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Nishikawa DRC, Saito GH, Mendes AAM, Marangon A, Tardini CH, de Oliveira Junior AS, Duarte FA, Prado MP. Functional outcomes and rates of return to sport activities in a non-athlete population after the open Brostrom-Gould repair: a seven-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1957-1962. [PMID: 38472435 DOI: 10.1007/s00590-024-03882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION After an ankle sprain, up to 20% of patients may develop chronic lateral ankle instability (CLAI) requiring surgical treatment. The objective of this study was to investigate the functional outcomes and rates of return to sport activities in a cohort of non-athlete patients with chronic lateral ankle instability (CLAI) who underwent the opened Brostrom-Gould technique (BGT). MATERIALS AND METHODS Seventy-nine patients (seventy-nine feet) from three different centers undergoing BGT were reviewed. For clinical and functional analysis, the AOFAS ankle-hindfoot scale was applied and rates of return to sport activities were assessed. Correlation of Δ-AOFAS and rates of return to sport activities with all variables analyzed was performed. RESULTS Mean AOFAS score improved from 64.6 to 97.2 (p < 0.001). Sixty-one (77.2%) returned to preinjury activities and 18 (22.8%) changed to a lower-level modality. Symptoms of instability were related to Δ-AOFAS (p = 0.020). Change in the sport activity was related to pain and symptoms of instability (p = 0.41 and p < 0.001). CONCLUSION Recreational athlete patients who underwent the BGT demonstrated excellent functional outcomes after a mean follow-up of 7 years. Residual pain and symptoms of instability after surgery were the main complaints associated with limitations in physical activities.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil.
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP:01308-050, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Alberto Marangon
- Department of Orthopaedic Surgery, Clinica San Francesco, 21/B, Monte Ortigara Street, 37127, Verona, VR, Italy
| | - Carlos Henrique Tardini
- Department of Orthopaedic Surgery, Instituto Prata de Ortopedia, 161, Paineiras Street, Jardim, Santo André, SP, CEP 09090-521, Brazil
| | - Adilson Sanches de Oliveira Junior
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
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Saliba I, Hardy A, Wang W, Vialle R, Feruglio S. A Review of Chronic Lateral Ankle Instability and Emerging Alternative Outcome Monitoring Tools in Patients following Ankle Ligament Reconstruction Surgery. J Clin Med 2024; 13:442. [PMID: 38256576 PMCID: PMC10816882 DOI: 10.3390/jcm13020442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/31/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Ankle sprains are exceedingly common injuries in both athletes and the general population. They account for 10 to 30% of all sports injuries. Although the vast majority of lateral ankle ligament injuries respond successfully to conservative management, the absolute number of those that progress to chronic lateral ankle instability (CLAI) remains considerably important. This condition is characterized by persistent symptoms and may be associated with short-term and long-term complications and functional deficits. There is still a lack of ideal postoperative management of CLAI patients. Furthermore, an evidence-based rehabilitation phasing does not exist and most of the published studies regarding this subject suggest some protocols based on a wide variety of functional assessment scores and other modalities that are not accurate enough. Moreover, the literature that assesses the ability to return to work (RTW) and return to sport (RTS) in the general population and athletes operated for CLAI most commonly shows aggregated results with global rates of RTW or RTS without describing a detailed timeline based on the readiness of patients to return to each level of activity. Although stress radiographs and MRI have been assessed as potential tools to improve postoperative management of CLAI patients, the first modality is limited by its low sensitivity to detect laxity and the second one by its static character and its inability to predict neither the healing process phase nor the mechanical properties of the repaired/reconstructed ligaments. Bioelectrical impedance, mechanical impedance and near-infrared spectroscopy are non-invasive methods of measurement that could be potential assessment tools to help surgeons improve the postoperative management of patients after CLAI surgery.
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Affiliation(s)
- Ibrahim Saliba
- LIP6 Department, Sorbonne Université, 75005 Paris, France
| | | | - Wenzheng Wang
- LIP6 Department, Sorbonne Université, 75005 Paris, France
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Chen Y, Cao S, Wang C, Zhang C, Huang J, Wang X, Ma X. Diagnostic Evaluation of Mechanical Ankle Instability by Comparing Injured and Uninjured Contralateral Ankles Using Arthrometry. J Athl Train 2023; 58:934-940. [PMID: 36827611 PMCID: PMC10784880 DOI: 10.4085/1062-6050-0494.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
CONTEXT Individuals with mechanical ankle instability (MAI) have obvious lateral ligament laxity and excessive ankle joint motion beyond the physiological range. Arthrometry has been introduced to quantitatively measure the laxity of the ankle joint. However, the diagnostic accuracy of arthrometry in MAI is still debatable. OBJECTIVES To (1) evaluate the difference in laxity between bilateral ankles in patients with and those without MAI and (2) calculate the diagnostic accuracy of ankle arthrometry using bilateral comparisons. DESIGN Cross-sectional study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 38 individuals with unilateral MAI (age = 31.24 ± 7.90 years, height = 168.93 ± 7.69 cm, mass = 65.72 ± 10.47 kg) and 38 individuals without MAI (control group; age = 32.10 ± 7.10 years, height = 166.59 ± 7.89 cm, mass = 62.93 ± 10.72 kg). MAIN OUTCOME MEASURE(S) Bilateral ankle laxity in each participant was quantitatively measured by performing the arthrometric anterior drawer test. Continuous data of loading force and joint displacement were recorded. Data from both ankles were compared for the ankle joint displacement at a loading force of 75 N (D75) and load-displacement ratio from 10 to 40 N (LDR 10-40). RESULTS The D75 between injured and uninjured ankles in patients with MAI was different (t37 = 9.78, P < .001). The mean LDR 10-40 in injured ankles was higher than that in uninjured ankles (t37 = 9.80, P < .001). In the control group, no differences were found between the left and right ankles. The MAI group had larger bilateral differences than the control group (t37 range = 7.33-8.18; P < .001). When LDR 10-40 was used to diagnose MAI, the arthrometer showed sensitivity and specificity of 0.900 and 0.933, respectively, with a cutoff value of 0.0351 mm/N. CONCLUSIONS An ankle arthrometer can be used to quantitatively measure the difference in bilateral ankle laxity in patients with MAI. Arthrometer-measured LDR 10-40 can be used to diagnose MAI with high diagnostic accuracy.
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Affiliation(s)
- Yungu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, Jingan District, Shanghai, China
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Wilke AJ, Martin R, Bates NA, Jastifer JR, Martin KD. Technique Variation in the Surgical Treatment of Lateral Ankle Instability. Foot Ankle Spec 2023:19386400231202029. [PMID: 37823588 DOI: 10.1177/19386400231202029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Lateral ankle sprains are the most common type of injury to the ankle and can lead to ankle instability. There are many described techniques for the surgical treatment of lateral ankle instability. The purpose of this study is to quantify the variation in surgeon technique for lateral ankle instability treatment. METHODS Surveys were sent to 62 orthopaedic foot and ankle surgeons regarding surgical technique for the treatment of lateral ankle instability. Clinical agreement was defined as greater than 80% agreement to assess the cohesiveness of surgical methods as described by Marx et al. Results. Response rate was 49/62 (79%). There was clinical agreement for not using bone tunnels and not using metal anchors. All other factors lacked clinical agreement. A greater average number of throws and knots (4.2 for each, range 1-6 throws, range 2-12 knots) were used by surgeons that do not believe knots cause pain compared to an average of 3.9 (range, 1-6) throws and 4.0 (range, 2-15) knots by surgeons who do believe knots cause pain. The association that surgeon who believed knots do cause pain and thus used fewer knots and throws was not statistically significant (P > .05). The preferred material by surgeons in our study are as follows: nonabsorbable braided suture (26/49, 53%), suture tape (15/49, 31%), and fiber tape (4/49, 8%). Among surgeons who use absorbable suture (34/49, 69%), there was no significant difference (P > .05) between surgeons who believe knots cause pain (23/34, 68%) and those who do not (11/34, 32%). DISCUSSION AND CONCLUSION Among this small sample of orthopaedic foot and ankle surgeons, there is wide variation in surgical technique for lateral ankle instability treatment and little agreement on the clinical standard of care. This disagreement highlights the need for comparative outcome studies in the treatment of ankle instability. LEVEL OF EVIDENCE Level III: Retrospective cohort study.
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Affiliation(s)
| | | | | | | | - Kevin D Martin
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Wang AH, Su T, Jiang YF, Zhu YC, Jiao C, Hu YL, Guo QW, Jiang D. Arthroscopic modified Broström procedure achieved similar favorable short term outcomes to open procedure for chronic lateral ankle instability cases with generalized joint laxity. Knee Surg Sports Traumatol Arthrosc 2023; 31:4043-4051. [PMID: 37162539 DOI: 10.1007/s00167-023-07431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To compare the short-term clinical outcomes of the open versus arthroscopic modified Broström procedure in generalized joint laxity (GJL) patients. METHODS From January 2018 to January 2020, 64 consecutive patients with chronic lateral ankle instability (CLAI) and GJL (Beighton score ≥ 4) were prospectively enrolled into two groups: those who underwent the open modified Broström procedure (open group, n = 32) and those who underwent the arthroscopic modified Broström procedure (arthroscopic group, n = 32). Patients underwent an open or arthroscopic modified Broström procedure based on the time when they attended the clinic for consultation. All patients were followed-up at 3, 6, 12, and 24 months postoperatively. The clinical outcomes were evaluated using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Karlsson score, and the radiographic outcomes were assessed using stress radiography at 24 months postoperatively. The time to return to work and the failure rate were also evaluated and compared. RESULTS Follow-up was completed for 31 patients in the open group and 30 patients in the arthroscopic group. No significant differences were found between the two groups in terms of demographic characteristics, Beighton score (6.2 ± 1.9 vs. 5.5 ± 1.4, n.s.), or duration of symptoms. There were no significant differences in the functional scores before surgery and at 6, 12 and 24 months postoperatively or in the mean anterior translation of the talus and talar tilt angle on stress radiography at 24 months postoperatively between the open and arthroscopic groups. Compared to the open group, the arthroscopic group showed a significantly earlier return to work (6.8 ± 2.1 vs. 8.1 ± 2.4 weeks, p = 0.006). There was no significant difference in terms of the failure rate between the open and arthroscopic groups (16.1% vs. 23.3%, n.s.). CONCLUSION Arthroscopic modified Broström procedure achieved similar short-term outcomes to the open procedure for GJL patients. Arthroscopic modified Broström procedure showed an earlier return to work than the open modified Broström procedure and was an alternative to open surgery for CLAI patients with GJL. LEVEL OF EVIDENCE III. CLINICAL TRIAL REGISTRATION This study is a prospective study NCT05284188.
