumatologique, CHU Saint-Etienne, Hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - B Boyer
- Service de Chirurgie Orthopédique et Traumatologique, CHU Saint-Etienne, Hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | - P Edouard
- Laboratoire de Physiologie de l'Exercice (LPE EA 4338), Université de Lyon, 42023 Saint-Etienne, France; Service de Physiologie Clinique et de l'Exercice, Unité de Médecine du Sport, CHU Saint-Etienne, 42055 Saint-Etienne, France
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Lateral ligament reconstruction with allograft in patients with severe chronic ankle instability. Arch Orthop Trauma Surg 2014; 134:263-8. [PMID: 24357024 DOI: 10.1007/s00402-013-1911-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Chronic ankle instability is a condition of perception of giving way and persistent pain usually following multiple ankle sprains. In case of severe joint laxity, surgical treatment with reconstruction of the lateral ligamental complex is recommended. The aim of this study was to evaluate the functional outcome of patients treated with lateral ligament reconstruction with allograft for severe chronic lateral ankle instability. MATERIALS AND METHODS We performed a retrospective cohort study of ten patients who underwent allograft external non-anatomic ligamentoplasty for severe chronic lateral ankle instability between 2009 and 2011, with an average follow-up of 16.3 months (SD 8.2). Median age at surgery was 29 years (range 25-35). All patients presented both ATFL and CFL lesion. Patients were evaluated using American Orthopaedic Foot and Ankle Society score, Karlsson-Peterson score, Tegner activity level, Sefton stability scale, and objective examination comprehending range of motion, anterior drawer sign and talar tilt test. Telos stress equipment was used for pre- and post-operative radiographic laxity testing. RESULTS Follow-up examination at an average of 16.3 months (SD 8.2) after surgery showed significant improvement of all variables compared to pre-operative values (p < 0.001). Most patients rated their outcome as good/excellent. Telos stress radiographs documented improvement in joint stability. CONCLUSIONS Lateral ligament reconstruction with allograft represents a valid treatment option in patients with severe chronic lateral ankle instability.
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Sofka CM. Postoperative magnetic resonance imaging of the foot and ankle. J Magn Reson Imaging 2013; 37:556-65. [DOI: 10.1002/jmri.23792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/27/2012] [Indexed: 11/06/2022] Open
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Tourné Y, Mabit C, Moroney PJ, Chaussard C, Saragaglia D. Long-term follow-up of lateral reconstruction with extensor retinaculum flap for chronic ankle instability. Foot Ankle Int 2012. [PMID: 23199857 DOI: 10.3113/fai.2012.1079] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic instability is a common complication of lateral ankle sprains. Furthermore, patients often have unrecognized associated lesions affecting the ankle and subtalar joints. Many stabilizing surgical techniques have been described, each with variable results. This article reports the long-term results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap. PATIENTS AND METHODS This is a retrospective, multicenter study. One hundred fifty cases were reviewed at a mean follow-up of 11 years. Functional results were assessed using the Karlsson score. Pre- and postoperative radiological assessment employed stress x-rays to measure varus tilt and anterior drawer and the Van Dijk classification to grade osteoarthrosis. The Stata 10 program was used for statistical analysis. RESULTS A thorough preoperative workup identified ligamentous lesions of the subtalar joint in 30% of cases. At review, 93% of patients were satisfied. Residual instability was present in only 4.8%. Radiographic analysis of both ankles revealed a differential in varus tilt of only 0.12° and in anterior drawer of 0.17~mm. There was no deterioration of the articular surfaces after 11 years of follow-up. CONCLUSION To the authors' knowledge, this is the largest series reported with such a follow-up. This technique addressed both lateral ankle and subtalar instability without sacrificing the peroneal tendons. It protected against progression of posttraumatic arthrosis and provided superior results to other reported techniques in terms of patient satisfaction and residual instability.
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Affiliation(s)
- Yves Tourné
- Groupe Chirurgical République-Grenoble-France, Foot and Ankle Surgery, Grenoble, France.