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Affiliation(s)
- An-Hong Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yi-Chuan Zhu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Usuelli FG, Montagna A, Sangaletti R, Indino C, Maccario C, Grassi FA. Minimally Invasive Reconstruction of the Ankle Lateral Ligament Complex in Chronic Ankle Instability: Clinical Outcomes, Return to Sport and Recurrence Rate at Minimum Follow up of 5 Years. APPLIED SCIENCES 2023; 13:7923. [DOI: 10.3390/app13137923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Chronic ankle instability is a common condition that develops after lateral ankle sprains. Many surgical techniques have been described in case of failure of conservative treatment. The purpose of this paper is to present the results in terms of clinical outcomes, return to sport and recurrence rate after reconstruction of the lateral ligament complex of the ankle with a minimally invasive approach at a minimum follow up of five years. Methods: This retrospective study involved forty-seven patients treated for chronic ankle instability from January 2013 to November 2017. The clinical outcomes were evaluated with the American Orthopedic Foot and Ankle Society ankle and hindfoot score (AOFAS score), the University of California–Los Angeles Rating Scale (UCLA Rating Scale), the Karlsson–Peterson ankle instability score and the Halasi scale at a mean follow up time of 80 months. Results: The mean age of the patients was 42 years (23–63). The mean VAS pain score decreased from 5.6 (2–9) pre-operatively to 0.7 (0–7) post-operatively. The mean UCLA Rating Scale score improved from 7.7 (4–8) before surgical treatment to 9.2 (6–10) afterwards. The AOFAS score increased from a pre-operative mean value of 66.5 (40–95) to a post-operative mean value of 94 (88–100) and the Halasi scale from a pre-injury mean value of 4.3 (2–8) to 4.5 post-operatively (2–8). The mean Karlsson–Peterson ankle instability score increased from 71 (40–90) pre-operatively to 87.9 (70–90) post-operatively. During this period of follow up, the procedure survival rate was 95.7%, with two cases of recurrence of ankle sprain post-operatively after twelve months in one case and forty months in the other case. Conclusions: The described technique of reconstruction of the anterior talofibular and calcaneofibular ligament with a minimally invasive approach with a semitendinosus autograft is a viable treatment option for chronic ankle instability and enables the majority of patients to regain their activity and sport level with a low recurrence rate at a mid-term follow up.
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Affiliation(s)
| | - Alice Montagna
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124 Brescia, Italy
| | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Camilla Maccario
- Ankle and Foot Unit, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Federico Alberto Grassi
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Roward Z, Latt LD. Republication of "Fracture Through a Distal Fibular Tunnel Used for an Anatomic Lateral Ankle Ligament Reconstruction". FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231188115. [PMID: 37506167 PMCID: PMC10369089 DOI: 10.1177/24730114231188115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has become a popular technique for revision reconstruction of the lateral ankle ligaments. With the procedure's burgeoning popularity, an accompanying increase in postoperative complications is likely to occur. We report on one such complication: traumatic distal fibula fracture through the transosseous tunnels.
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Affiliation(s)
- Zachary Roward
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - L Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
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Butler JJ, Brash AI, Azam MT, DeClouette B, Kennedy JG. The Role of Needle Arthroscopy in the Assessment and Treatment of Ankle Sprains. Foot Ankle Clin 2023; 28:345-354. [PMID: 37137628 DOI: 10.1016/j.fcl.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ankle ligament complex injuries are most commonly managed nonoperatively. If no improvements have been made following conservative management, surgical intervention is warranted. Concerns have been raised regarding complication rates following open and traditional arthroscopic anatomical repair. In-office needle arthroscopic anterior talo-fibular ligament repair provides a minimally invasive arthroscopic approach to the diagnosis and treatment of chronic lateral ankle instability. The limited soft tissue trauma facilitates rapid return to daily and sporting activities making this an attractive alternative approach to lateral ankle ligament complex injuries.
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Affiliation(s)
- James J Butler
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Andrew I Brash
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Mohammad T Azam
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - Brittany DeClouette
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA
| | - John G Kennedy
- Foot and Ankle Division, Department of Orthopedic Surgery, NYU Langone Health, 171 Delancey Street, 2nd Floor, New York, NY 10002, USA.
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Liu Z, Lu H, Yuan Y, Fu Z, Xu H. Mid-term follow-up evaluation of a new arthroscopic Broström procedure for chronic lateral ankle instability. J Orthop Surg Res 2023; 18:316. [PMID: 37095551 PMCID: PMC10123977 DOI: 10.1186/s13018-023-03789-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/10/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Chronic lateral ankle instability (CLAI) usually progresses from a previous lateral ankle sprain that was not treated properly. Several procedures have been introduced to address these patients, including open or arthroscopic techniques, the most common of which is the Broström procedure. Here, we describe a new outside-in arthroscopic Broström procedure and its results for treating patients with CLAI. METHODS Thirty-nine patients (16 male and 23 female; mean age, 35 years [range, 16-60 years]) with CLAI were treated arthroscopically after failing non-operative management. All patients were symptomatic with a combination of recurrent ankle sprains, "giving way," and avoidance of sports and presented with a positive anterior drawer test upon the physical examination. All patients underwent arthroscopic lateral ligament reconstruction using the new technique. Patient characteristics and pre- and postoperative visual analog scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale system (AOFAS), and Karlsson scores were recorded. RESULTS The mean AOFAS score increased from 48 (mean 48, range 33-72) preoperatively to 91 (mean 91, range 75-98) at the final follow-up, Karlsson-Peterson and FAAM scores were also significantly improved. Two patients (5.13%) reported superficial peroneal nerve irritation symptoms postoperatively. Three patients (7.69%) complained of mild pain anteroinferior to the lateral ankle. CONCLUSIONS The arthroscopic outside-in Broström procedure with a single suture anchor was a safe, effective, and reproducible technique for CLAI. Ankle stability resumed with a high clinical success rate. The main complication was injury to the superficial peroneal nerve, which crossed the area of repair.
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Affiliation(s)
- Zhongdi Liu
- National Center for Trauma Medicine, Ministry of Education Key Laboratory of Trauma and Neural Regeneration, Trauma Medicine Center, Peking University People's Hospital, Beijing, China
| | - Hao Lu
- Department of Trauma and Orthopedics, Peking University People's Hospital, No. 11, South XiZhiMen Street, Beijing, 100044, China
| | - Yusong Yuan
- Department of Trauma and Orthopedics, Peking University People's Hospital, No. 11, South XiZhiMen Street, Beijing, 100044, China
| | - Zhongguo Fu
- Department of Trauma and Orthopedics, Peking University People's Hospital, No. 11, South XiZhiMen Street, Beijing, 100044, China
| | - Hailin Xu
- Department of Trauma and Orthopedics, Peking University People's Hospital, No. 11, South XiZhiMen Street, Beijing, 100044, China.
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Dias S, Lewis TL, Alkhalfan Y, Ahluwalia R, Ray R. Current concepts in the surgical management of chronic ankle lateral ligament instability. J Orthop 2022; 33:87-94. [PMID: 35874042 PMCID: PMC9305620 DOI: 10.1016/j.jor.2022.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022] Open
Abstract
Background/aims Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI). Methods The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI. Results Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes. Conclusion Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.
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Affiliation(s)
- Shiluka Dias
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas L. Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Raju Ahluwalia
- King's College Hospital MTC, London; King's College Hospital Diabetic Foot Unit & King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
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Vopat ML, Lee B, Mok AC, Hassan M, Morris B, Tarakemeh A, Zackula R, Mullen S, Schroeppel P, Vopat BG. Primary Repair, Reconstruction, and Suture Tape Augmentation All Provide Excellent Outcomes for Lateral Ligament Instability: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e747-e762. [PMID: 35494264 PMCID: PMC9042746 DOI: 10.1016/j.asmr.2021.09.023] [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: 05/01/2020] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose To analyze the literature to compare outcomes and complications following primary lateral ankle ligament repair compared with lateral ankle ligament reconstruction and the suture tape augmentation in patients with lateral ankle instability. Methods Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, a systematic literature review using the PubMed/Ovid Medline database was performed (October 11, 1947, to October 1, 2019). Clinical trials that included all the following criteria were considered eligible; published in the English language; patients undergoing primary lateral ankle repair or reconstruction with/without autograft or allograft (anterior talofibular ligament, anterior talofibular ligament + calcaneofibular ligament) or suture tape augmentation; a follow-up at least 1 year; reported least 1 of the measured outcomes (The American Orthopaedic Foot Ankle Score, Karlsson Score, return to sport [RTS], complications, skin wound complications, reoperation). Surgical techniques were evaluated, and studies were subdivided by the following categories: primary repair (PR), reconstruction with graft (GR), and suture tape augmentation (STA). Complications, radiographic outcomes, functional outcome scores, and RTS were analyzed. Results A total of 41 of 1,991 studies met the criteria for final analysis. This included 1,920 patients who underwent surgical intervention for chronic lateral instability with at least a 1-year follow-up. There were 350 patients who had GR, 1,486 who underwent the PR, and 84 who had STA. GR group appeared to have the lowest rate of complications: GR 3.1% (11 of 350), PR 4.2% (63 of 1486), and STA 10.7% (9 of 84). Postoperative American Orthopaedic Foot Ankle Score ranged from 89.0 to 95.1 for GR and 90.0 to 98.8 for PR. Postoperative Karlsson scores ranged from 80.9 to 94.4 for GR and from 89.2 to 94.1 for PR. Anterior drawer postoperative scores ranged from 1.4 to 30.3 mm for GR, 2.7 to 8.6 mm for PR, and 4.1 to 4.2 mm for STA. Postoperative talar tilt ranged from 2.4 to 7.3° for GR, 1.9 to 6.0° for PR, and 3.6 to 4.5° for STA. RTS ranged from 9.5 to 20.4 weeks for the PR group; one study reported a RTS of 10.6 weeks for STA. Conclusions Excellent outcomes were noted across all intervention groups. Current literature may suggest there is no difference in functional outcomes between patients treated with PR versus GR. However, there may be a potential improvement in functional outcomes with PR versus STA. Level of Evidence Level IV, systematic review of Level I to Level IV studies.
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12
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May NR, Driscoll M, Nguyen S, Ferkel RD. Analysis of Return to Play After Modified Broström Lateral Ankle Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671211068541. [PMID: 35127960 PMCID: PMC8814985 DOI: 10.1177/23259671211068541] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Despite marked improvements in stability after lateral ankle ligament repair, many patients do not return to their preinjury activity level. There are few studies addressing athletes’ assessment of their ability to return to play after lateral ankle ligament reconstruction for recurrent instability. Purpose: To determine the rate of return to the preinjury activity level among physically active patients after the modified Broström procedure (MBP) for recurrent lateral ankle instability. Study Design: Case series; Level of evidence, 4. Methods: Included were patients who had undergone a primary MBP by a single surgeon over a 6-year period and had a minimum 24 months of follow-up. A telephone questionnaire was conducted to ascertain the patient’s ability to return to sport and/or work activity at final follow-up. Activity levels were evaluated utilizing the Tegner activity score. Outcome scores and other measured variables were compared between patients who returned to their preinjury level and those who did not. The reasons for failing to return were also documented. Results: Of the 59 patients who met the inclusion criteria, 41 (69%; 20 men and 21 women) participated in the telephone interview. Results indicated that 22 (54%) returned to their prior level of activity (returners). The mean age of returners was 27.2 years; for nonreturners, the mean age was 27.1 years. Most patients (36/41; 88%) were satisfied with surgery and the overall outcome. Of the 19 nonreturners, 7 (37%) noted ankle-related reasons for not returning (pain: 57%; residual instability: 29%; decreased range of motion: 14%), and 12 (63%) cited non–ankle-related reasons. The mean preinjury and postoperative Tegner score for returners was 6.8. Moreover, 7 of 14 (50%) high-level athletes with preinjury Tegner scores ≥8 returned to their preinjury activity level. For high-level athletes who did not return to their previous level, the mean postoperative Tegner score was 6.6, and only 1 (7%) cited an ankle-related reason for not returning. Conclusion: A high patient satisfaction rate was reported after the MBP for recurrent lateral ankle instability. The majority of patients who did not return to their preinjury level cited a non–ankle-related factor as the reason for not returning to sport. This was especially true for the higher level athletes.
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Affiliation(s)
- Nolan R. May
- New West Sports Medicine, Kearney, Nebraska, USA
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13
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Rupp MC, Degenhardt H, Winkler PW, Hinz M, Ehmann YJ, Imhoff AB, Pogorzelski J, Themessl A. High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:3862-3870. [PMID: 35357531 PMCID: PMC9568480 DOI: 10.1007/s00167-022-06937-0] [Citation(s) in RCA: 1] [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: 09/21/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft. METHODS Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24-112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed. RESULTS Patients reported a Karlsson score of 82.1 ± 17.5 (37-100), a FAOS score of 87.8 ± 8.4 (73-99), a median Tegner activity scale of 5.0 (IQR 4-6) and a VAS for pain of 0.5 ± 0.9 (0-4) at rest and of 2.0 ± 2.1 (0-7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0-24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed. CONCLUSION Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients' expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Hannes Degenhardt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Philipp W. Winkler
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Maximilian Hinz
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Yannick J. Ehmann
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany ,Alps Surgery Institute, Clinique Générale Annecy, 4 Chem. de la Tour la Reine, 74000 Annecy, France
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Spennacchio P, Seil R, Mouton C, Scheidt S, Cucchi D. Anatomic reconstruction of lateral ankle ligaments: is there an optimal graft option? Knee Surg Sports Traumatol Arthrosc 2022; 30:4214-4224. [PMID: 35916928 PMCID: PMC9668940 DOI: 10.1007/s00167-022-07071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle. METHODS A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient's subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures. RESULTS Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes. CONCLUSIONS The systematic analysis of validated CAI outcome measures and the patient's subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient's subjective satisfaction. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Pietro Spennacchio
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg ,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg ,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Sebastian Scheidt
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany.
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15
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Yang H, Su M, Chen Z, Qu R, Yuan Z, Yuan J, He S, Li Z, Liu C, Xiao Z, Liang H, Ouyang J, Dai J. Anatomic Measurement and Variability Analysis of the Anterior Talofibular Ligament and Calcaneofibular Ligament of the Ankle. Orthop J Sports Med 2021; 9:23259671211047269. [PMID: 34820459 PMCID: PMC8607490 DOI: 10.1177/23259671211047269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL)
contribute greatly to the overall stability of the ankle joint; however,
ATFL and combined ATFL-CFL sprains are common. Anatomic reconstruction of
the lateral collateral ligament with grafts has been proposed for patients
with poor tissue quality or inadequate local tissue. Anatomic reconstruction
of the lateral ankle ligaments requires a good understanding of their
anatomic location. Purpose: To describe the anatomy of the ATFL and CFL ligaments quantitatively and
qualitatively and explore the relationship of some morphological
parameters. Study Design: Descriptive laboratory study. Methods: A total of 66 adult ankle specimens were analyzed for ATFL band type, origin,
length, width, thickness, and angle between the ATFL and CFL, and 73 adult
ankle specimens were used for measuring the origin of the CFL. The
coefficient of variation was used to describe and compare the respective
variability of angle, length, width, and thickness. The origin of the ATFL
was labeled as point A, and the leading edge of the CFL
intersection with the articular surface of the calcaneus was considered
point B. Results: The ATFL had a variable number of bands. A high degree of variability
(coefficient of variation >0.2) was seen for most morphological
measurements of the ATFL. In addition, the length of distance
AB also varied. The CFL originated at the tip of the
fibula in only 9% of specimens. It was found more commonly at the anterior
border of the lateral malleolus (4.94 ± 1.70 mm from the tip). The angle
between the ATFL and CFL was consistent at 100° to 105º. Conclusion: A fair amount of variability of ATFL length, width, and thickness were found
in our study, with less variability in the ATFL-CFL angle. Most CFLs
attached anterior to the tip of the fibula. Clinical Relevance: Providing relevant anatomic data of ATFL and CFL is important in ensuring
proper surgical treatment of ankle joint injuries.
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Affiliation(s)
- Han Yang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Minghao Su
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Zhimin Chen
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Rongmei Qu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhirong Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Jiajie Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Shanli He
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zeyu Li
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhaoming Xiao
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Haibin Liang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jingxing Dai
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
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16
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Guerra-Pinto F, Andrade R, Diniz P, Luisa Neto A, Espregueira-Mendes J, Guimarães Consciência J. Lack of Definition of Chronic Ankle Instability With Arthrometer-Assisted Ankle Joint Stress Testing: A Systematic Review of In Vivo Studies. J Foot Ankle Surg 2021; 60:1241-1253. [PMID: 34134919 DOI: 10.1053/j.jfas.2020.04.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/09/2020] [Accepted: 04/14/2020] [Indexed: 02/03/2023]
Abstract
Despite extensive research on ankle instability a consensual and clear objective definition for pathological mechanical lateral ankle instability is yet to be determined. This systematic review aimed to summarize current available arthrometric devices, measuring methods and lateral ankle laxity outcomes in patients with chronic ankle instability that underwent objective arthrometric stress measurement. Sixty-eight studies comprising a total of 3,235 ankles with chronic ankle instability were included. Studies reported a wide range of arthrometric devices, testing position and procedures, and measuring methods. For the anterior drawer test, the average mean differences between injured and uninjured ankles ranged from -0.9 to 4.1 mm, and total translation in the injured ankle from 3.2 to 21.0 mm. Most common pathological threshold was ≥4 mm or ≥10 mm unilaterally and ≥3 mm bilaterally. For the talar tilt test, the average mean differences between injured and uninjured ankles ranged from 0.0° to 8.0°, and total tilt from injured ankle from 3.3 to 60.2°. Most common pathological threshold was ≥ 10° unilaterally and ≥ 6° mm bilaterally. It was found high heterogeneity in the scientific literature regarding the arthrometric devices, use of concomitant imaging and measuring methods of arthrometer-assisted anterior drawer and talar tilt tests which led to variable laxity outcomes in individuals with chronic ankle instability. Future studies should focus on standardizing the testing and measuring methods for an objective definition of mechanical ankle instability.
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Affiliation(s)
- Francisco Guerra-Pinto
- NOVA Medical School, Lisbon NOVA University, Lisbon, Portugal; Hospital da Cruz Vermelha, Lisbon, Portugal; Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain, Portugal; Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal.
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Faculty of Sports, University of Porto, Porto, Portugal
| | - Pedro Diniz
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal; Institute for Bioengineering and Biosciences, Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal; Human Performance Department, Sport Lisboa e Benfica, Lisboa, Portugal; Fisiogaspar, Lisboa, Portugal
| | - Ana Luisa Neto
- Department of Orthopaedic Surgery, Hospital de Sant'Ana, Parede, Portugal
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga, Guimarães, Portugal; School of Medicine, University of Minho, Braga, Portugal
| | - José Guimarães Consciência
- NOVA Medical School, Lisbon NOVA University, Lisbon, Portugal; Director of the Orthpaedic Department at CHLO - S F Xavier Central Hospital, Lisbon, Portugal
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17
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Machado M, Amado P, Babulal J. Ankle instability – review and new trends. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211035552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Ankle instability is an old topic with increasing importance in Orthopaedics’ world, as we start now realising how underdiagnosed this pathology has been. A lot of effort has been made in recent years to better understand the pathomechanics of this injury, with new surgical techniques being tried and even new anatomic structures being described. The objective of this paper is to review and compile the most important and recent literature on this matter, in an academic way, but oriented to clinical practice, so it can help surgeons keep updated in this so important subject.