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Budny AM, Schuberth JM. Autologous split peroneus longus lateral ankle stabilization. J Foot Ankle Surg 2012; 51:588-92. [PMID: 22819615 DOI: 10.1053/j.jfas.2012.05.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Indexed: 02/03/2023]
Abstract
Lateral ankle instability is a common clinical entity, and a variety of surgical procedures are available for stabilization after conservative management fails. Herein the authors reviewed outcomes after performing autologous split peroneus longus lateral ankle stabilization, using a previously described surgical technique to anatomically recreate the anterior talofibular and calcaneofibular ligaments. Twenty-five consecutive patients from 2 surgeons' practices underwent reconstruction between March 2007 and January 2011 with a minimum follow-up of 12 (range 12 to 51) months (mean 29.5 months). Follow-up interviews demonstrated 92.0% good or excellent outcomes with only 8.0% rating the outcome as fair and none as poor; 92.0% had no recurrent sprains or difficulty going up or down hills; 88.0% related no difficulty with uneven ground. The authors conclude that the autologous split peroneus longus lateral ankle stabilization results in a stable ankle with a low rate of complications and high patient satisfaction.
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Affiliation(s)
- Adam M Budny
- Attending Physician, Blair Orthopedics, Altoona, PA 16635, USA.
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Rodriguez-Merchan EC. Chronic ankle instability: diagnosis and treatment. Arch Orthop Trauma Surg 2012; 132:211-9. [PMID: 22057817 DOI: 10.1007/s00402-011-1421-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is a very common injury but still remains an area of debate. QUESTIONS This review aims to define the current diagnosis and treatment of persons with CAI. METHODS A PubMed (MEDLINE) search of the years 2010 and 2011 (1 January 2010 to 15 July 2011) was performed using three keywords: ankle and chronic and instability. The number of articles in English language that was identified was 57. RESULTS Low reliability has been found in effectively testing CAI in a clinical setting. No single force-plate measure is very effective in predicting if an individual had CAI or not. Availability of a nonradiographic device (ankle arthrometer) to measure ankle instability could improve diagnostic accuracy and facilitate decision making in patients with CAI. The sensitivity of magnetic resonance imaging (MRI) may not be adequate to detect lesions in these patients before surgery. In a symptomatic patient, negative results on MRI must be viewed with caution and an arthroscopy may still be required for a definitive diagnosis and treatment. Conservative treatment (rehabilitation, taping, brace) may reduce the occurrence of recurrent ankle sprains and may be effective in managing CAI. In patients with CAI, strengthening of the muscles around the ankle with well-planned proprioceptive exercises helped the patients return to normal living and sports activities, and prevents unnecessary surgery, especially in cases with functional instability. There is no consensus regarding optimum surgical treatment for CAI, but all of them often have good results. CONCLUSIONS Conservative treatment of patients with CAI must be the first-line therapy. Surgical treatment must be indicated only when conservative treatment fails.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital, Paseo de Castellana 261, 28046 Madrid, Spain.
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Schepers T, Vogels LMM, Van Lieshout EMM. Hemi-Castaing ligamentoplasty for the treatment of chronic lateral ankle instability: a retrospective assessment of outcome. INTERNATIONAL ORTHOPAEDICS 2011; 35:1805-12. [PMID: 21637958 PMCID: PMC3224610 DOI: 10.1007/s00264-011-1284-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 05/17/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE In the treatment of chronic ankle instability, most non-anatomical reconstructions use the peroneus brevis tendon. This, however, sacrifices the natural ankle stabilising properties of the peroneus brevis muscle. The aim of this study was to evaluate the functional outcome of patients treated with a hemi-Castaing procedure, which uses only half the peroneus brevis tendon. METHODS We performed a retrospective cohort study of patients who underwent hemi-Castaing ligamentoplasty for chronic lateral ankle instability between 1993 and 2010, with a minimum of one year follow-up. Patients were sent a postal questionnaire comprising five validated outcome measures: Olerud-Molander Ankle Score (OMAS), Karlsson Ankle Functional Score (KAFS), Tegner Activity Level Score (pre-injury, prior to surgery, at follow-up), visual analog scale on pain (VAS) and the Short Form 36 (SF-36). RESULTS Twenty patients completed the questionnaire on functional outcome. The OMAS showed good to excellent outcome in 80% and the KAFS in 65%, the Tegner Score improved from surgery but did not reach pre-injury levels, the VAS on pain was 1 of 10 and the SF-36 returned to normal compared with the average population. CONCLUSIONS Even though most patients were satisfied with the results, outcome at long-term follow-up was less favourable compared with the literature on anatomical reconstructions. In accordance with the literature, we therefore conclude that the initial surgical treatment of chronic lateral ankle instability should be an anatomical repair with augmentation (i.e. the Broström-Gould technique) and the non-anatomical repair should be reserved for unsuccessful cases after anatomical repair or in cases where no adequate ligament remnants are available for reconstruction.
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Affiliation(s)
- Tim Schepers
- Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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