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Affiliation(s)
- Marino Machado
- Orthopaedics Department, Centro Hospitalar de Lisboa Central EPE, Portugal
| | - Paulo Amado
- Unidade de Medicina Desportiva e Artroscopia Avançada,
Hospital Lusíadas Porto, Portugal
| | - Jaime Babulal
- Unidade de Medicina Desportiva e Artroscopia Avançada,
Hospital Lusíadas Porto, Portugal
- Serviço de Ortopedia, Centro Hospitalar do Médio Ave
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18
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Sprinchorn AE, Beischer AD. Cavovarus Foot Surgery Including a Peroneus Longus Transfer: A 2- to 6-Year Follow-up. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211021030. [PMID: 35097459 PMCID: PMC8564929 DOI: 10.1177/24730114211021030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The primary aim of this longitudinal study was to describe patient satisfaction and clinical outcome at least 2 years following cavovarus foot surgery, utilizing a peroneus longus to brevis transfer, lateral ligament reconstruction, and corrective osteotomies of the first metatarsal, occasionally with the added calcaneal osteotomy. Methods: Sixteen patients (17 feet) were examined in 2010-2012, 3.5 (range, 2-6.5) years after cavovarus foot surgery performed in 2004-2010 utilizing a peroneus longus to brevis transfer, lateral ligament reconstruction, and osteotomy of the first metatarsal with or without additional calcaneal osteotomy. The mean age at surgery was 45 years. Evaluation at baseline before surgery and at follow-up assessed patient satisfaction, using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. At follow-up, visual analog scale (VAS) score for pain at walking was recorded, and a clinical and radiographic evaluation was included. Results: The mean AOFAS score improved from 57 (SD 11) to 83 (SD 12.5) points, with an average score improvement of 25 score points (95% confidence interval 16-35, P < .0001). Postoperative VAS score for pain at walking was mean 2 (range, 0-6). All feet had a residual cavovarus both clinically and on the radiographs. Conclusion: Patient satisfaction and clinical outcome was shown to improve pre- to postsurgery at intermediate follow-up after peroneus longus to brevis transfer and metatarsal osteotomies with or without additional calcaneal osteotomies as part of a cavovarus foot correction. Level of Evidence: Level IV, case series.
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Affiliation(s)
- Anna E. Sprinchorn
- Uppsala University Faculty of Science and Technology, Uppsala University Hospital, Uppsala, Sweden
| | - Andrew D. Beischer
- Victorian Orthopaedic Foot & Ankle Clinic, Richmond, Victoria, Australia
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19
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Vopat ML, Wendling A, Lee B, Hassan M, Morris B, Tarakemeh A, Zackula R, Mullen S, Schroeppel P, Vopat BG. Early Versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Reconstruction: A Systematic Review and Meta-Analysis. Kans J Med 2021; 14:141-148. [PMID: 34178244 PMCID: PMC8222086 DOI: 10.17161/kjm.vol1415028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. However, some patients experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization, which can include primary lateral ligament reconstruction with a graft to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament reconstruction remains unknown, as surgeons vary in how long they immobilize their patients post-operatively. The aim of this review was to provide insight into early mobilization (EM) versus delayed mobilization (DM) post-operative protocols in patients undergoing primary lateral ankle ligament reconstructions to determine if an optimal evidence-based post-operative rehabilitation protocol exists in the literature. Methods Following PRIMSA criteria, a systematic review/meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947 – 1/28/2020). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical, and non-English language were excluded. Protocols were reviewed and divided into two categories: early mobilization (within three weeks of surgery) and delayed mobilization (after three weeks of surgery). Functional outcome scores (American Orthopedic Foot and Ankle Society Score (AOFAS), Karlsson scores), radiographic measurements (anterior drawer, talar tilt), and complications were evaluated using weighted mean differences (pre- and post-operative scores) and mixed-effect models. Results After our search, twelve out of 1,574 studies met the criteria for the final analysis, representing 399 patients undergoing lateral ankle reconstruction. Using weighted mean differences the DM group showed superior AOFAS functional scores compared to the EM group (28.0 (5.5) vs. 26.3 (0.0), respectively; p < 0.001), although sample size was small. Conversely, no significant differences were found for Karlsson functional score (p = 0.246). With regards to radiographic outcome, no significant differences were observed; anterior drawer was p = 0.244 and talar tilt was p = 0.937. A meta-analysis using mixed-effects models confirmed these results, although heterogeneity was high. Conclusions While there are some conflicting results, the findings indicated the timing of post-operative mobilization made no difference in functional outcomes or post-operative stability for patients undergoing lateral ankle ligament reconstruction. Because heterogeneity was high, future studies are needed to evaluate these protocols in less diverse patient groups and/or more consistent techniques for lateral ankle ligament reconstruction.
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Affiliation(s)
- Matthew L Vopat
- Department of Orthopaedics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Alexander Wendling
- Department of Orthopaedics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Brennan Lee
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Maaz Hassan
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Brandon Morris
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Rosey Zackula
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Scott Mullen
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Paul Schroeppel
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
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20
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Larkins LW, Baker RT, Baker JG. Physical Examination of the Ankle: A Review of the Original Orthopedic Special Test Description and Scientific Validity of Common Tests for Ankle Examination. Arch Rehabil Res Clin Transl 2021; 2:100072. [PMID: 33543095 PMCID: PMC7853358 DOI: 10.1016/j.arrct.2020.100072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives To review the literature, identify and describe commonly used special tests for diagnosing injury to the ligaments of the ankle complex, present the distinguishing characteristics and limitations of each test, and discuss the current evidence for the clinical use of each test. Data Sources Multiple PubMed (1920-2018) and CINAHL (1920-2018) searches were conducted and various musculoskeletal examination textbooks were reviewed to examine common orthopedic tests used to assess the ankle. The articles were reviewed for additional references and the search continued until the original description was found when possible. Study Selection All articles discussing the performance of the test or its validity (ie, sensitivity and specificity) were reviewed and summarized. Data Extraction Articles were reviewed for additional references and the search continued until the original description was found when possible. Data Synthesis The literature was reviewed, commonly used special tests for diagnosing ankle injuries were identified and described, distinguishing characteristics and limitations of each test were presented, and the current evidence for the clinical use of each test was discussed. Conclusions A complete physical examination is critical in the diagnosis of ankle injuries. The combination of available information such as mechanism of injury, all signs and symptoms, and changes in gait, is key to a conclusive and correct diagnosis. Clinicians should be aware of the severely limited evidence supporting the use of many commonly used special tests. Applying evidence from the literature will improve diagnostic accuracy. Further research is needed to understand the performance ability of special tests, both individually and when grouped as part of a test battery.
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Affiliation(s)
- Lindsay W Larkins
- Department of Movement Sciences, Athletic Training Programs, University of Idaho, Moscow, ID
| | - Russell T Baker
- Department of Movement Sciences, Athletic Training Programs, University of Idaho, Moscow, ID.,University of Washington School of Medicine, WWAMI Medical Education Program, Moscow, ID
| | - Jayme G Baker
- Department of Movement Sciences, Athletic Training Programs, University of Idaho, Moscow, ID
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Hou ZC, Miao X, Ao YF, Hu YL, Jiao C, Guo QW, Xie X, Zhao F, Pi YB, Li N, Zhang ZY, Jiang D. Characteristics and predictors of muscle strength deficit in mechanical ankle instability. BMC Musculoskelet Disord 2020; 21:730. [PMID: 33172443 PMCID: PMC7654059 DOI: 10.1186/s12891-020-03754-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 10/29/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy. Methods A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed. Results There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p < 0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p < 0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p = 0.016) and isolated ATFL injury (0.86 vs 0.95, p = 0.012). No other factors were found to be associated with muscle strength deficits. Conclusion MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-020-03754-9.
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Affiliation(s)
- Zong-Chen Hou
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Xin Miao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Ying-Fang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Yue-Lin Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Chen Jiao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Qin-Wei Guo
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Xing Xie
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Feng Zhao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Yan-Bin Pi
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Zhi-Yu Zhang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Dong Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Haidian, Beijing, 100191, China.
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22
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Tay KS, Chew CP, Lie DTT. Effect of Periosteal Flap Augmentation on Outcomes of Modified Broström-Gould Procedure for Chronic Lateral Ankle Instability. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420934735. [PMID: 35097395 PMCID: PMC8697196 DOI: 10.1177/2473011420934735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Chronic lateral ankle instability is relatively common after ankle sprains. The modified Broström-Gould procedure (MBG) is the gold standard operative treatment but has a known failure rate of up to 10%, or even more in high-risk groups. Periosteal flap augmentation (PFA) has been proposed to strengthen the repair. This study aimed to compare the outcomes of MBG with and without PFA. Methods: A matched-pair study was performed based on prospectively collected registry data for all patients undergoing lateral ankle ligament reconstruction in a tertiary institution. Patients who underwent the MBG with PFA were matched in a 1:1 ratio with patients undergoing MBG alone, based on age, gender, and body mass index (BMI). Patients with generalized ligamentous laxity or obesity were excluded. Clinical outcome scores were compared preoperatively and 2 years postoperatively. A total of 48 patients were included in the study (24 in each group). The mean age was 24.1 years, mean BMI was 23.1, and all patients were male. The baseline demographics and clinical scores in both groups were similar. Results: At 2 years postoperatively, both groups demonstrated significantly improved AOFAS Ankle-Hindfoot scores (P < .001), but there were no between-group differences in total AOFAS scores (PFA score 90, MBG score 88, P = .79). There were no recurrences of instability or revision surgeries. Conclusion: Routine PFA did not improve the outcomes of MBG for chronic lateral ankle instability in the absence of risk factors for failure. Further studies are warranted to determine if there is a long-term benefit for augmentation in this population. Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
- Kae Sian Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Chee Ping Chew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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23
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Vopat ML, Tarakemeh A, Morris B, Hassan M, Garvin P, Zackula R, Mullen S, Schroeppel JP, Vopat BG. Early Versus Delayed Mobilization Postoperative Protocols for Lateral Ankle Ligament Repair: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120925256. [PMID: 32613020 PMCID: PMC7309402 DOI: 10.1177/2325967120925256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: The majority of patients with an acute lateral ankle ligamentous injury are successfully treated nonoperatively with functional rehabilitation; however, a small proportion of these patients experience persistent chronic instability and may require surgical intervention. Delayed primary repair of the ruptured ligaments is most commonly indicated for these patients. Optimal rehabilitation after lateral ankle ligament repair remains unknown, as surgeons vary in how they balance protection of the surgical repair site with immobilization against the need for ankle joint mobilization to restore optimal postoperative ankle range of motion. Purpose: To compare early and delayed mobilization (EM and DM, respectively) postoperative protocols in patients undergoing primary lateral ankle ligament repair to determine optimal evidence-based rehabilitation recommendations. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a meta-analysis using the PubMed/Ovid MEDLINE database was performed (October 11, 1947 to October 16, 2017), searching for articles involving lateral ankle ligament repair. Postoperative protocols were reviewed and divided into 2 categories: EM (within 3 weeks of surgery) and DM (more than 3 weeks post surgery). Return to sport (RTS), outcome scores (American Orthopaedic Foot and Ankle Society [AOFAS] ankle-hindfoot scale and Karlsson score), radiographic outcomes (talar tilt and anterior drawer), and complications of both populations were recorded and statistically analyzed. Results: A total of 28 of 1574 studies met the criteria for the final analysis, comprising 1457 patients undergoing primary lateral ankle ligament repair. The postoperative AOFAS score was significantly greater in the EM versus DM group (98.8 vs 91.9, respectively; P < .001), as was the postoperative Karlsson score (92.2 vs 90.0, respectively; P < .001). However, the EM group had significantly greater postoperative laxity on both the anterior drawer test (6.3 vs 3.9 mm, respectively; P < .001) and talar tilt test (5.1° vs 4.5°, respectively; P < .001). Also, the DM group had significantly lower rates of overall complications (3.1% vs 11.4%, respectively; P < .001) and skin wound complications (1.3% vs 3.8%, respectively; P = .005). RTS was not significantly different between groups (P = .100). Conclusion: Patients with EM postoperative protocols demonstrated improved functional outcomes; however, the EM group had increased objective laxity and a higher complication rate. Additional randomized studies are needed to definitively evaluate early versus delayed rehabilitation protocol timetables to optimize functional outcomes without compromising long-term stability.
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Affiliation(s)
- Matthew L Vopat
- University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Armin Tarakemeh
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brandon Morris
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Maaz Hassan
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Pat Garvin
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rosey Zackula
- University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Scott Mullen
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Bryan G Vopat
- University of Kansas Medical Center, Kansas City, Kansas, USA
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24
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Guerra-Pinto F, Côrte-Real N, Gomes TM, Consciência JG, Glazebrook M, Oliva XM. Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments' injury - cadaver study. Foot Ankle Surg 2020; 26:258-264. [PMID: 30992182 DOI: 10.1016/j.fas.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/22/2019] [Accepted: 03/15/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The lack of consensus on the relevance of the varus talar tilt test (VTTT) might be due to the divergence between the insufficiency vector of lateral ankle instability and the direction of this clinical test. Our hypothesis is that the VTTT is more accurate to diagnose lateral ankle ligaments rupture when it's applied with a pre-positioning of the foot in internal rotation (IR). METHODS We compared, in 12 cadaver ankles, the varus opening during a classic VTTT with the same test starting in an IR pivot, using a new arthrometer. RESULTS The classic VTTT caused a 13° tilt after ATFL section and 23,8° after ATFL and CFL section. The application of a VTTT with an IR prepositioning caused a 21,2° tilt after ATFL section (p = 0,002) and 29,5° after ATFL and CFL section (p = 0,006). CONCLUSION The VTTT is better to identify lateral ankle ligaments' insufficiency when it's applied with a pre-positioning of the foot in internal rotation. The resulting vector is similar to the supination trauma.
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Affiliation(s)
- Francisco Guerra-Pinto
- Department of Orthopaedics, Hospital Dr. José de Almeida, Cascais, Portugal; NOVA Medical School, Lisbon NOVA University, Portugal; Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain.
| | - Nuno Côrte-Real
- Director of the Department of Orthipaedics, Hospital Dr. José de Almeida, Cascais, Portugal
| | - Tiago Mota Gomes
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain
| | - José Guimarães Consciência
- Vice Dean - Education NOVA Medical School, Lisbon NOVA University, Portugal; Director of the Orthopedic Department at CHLO - S F Xavier Central Hospital, Lisbon, Portugal
| | - Mark Glazebrook
- Professor of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Xavier Martin Oliva
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Spain; Department of Orthopaedics, Clinica del Remei, Barcelona, Spain
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25
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Kim H, Kipp K. Simulated anterior translation and medial rotation of the talus affect ankle joint contact forces during vertical hopping. Comput Methods Biomech Biomed Engin 2020; 23:484-490. [DOI: 10.1080/10255842.2020.1738405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hoon Kim
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Kristof Kipp
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
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26
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Individuals with recurrent ankle sprain demonstrate postural instability and neuromuscular control deficits in unaffected side. Knee Surg Sports Traumatol Arthrosc 2020; 28:184-192. [PMID: 30291398 DOI: 10.1007/s00167-018-5190-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 10/01/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare proprioception, postural stability, and neuromuscular control between patients with mechanical laxity and recurrent ankle sprain. METHODS Among 86 patients with ankle instability, 45 patients had mechanical laxity (mean age 27.2 ± 7.0 years) and 41 had recurrent ankle sprain (mean age 25.1 ± 9.2 years). Both the affected and unaffected ankles of each patient were evaluated. Proprioception and neuromuscular control tests were conducted using an isokinetic machine, and postural stability was tested using a postural stabilometry system. RESULTS Proprioception was not significantly different between the unaffected or affected ankles of the mechanical laxity group compared with those of the recurrent ankle sprain group (n.s). Static and dynamic postural stability and neuromuscular control were similar in the affected ankles between the two groups (n.s). However, postural stability (static, overall: p = 0.009, anterior-posterior: p = 0.028, medial-lateral: p = 0.022; dynamic, overall: p = 0.012, anterior-posterior: p = 0.004, medial-lateral: p = 0.001) and neuromuscular control (inversion: p = 0.031, eversion: p = 0.039, dorsiflexion: p = 0.029, plantarflexion: p = 0.035) were significantly decreased in the unaffected ankles of the recurrent ankle sprain group compared with those of the mechanical laxity group. CONCLUSION The unaffected ankles of the recurrent ankle sprain group showed significant decreases in both postural stability and neuromuscular control compared with the mechanical laxity group. Clinicians and therapists should consider unaffected ankle rehabilitation in patients with recurrent ankle sprain to prevent future sprain events. LEVEL OF EVIDENCE Case-control study, III.
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Chew CP, Koo KOT, Lie DTT. Periosteal flap augmentation of the Modified Broström-Gould procedure for chronic lateral ankle instability. J Orthop Surg (Hong Kong) 2019; 26:2309499018757530. [PMID: 29455631 DOI: 10.1177/2309499018757530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Chronic lateral ankle instability occurs in up to 20% of ankle injuries. Most can be treated conservatively, but surgical reconstruction is required if conservative treatment fails. Modified Broström-Gould procedure is an effective surgical treatment and the augmentation of this procedure with a periosteal flap may confer additional stability. We report on the outcome of a technique combining a modified Broström-Gould procedure augmented with a periosteal flap in patients with chronic lateral ankle instability. METHOD Twenty-four males aged 18-42 (mean, 24) with chronic lateral ankle instability affecting 24 ankles underwent the modified Broström-Gould procedure augmented with a periosteal flap, and these surgeries were performed by a single surgeon. The mean follow-up period was 28.7 months. Patients were assessed pre- and post-operatively with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hind foot score. RESULTS Preoperatively, the mean AOFAS ankle and hind foot score was 67.38. Post-operatively, significant improvement was seen, with a score of 88.71 ( p < 0.05). None of the patients reported surgical or wound complications. CONCLUSION The technique of modified Broström-Gould procedure with periosteal flap augmentation appears to be a simple and safe operation for chronic lateral ankle instability. Patients with poor quality local ligamentous tissue, obese patients or high demand athletes generally benefit from this procedure. It allows effective augmentation of the reconstruction without causing any harm to local tendons or using additional costly implants.
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Affiliation(s)
- Chee Ping Chew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kevin Oon Thien Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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28
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Chen C, Lu H, Hu J, Qiu X, Li X, Sun D, Qu J, Zhang T, Xu D. Anatomic reconstruction of anterior talofibular ligament with tibial tuberosity-patellar tendon autograft for chronic lateral ankle instability. J Orthop Surg (Hong Kong) 2019; 26:2309499018780874. [PMID: 29890893 DOI: 10.1177/2309499018780874] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Anatomic repair of the anterior talofibular ligament (ATFL) is challenging when the local ligamentous tissue is severely attenuated. Anatomic reconstruction of the ATFL with tibial tuberosity-patellar tendon (TT-PT) autograft is a feasible choice that can avoid the complicated tendon-bone healing and restore ankle stability. MATERIALS AND METHODS From 2009 to 2015, 31 chronic lateral ankle instability (CLAI) patients (31 ankles), who had a serious injury on the ATFL only, were treated with anatomic reconstruction of ATFL with TT-PT. American orthopedic foot and ankle society ankle-hindfoot score (AHS), visual analog scale for pain score (VAS), Karlsson-Peterson score, Tegner activity level, and objective examination comprehending range of motion were used to evaluate the clinical outcomes before and after operation. Radiographically, talar tilt angles and anterior drawer were assessed in pre- and postoperative ankle stress views. RESULTS Among the 31 ankles, 17 ankles with single-bundle ATFL and 14 ankles with double-bundle ATFL were found at operation. At a mean follow-up of 42 months (24-82 months), all patients were satisfied with the procedure. Mean AHS significantly increased from 60.5 ± 8.2 to 93.5 ± 4.8. Mean Karlsson-Peterson score significantly increased from 55.2 ± 11.0 preoperatively to 91.2 ± 6.9 at final follow-up. Average VAS significantly decreased from 5.9 ± 1.6 preoperatively to 1.4 ± 1.0 at the latest follow-up. Mean Tegner activity level was 3.7 ± 0.9 before operation, compared with 7.0 ± 0.8 after operation. On stress radiographs, mean talar tilt angle was 17.0 ± 3.4° before operation and 3.8 ± 2.1° at the latest follow-up. In addition, mean anterior tibiotalar translation was 7.5 ± 2.2 mm before operation and 1.8 ± 1.1 mm at the latest follow-up. CONCLUSION Anatomic reconstruction of the ATFL using a TT-PT autograft allows bone-bone healing in talus and tendon-tendon/periosteum healing in fibula rather than requiring tendon-bone healing, which is an alternative choice for treating CLAI caused by single ATFL insufficiency.
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Affiliation(s)
- Can Chen
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jianzhong Hu
- 2 Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xuqiang Qiu
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiong Li
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Deyi Sun
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Jin Qu
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Zhang
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Daqi Xu
- 1 Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
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Abstract
Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.
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Affiliation(s)
| | | | - Yu Deng
- Department of Foot and Ankle Surgery, Wuhan University, Hubei, China
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson
- San Antonio Military Medical Center, TX
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30
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Porter M, Shadbolt B, Ye X, Stuart R. Ankle Lateral Ligament Augmentation Versus the Modified Broström-Gould Procedure: A 5-Year Randomized Controlled Trial. Am J Sports Med 2019; 47:659-666. [PMID: 30699039 DOI: 10.1177/0363546518820529] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND "Ankle sprain" is a common injury, and >20% of patients may develop chronic instability for which surgery is indicated. The modified Broström-Gould (MBG) procedure remains the gold standard; however, there are a number of relative contraindications to this procedure, and the longer-term outcomes after the MBG have been questioned. An alternative procedure is augmentation of a primary repair with a ligament augmentation reconstruction system (LARS). PURPOSE To conduct a randomized controlled trial testing the null-hypothesis that there is no difference in patient scored outcomes and activity levels, between patients undergoing a MBG procedure compared with those undergoing a primary repair with LARS augmentation, for lateral ligament instability of the ankle. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients who satisfied the inclusion criteria were invited to take part in the study. Patients were randomly allocated to undergo the LARS or MBG procedure. Both groups followed similar postoperative rehabilitation. Patients completed the Foot and Ankle Outcome Score (FAOS) before surgery and then at 1, 2, and 5 years after surgery. Tegner activity scores were recorded at 5years. The scores in the 2 groups were compared via statistical analysis ( P < .05). RESULTS Of the 50 patients satisfying the inclusion criteria, 47 agreed to take part in the study. Twenty-two were randomized to the LARS group and 25 to the MBG group. At 5 years, follow-up data were complete for 20 patients in the LARS group and 21 in the MBG. There were 2 failures in the MBG group and 0 in the LARS group. The LARS group had significantly better improvement in total FAOS at 1 year (mean ± SD, 92.4 ± 2.5 vs 78.2 ± 3.4, P = .005), 2 years (94.0 ± 3.0 vs 78.0 ± 5.2, P = .003), and 5 years (93.7 ± 6.0 vs 75.1 ± 5.5, P = .002) after surgery. The 5-year Tegner activity scores were higher in the LARS group (8.25 ± 1.1 vs 7.2 ± 0.9, P = .03). CONCLUSION Among physically active patients with chronic lateral ligament instability, primary repair combined with LARS results in better total FAOS at 5-year follow-up and higher Tegner activity scores as compared with the MBG procedure. REGISTRATION ACTRN12618000906257 (Australia New Zealand Clinical Trial Registry).
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Affiliation(s)
- Mark Porter
- Canberra Orthopaedics and Sports Medicine, Calvary Clinic, Bruce, Australia
| | - Bruce Shadbolt
- Department of Epidemiology, Canberra Hospital, Garran, Australia
| | - Xuan Ye
- Prince of Wales Hospital, Randwick, Australia
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31
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Abstract
Ankle sprains continue to be among the most common musculoskeletal injuries, most of which never require surgical treatment. Surgical treatment has traditionally been successful for those patients whose symptoms do not improve with nonoperative care. However, recurrent instability, although rare, can occur early or late after a stabilization procedure, as the result of an acute traumatic event or chronic repetitive minor injury. A complete workup of patients with recurrent ankle instability should be completed before revision surgery and should include evaluation for generalized joint hypermobility as well as anatomic variations, such as hindfoot varus, first ray plantarflexion, and midfoot cavus.
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Affiliation(s)
- Joseph T O'Neil
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Gregory P Guyton
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
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32
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Trichine F, Friha T, Boukabou A, Belaid L, Bouzidi T, Bouzitouna M. Surgical Treatment of Chronic Lateral Ankle Instability Using an Inferior Extensor Retinaculum Flap: A Retrospective Study. J Foot Ankle Surg 2018; 57:226-231. [PMID: 28826786 DOI: 10.1053/j.jfas.2017.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Indexed: 02/03/2023]
Abstract
Chronic lateral ankle instability causes significant problems with physical activity. The purpose of the present study was to evaluate the results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap. A consecutive series of 38 patients were included with a minimum follow-up duration of 2 years. The functional results were assessed using the Karlsson and American Orthopaedic Foot and Ankle Society scale scores. The pre- and postoperative radiologic assessment was performed using stress radiographs to measure varus tilt and anterior drawer tests. All 38 patients were followed up for 2.5 to 7.2 years, and 35 patients were satisfied. The American Orthopaedic Foot and Ankle Society scale score had improved significantly from 57 (range 20 to 70) points preoperatively to 95 (range 80 to 100) points postoperatively (p < .0001), and 35 patients believed their ankle was more stable after surgery. The patients had returned to their previous sports activities an average of 4.7 (range 2 to 12) months after surgery. On the stress radiographs, the mean talar tilt angle had improved significantly from 15.2° (range 6° to 26°) preoperatively to 3.8° (range 1° to 8°) at the final follow-up visit (p < .001), and the mean anterior talar had improved significantly from 13.2 (range 8 to 18) mm preoperatively to 4 (range 4 to 7) mm at the final follow-up visit (p < .002). Regarding the prognostic factors, a link was found between the functional result and residual radiologic laxity measured on the stress radiographs. Reconstruction of the lateral ligaments for chronic ankle instability combining capsuloligamentous retensioning and reinforcement with an extensor retinaculum flap resulted in successful outcomes, excellent ankle stability, and preservation of ankle joint mobility. This technique addressed both lateral ankle and subtalar instability by developing an extraarticular interosseous ligament.
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Affiliation(s)
- Faycal Trichine
- Surgeon, Department of Orthopaedic Surgery and Traumatology, University Military Hospital of Constantine, Constantine, Algeria.
| | - Toufik Friha
- Surgeon, Department of Orthopaedic Surgery and Traumatology, University Military Hospital of Constantine, Constantine, Algeria
| | - Azzedine Boukabou
- Surgeon, Department of Orthopaedic Surgery and Traumatology, University Military Hospital of Constantine, Constantine, Algeria
| | - Lamine Belaid
- Surgeon, Department of Orthopaedic Surgery and Traumatology, University Military Hospital of Constantine, Constantine, Algeria
| | - Terek Bouzidi
- Surgeon, Department of Orthopaedic Surgery and Traumatology, University Military Hospital of Constantine, Constantine, Algeria
| | - Mahdjoub Bouzitouna
- Professor, Department of Orthopaedic Surgery and Traumatology, Academic Medical Center of Constantine, Constantine, Algeria
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Abstract
OBJECTIVE The purpose of this article is to review imaging after commonly encountered surgical interventions of the ligaments, tendons, and soft tissues around the ankle. Intraoperative images, when available, are provided to improve conceptual understanding of these complex procedures. CONCLUSION Surgical interventions in the ankle are becoming more prevalent with increasing athletic demands and emerging focus on techniques for prevention of joint injury. Knowledge of the surgical techniques, imaging appearances, and complications in the postoperative ankle is necessary for the accurate diagnosis of postoperative complications and for optimal patient care.
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Roward Z, Latt LD. Fracture Through a Distal Fibular Tunnel Used for an Anatomic Lateral Ankle Ligament Reconstruction. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418763593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has become a popular technique for revision reconstruction of the lateral ankle ligaments. With the procedure’s burgeoning popularity, an accompanying increase in postoperative complications is likely to occur. We report on one such complication: traumatic distal fibula fracture through the transosseous tunnels.
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Affiliation(s)
- Zachary Roward
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
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Řezaninová J, Hrazdira L, Moc Králová D, Svoboda Z, Benaroya A. Advanced conservative treatment of complete acute rupture of the lateral ankle ligaments: Verifying by stabilometry. Foot Ankle Surg 2018; 24:65-70. [PMID: 29413777 DOI: 10.1016/j.fas.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/03/2016] [Accepted: 12/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the result of the specific conservative treatment of acute lateral ankle ligaments rupture and verify the effect of this therapy by stabilometry. METHODS 17 young athletes were examined after acute lateral ankle sprain (grade III). Diagnosis was based on musculoskeletal ultrasound examinations. Pressure plate evaluated postural stability after conservative treatment at regular intervals during 1year. RESULTS There were no significant differences in postural stability in double-leg stance between limbs. In single-leg stance, COP confidence ellipse (p=0,011) and COP excursion in sagittal plane (p=0,000) were significantly higher for the injured leg when compared with the uninjured leg only one week after removing the cast. CONCLUSIONS After conservative treatment of grade III injuries with STABHA, immobilization with full weight bearing on the injured leg for 6 weeks and rehabilitation, stabilometry results showed that none of the patients had impaired postural stability or were at risk of functional ankle instability in the monitored period.
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Affiliation(s)
- Jana Řezaninová
- Faculty of Sports Studies, Masaryk University, Brno, Czechia.
| | - Luboš Hrazdira
- Faculty of Sports Studies, Masaryk University, Brno, Czechia
| | | | - Zdeněk Svoboda
- Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Azriel Benaroya
- Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Pereira H, Vuurberg G, Spennacchio P, Batista J, D’Hooghe P, Hunt K, Van Dijk N. Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:85-108. [DOI: 10.1007/978-3-319-76735-2_4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cho BK, Kim YM, Choi SM, Park HW, SooHoo NF. Revision anatomical reconstruction of the lateral ligaments of the ankle augmented with suture tape for patients with a failed Broström procedure. Bone Joint J 2017; 99-B:1183-1189. [PMID: 28860398 DOI: 10.1302/0301-620x.99b9.bjj-2017-0144.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/04/2017] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this prospective study was to evaluate the intermediate-term outcomes after revision anatomical ankle ligament reconstruction augmented with suture tape for a failed modified Broström procedure. PATIENTS AND METHODS A total of 30 patients with persistent instability of the ankle after a Broström procedure underwent revision augmented with suture tape. Of these, 24 patients who were followed up for more than two years were included in the study. There were 13 men and 11 women. Their mean age was 31.8 years (23 to 44). The mean follow-up was 38.5 months (24 to 56) The clinical outcome was assessed using the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) score. The stability of the ankle was assessed using stress radiographs. RESULTS The mean FAOS and FAAM scores improved significantly to 87.5 (73 to 94) and 85.1 (70 to 95) points at final follow-up, respectively (p < 0.001). The mean angle of talar tilt and anterior talar translation improved significantly to 2.8° (0° to 6°) and 4.1 mm (2 to 7) at final follow-up, respectively (p < 0.001). Side to side comparison in stress radiographs at final follow-up showed no significant difference. The revision failed in one patient who underwent a further revision using allograft tendon. CONCLUSION The revision modified Broström procedure augmented with suture tape is an effective form of treatment for recurrent instability of the ankle following a failed Broström procedure. This technique provides reliable stability and satisfactory clinical outcomes at intermediate-term follow-up. Cite this article: Bone Joint J 2017;99-B:1183-9.
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Affiliation(s)
- B K Cho
- College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Y M Kim
- College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - S M Choi
- College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - H W Park
- School of Medicine, University of California, Los Angeles, California, USA
| | - N F SooHoo
- School of Medicine, University of California, Los Angeles, California, 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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Xu HX, Lee KB. Modified Broström Procedure for Chronic Lateral Ankle Instability in Patients With Generalized Joint Laxity. Am J Sports Med 2016; 44:3152-3157. [PMID: 27496909 DOI: 10.1177/0363546516657816] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Generalized joint laxity (GJL) has been considered a risk factor for late failure of ligament reconstruction in the knee; however, it is not known whether GJL is the cause of recurrent instability after the modified Broström procedure for chronic lateral ankle instability. PURPOSE To compare the clinical results of the modified Broström procedure for chronic lateral ankle instability in patients with or without GJL. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 100 patients (100 ankles) who underwent the modified Broström procedure were divided into 2 groups, with or without GJL, according to the Beighton criteria. Age and body mass index were matched between the 2 groups. The mean follow-up duration was 43.3 months in the laxity group (44 ankles; Beighton score ≥5) and 42.9 months in the nonlaxity group (56 ankles). RESULTS The mean preoperative Karlsson and American Orthopaedic Foot and Ankle Society (AOFAS) scores were a respective 53.2 and 60.9 in the laxity group and 53.9 and 62.6 in the nonlaxity group, and these scores improved to 87.4 and 89.5, respectively, in the laxity group and to 94.1 and 94.8, respectively, in the nonlaxity group at final follow-up. The mean preoperative talar tilt angle and anterior talar translation were a respective 12.5° and 8.8 mm in the laxity group and 10.8° and 8.5 mm in the nonlaxity group, and these values improved to 7.3° and 6.0 mm, respectively, in the laxity group and to 5.2° and 5.0 mm, respectively, in the nonlaxity group at final follow-up. Failure rates were 11.4% (5 patients) in the laxity group and 1.8% (1 patient) in the nonlaxity group. Significant differences were found between the 2 groups in terms of the Karlsson score, AOFAS score, talar tilt angle, anterior talar translation, and failure rate at final follow-up (P < .05). CONCLUSION Patients with GJL showed inferior outcomes and a higher failure rate compared with patients without GJL. Therefore, GJL appears to be a risk factor associated with recurrent instability after the modified Broström procedure.
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Affiliation(s)
- He-Xing Xu
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Korea
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40
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Huang B, Kim YT, Kim JU, Shin JH, Park YW, Kim HN. Modified Broström Procedure for Chronic Ankle Instability With Generalized Joint Hypermobility. Am J Sports Med 2016; 44:1011-6. [PMID: 26786901 DOI: 10.1177/0363546515623029] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic ankle instability with generalized joint hypermobility (GJH) is considered a contraindication for the modified Broström procedure. The most widely accepted definition of GJH is a Beighton score of ≥4 on a 9-point scale. However, it is not clear whether this criterion can be applied to determine the GJH that would lead to a poor outcome after a modified Broström procedure. Some of the previous studies that report unfavorable outcomes do not specify the tests or cutoff scores used to determine the GJH, and, in fact, some of the patients with GJH in these studies had good outcomes. HYPOTHESIS The modified Broström procedure results in satisfactory outcomes in patients who have chronic ankle instability with GJH if the contralateral uninjured ankle shows a normal varus talar tilt and anterior talar translation during stress tests. STUDY DESIGN Case series; Level of evidence, 4. METHODS Modified Broström procedure was performed in 32 patients with chronic ankle instability with GJH if the contralateral uninjured ankle showed a normal varus talar tilt and anterior talar translation on stress tests. The mean patient age at surgery was 21.7 years, and the mean follow-up duration was 27.4 months. RESULTS The Karlsson-Peterson ankle score significantly improved from a mean ± SD of 63.6 ± 7.1 preoperatively to 90.4 ± 6.7 at the final postoperative follow-up (P < .001). Sixteen patients were very satisfied with the results, 10 patients were satisfied, 3 patients rated their satisfaction as fair, and 1 patient was dissatisfied with the results. Nine patients sustained ankle sprains after the surgery, 6 of which were mild sprains. Although 3 of these 9 patients had a mechanically unstable ankle on stress radiographs, they were satisfied with the postoperative results. None of the patients required a reoperation. CONCLUSION GJH was not a contraindication for the modified Broström procedure if the contralateral uninjured ankle showed a normal varus talar tilt and a normal anterior talar translation on stress tests. Further studies are needed to better define GJH affecting the ankle.
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Affiliation(s)
- Bingzhe Huang
- Department of Orthopaedic Surgery, The Second Hospital, Jilin University, Changchun, China
| | - Yong Tae Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung Uk Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Jung Hoon Shin
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Yong Wook Park
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hyong Nyun Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
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Kosiol J, Wille M, Putzer D, Biedermann R. [Calcaneo-fibular ligament surgery for chronic lateral instability of the upper ankle : Broström technique with modification by Wille. Video article]. DER ORTHOPADE 2015; 44:909-13. [PMID: 26395449 DOI: 10.1007/s00132-015-3168-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND An acute ligament rupture of the lateral ligament complex of the ankle joint is treated without surgery. Treatment failure may lead to a chronically unstable situation of the ankle joint, in which case surgery is an effective procedure for stabilizing the ruptured ligaments. Anatomical reconstruction is the best operative technique if the ligament tissue is of good quality. METHOD In our video we demonstrate a new possibility for the positioning of an anchor to tighten the calcaneo-fibular ligament. Modified Broström repairs are described in the literature in which the calcaneo-fibular ligament is released and reattached to the fibula to tighten it. We present the option to release the ligament at the calcaneus and reattach it using a suture anchor. This offers the advantage of preventing the possible dislocation of the peroneal tendons.
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Affiliation(s)
- J Kosiol
- Universitätsklinik für Unfallchirurgie Innsbruck, Anichstrasse 35, 6020, Innsbruck, Österreich.
| | - M Wille
- Universitätsklinik für Unfallchirurgie Innsbruck, Anichstrasse 35, 6020, Innsbruck, Österreich
| | - D Putzer
- Department für experimentelle Orthopädie, Universitätsklinik für Orthopädie Innsbruck, Innsbruck, Österreich
| | - R Biedermann
- Universitätsklinik für Orthopädie Innsbruck, Innsbruck, Österreich
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Shibuya N, Bazán DI, Evans AM, Agarwal MR, Jupiter DC. Efficacy and Safety of Split Peroneal Tendon Lateral Ankle Stabilization. J Foot Ankle Surg 2015; 55:812-6. [PMID: 26364699 DOI: 10.1053/j.jfas.2015.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Indexed: 02/03/2023]
Abstract
Chronic lateral ankle instability is a common condition. Split peroneal tendon lateral ankle stabilization, a modification of the Chrisman-Snook procedure, is biomechanically stable and often used for severe and/or recurrent chronic lateral ankle instability. The purpose of the present study was to evaluate the efficacy and safety of this technique. Specifically, the midterm recurrence of instability and postoperative complications, such as stiffness, neurologic pain, and wound healing complications, were evaluated. We evaluated 30 consecutive procedures with a minimal follow-up period of 1 year. The mean follow-up period was 25 ± 13 (median 19, range 13 to 62) months. Five patients (17%) developed recurrent ankle instability, of whom 4 underwent revision surgery. One superficial infection and two wound disruptions developed. Two patients experienced stiffness and eight (27%) surgically induced neurologic complaints, such as sural neuritis. Finally, 2 patients developed complex regional pain syndrome.
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Affiliation(s)
- Naohiro Shibuya
- Associate Professor, Department of Surgery, Texas A&M Health Science Center, College of Medicine, Temple, TX; Chief, Section of Podiatry, Surgical Services, Central Texas Veterans Affairs Health Care System, Temple, TX; Staff, Baylor Scott and White Health Care System, Temple, TX.
| | - D Issac Bazán
- Third-Year Resident, Scott and White Memorial Hospital, Temple, TX
| | - Andrew M Evans
- Second-Year Resident, Scott and White Memorial Hospital, Temple, TX
| | - Monica R Agarwal
- Clinical Assistant Professor, Department of Surgery, Texas A&M Health Science Center, College of Medicine, Bryan, TX; Staff, Section of Podiatry, Department of Surgery, Central Texas Veterans Affairs Health Care System, Temple, TX
| | - Daniel C Jupiter
- Assistant Professor, Department Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX
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43
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Jung HG, Shin MH, Park JT, Eom JS, Lee DO, Lee SH. Anatomical Reconstruction of Lateral Ankle Ligaments Using Free Tendon Allografts and Biotenodesis Screws. Foot Ankle Int 2015; 36:1064-71. [PMID: 25921199 DOI: 10.1177/1071100715584848] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Lateral ankle instability is one of the most common musculoskeletal disorders and can result in ankle damage. This study reports on the results of the anatomical reconstruction of ligaments using semitendinosus tendon allograft and bioabsorbable tenodesis screws for chronic lateral ankle instability, as well as the functional and radiological results of this procedure. METHODS From February 2007 to January 2013, 70 patients (72 ankles) underwent this procedure. Six patients were lost to follow-up, and ultimately 64 patients (66 ankles) were evaluated. Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, Karlsson-Peterson ankle scores, and patient satisfaction were evaluated at a mean of 22.1 months (range, 12-68 months) postoperatively. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. The mean patient age at surgery was 30.1 years (range, 16-59 years). RESULTS The mean VAS pain score decreased from 5.5 to 1.3 (P < .05), and the mean AOFAS improved from 71.0 to 90.9 (P < .05). The mean Karlsson-Peterson score improved from 55.1 to 90.3, whereas talar tilt decreased from 14.8 degrees to 3.9 degrees. There was no significant difference in clinical outcomes between the pretensioned and nonpretensioned groups. CONCLUSION This procedure yielded successful results, including satisfactory ankle stability and clinical outcomes, in ankles with poor lateral ligament tissues. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hong-Geun Jung
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea (ROK)
| | - Min-Ho Shin
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea (ROK)
| | - Jong-Tae Park
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea (ROK)
| | - Joon-Sang Eom
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea (ROK)
| | - Dong-Oh Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea (ROK)
| | - Sang-Hun Lee
- Department of Orthopedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea (ROK)
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Molloy AP, Ajis A, Kazi H. The modified Broström-Gould procedure--early results using a newly described surgical technique. Foot Ankle Surg 2014; 20:224-8. [PMID: 25103713 DOI: 10.1016/j.fas.2014.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 01/07/2014] [Accepted: 01/11/2014] [Indexed: 02/04/2023]
Abstract
Ankle lateral ligament injuries are one of the most common sporting injuries, with the majority being successfully treated conservatively. However, reconstruction is required if this fails. We present the clinical results of a newly described surgical technique of triple-breasting the lateral ligament complex using suture anchors. Sixteen patients (18 ankles) were treated with this new technique. The mean duration of symptoms was 77 months. The mean follow-up was 25 months. All patients underwent an arthroscopy followed by lateral ligament reconstruction by this new technique. Additional pathology included osteoarthritis (2), ankle impingement due to anterior cheilus (2), osteochondral defects (3) and non-union of fracture of anterior process of calcaneus. Additional procedures above diagnostic arthroscopy, soft tissue debridement and modified Broström-Gould repair included debridement and microfracture (3), open excision of anterior calcaneal process (1) and arthroscopic anterior ankle cheilectomy (2). At final follow-up, all ankles were subjectively and objectively stable. Mean AOFAS score improved from 53 to 88. This was statistically significant (p<0.05). Eight patients had resumed normal pre-injury level of activities (including sports), 8 had some reduction in normal level of activity. The early results of our modification show it to be safe, successful and comparable with previously published series with all patients having objectively and subjectively stable ankles at final follow-up.
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Affiliation(s)
- Andy P Molloy
- University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
| | - Adam Ajis
- University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
| | - Hussain Kazi
- University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
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Porter M, Shadbolt B, Stuart R. Primary ankle ligament augmentation versus modified Brostrom-Gould procedure: a 2-year randomized controlled trial. ANZ J Surg 2014; 85:44-8. [PMID: 25171115 DOI: 10.1111/ans.12837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than 20% of patients develop chronic instability following appropriate management of an 'ankle sprain'. There is little research comparing surgical techniques. 'Anatomical' procedures, such as the modified Brostrom-Gould (MBG), are generally preferred. However, not all patients are suitable for this procedure. Augmentation of a primary repair using a synthetic ligament, such as the ligament augmentation reconstruction system (LARS), is another 'anatomic' option. Our objective was to compare the clinical outcome following the MBG with that following the LARS technique using a prospective randomized clinical trial. METHODS Patients who satisfied the study criteria were randomly allocated to undergo the LARS procedure or the MBG procedure. All patients followed a similar rehabilitation programme. Patients completed the foot and ankle outcome score (FAOS) before surgery, and then at 1 year and 2 years following surgery. Statistical analysis was used to compare the groups (P < 0.05). RESULTS Forty-one patients took part in the study, 21 were randomized to the LARS group and 20 to the MBG group. The LARS group had a significantly better improvement in the total FAOS at both 1 year (25.5 standard error (SE) 3.8 versus 16.0 SE 3.3) and 2 years (27.1 SE 4.5 versus 15.8 SE 4.9) post-surgery. CONCLUSION Primary repair combined with LARS results in better patient-scored clinical outcome, at 2 years post-surgery, than the MBG procedure. Although longer follow-up is required, the LARS procedure may be considered as an alternative, especially in those patients for whom the MBG is relatively contra-indicated.
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Affiliation(s)
- Mark Porter
- Porter Sports Orthopaedics, Canberra, Australian Capital Territory, Australia
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Abstract
Chronic lateral ankle instability is a condition frequently encountered by orthopedic surgeons treating highly active patient populations, particularly military service members. Providers treating military service members must have a high index of suspicion for this condition when signs and symptoms of functional or mechanical instability exist. Stress testing and ankle MRI, although not definitive in sensitivity for detecting instability or other concomitant injuries, should be considered during the treatment decision-making process. Appropriate nonoperative treatment should be attempted initially; however, when nonoperative treatment fails, surgical management is warranted to prevent untoward long-term sequelae. Proper surgical treatment and subsequent postoperative management are at the discretion of the individual surgeon but must account for the concomitant diseases frequently associated with chronic lateral ankle instability. Low recurrence of lateral instability can be achieved even in high-demand military patient populations with a focused treatment plan.
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Wang J, Hua Y, Chen S, Li H, Zhang J, Li Y. Arthroscopic repair of lateral ankle ligament complex by suture anchor. Arthroscopy 2014; 30:766-73. [PMID: 24680321 DOI: 10.1016/j.arthro.2014.02.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Arthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique. METHODS We performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score. RESULTS After reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases. CONCLUSIONS Studies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Jingwei Wang
- Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
| | - Shiyi Chen
- Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China
| | - Jian Zhang
- Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China
| | - Yunxia Li
- Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China
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Abstract
Lateral ligament injuries are the most common sports injury and have a high incidence even in non-sportive activities. Although lateral ligament injuries are very common there is still a controversial debate on the best management. The diagnosis is based on clinical examination and X-ray images help to rule out fractures. Further imaging, especially magnetic resonance imaging (MRI) is used to diagnose associated injuries. According to the recommendations of the various scientific societies the primary therapy of lateral ligament injuries is conservative. Chronic ankle instability develops in 10-20 % of patients and the instability can be a result of sensomotoric deficits or insufficient healing of the lateral ligament complex. If the patient does not respond to an intensive rehabilitation program an operative reconstruction of the lateral ligaments has to be considered. Most of the procedures currently performed are anatomical reconstructions due to better long-term results compared to tenodesis procedures.
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Clanton TO, Viens NA, Campbell KJ, Laprade RF, Wijdicks CA. Anterior talofibular ligament ruptures, part 2: biomechanical comparison of anterior talofibular ligament reconstruction using semitendinosus allografts with the intact ligament. Am J Sports Med 2014; 42:412-6. [PMID: 24280308 DOI: 10.1177/0363546513509963] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anatomic reconstructions of the lateral ankle ligaments with grafts have been proposed for patients with generalized ligamentous laxity, long-standing instability with attenuated native tissues, varus hindfoot misalignment, or failed prior lateral ligament surgery and for very large patients or elite athletes because of increased demands. HYPOTHESIS Anatomic reconstruction of the anterior talofibular ligament (ATFL) using a semitendinosus allograft fixed with biocomposite interference fit screws would have similar biomechanical properties to the intact ATFL at time zero in a cadaveric model. STUDY DESIGN Controlled laboratory study. METHODS Allograft reconstruction of the ATFL was performed in 6 fresh-frozen cadaveric ankles. The specimens were loaded to failure to determine the strength and stiffness of the reconstruction and compared with data from 6 cadaveric specimens with intact ATFLs. RESULTS The mean ultimate load to failure of the allograft reconstruction (170.7 ± 54.8 N) was not significantly different from that of the intact ATFL (154.0 ± 63.7 N). The mean stiffness of the allograft reconstruction (23.1 ± 9.3 N/mm) was also not significantly different from that of the intact ATFL (14.5 ± 4.4 N/mm). CONCLUSION Anatomic reconstruction of the ATFL with allografts demonstrated similar strength and stiffness to the native ligament at time zero in a fresh-frozen cadaveric model. CLINICAL RELEVANCE This technique of anatomic reconstruction of the ATFL with allografts has biomechanical validation for use in clinical situations where a Broström repair of the lateral ankle ligaments is unlikely to be successful or has previously failed.
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Affiliation(s)
- Thomas O Clanton
- Thomas O. Clanton, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
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50
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Park J, Hahn S, Park JY, Park HJ, Lee H. Acupuncture for ankle sprain: systematic review and meta-analysis. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:55. [PMID: 23496981 PMCID: PMC3606608 DOI: 10.1186/1472-6882-13-55] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 02/26/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ankle sprain is one of the most frequently encountered musculoskeletal injuries; however, the efficacy of acupuncture in treating ankle sprains remains uncertain. We therefore performed a systematic review to evaluate the evidence regarding acupuncture for ankle sprains. METHODS We searched 15 data sources and two trial registries up to February 2012. Randomized controlled trials of acupuncture were included if they involved patients with ankle sprains and reported outcomes of symptom improvement, including pain. A Cochrane risk of bias assessment tool was used. Risk ratio (RR) or mean difference (MD) was calculated with 95% confidence intervals (CIs) in a random effects model. Subgroup analyses were performed based on acupuncture type, grade of sprain, and control type. Sensitivity analyses were also performed with respect to risk of bias, sample size, and outcomes reported. RESULTS Seventeen trials involving 1820 participants were included. Trial quality was generally poor, with just three reporting adequate methods of randomization and only one a method of allocation concealment. Significantly more participants in acupuncture groups reported global symptom improvement compared with no acupuncture groups (RR of symptoms persisting with acupuncture = 0.56, 95% CI 0.42-0.77). However, this is probably an overestimate due to the heterogeneity (I2 = 51%) and high risk of bias of the included studies. Acupuncture as an add-on treatment also improved global symptoms compared with other treatments only, without significant variability (RR 0.61, 95% CI 0.51-0.73, I2 = 1%). The benefit of acupuncture remained significant when the analysis was limited to two studies with a low risk of bias. Acupuncture was more effective than various controls in relieving pain, facilitating return to normal activity, and promoting quality of life, but these analyses were based on only a small number of studies. Acupuncture did not appear to be associated with adverse events. CONCLUSIONS Given methodological shortcomings and the small number of high-quality primary studies, the available evidence is insufficient to recommend acupuncture as an evidence-based treatment option. This calls for further rigorous investigations.
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Affiliation(s)
- Jimin Park
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Kyung Hee Dae-ro 26, Dongdaemun-gu, Seoul, 130-701, Korea
| | - Seokyung Hahn
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Yeun Park
- Department of Korean Medical Science, Graduate School, Kyung Hee University, Seoul, Korea
| | - Hi-Joon Park
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Hyangsook Lee
- Acupuncture and Meridian Science Research Center, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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