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Gottlieb U, Hayek R, Hoffman JR, Springer S. Exercise combined with electrical stimulation for the treatment of chronic ankle instability - A randomized controlled trial. J Electromyogr Kinesiol 2024; 74:102856. [PMID: 38198892 DOI: 10.1016/j.jelekin.2023.102856] [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] [Received: 04/23/2023] [Revised: 12/03/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI). METHODS Thirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAMSport). RESULTS Both groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI -8.1, -0.2]) and FAAMSport (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT. CONCLUSION The consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.
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Affiliation(s)
- Uri Gottlieb
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
| | - Roee Hayek
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Jay R Hoffman
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Shmuel Springer
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
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Wang A, Zhao F, Shi W, Lian C, Xie X, Jing L, Liu Z, Zhang K, Jiang D, Guo Q. The Distal Fascicle of the Anterior Inferior Tibiofibular Ligament: A Potential Landmark for Lateral Ankle Ligament Reconstruction. Foot Ankle Int 2024; 45:73-79. [PMID: 37902193 DOI: 10.1177/10711007231201343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND A reliable landmark and precise distances from the ligament attachments are needed for lateral ankle stabilization surgery. The distal fascicle of the anterior inferior tibiofibular ligament (AITFL) has been used to locate the anterior talofibular ligament (ATFL) or calcaneofibular ligament (CFL) centers on the fibula. However, there is no anatomic study to validate the distal fascicle of the AITFL as a landmark of lateral ankle ligament stabilization, and more importantly, the exact distances from the ATFL or CFL attachments to the distal fascicle of the AITFL are unknown. METHODS Sixteen frozen cadaveric specimens (8 paired specimens) with no previous history of ankle injury were used in this study. Whether the distal fascicle of AITFL was present in each specimen was confirmed. Then, the distances from the most distal insertion of the AITFL's distal fascicle to the footprint centers of the ATFL and CFL on the fibula were measured. All measurements were performed by 2 observers, and the intraobserver and interobserver reliabilities were analyzed by intraclass correlation coefficients (ICCs). RESULTS The distal fascicle of the AITFL was found in all specimens (100%). The mean distance from the most distal insertion of the AITFL's distal fascicle to the footprint centers of the ATFL, CFL, and the intersection center of the 2 ligaments on the fibula was 6.0 to 7.1 mm, 11.5 to 13.2 mm, and 9.0 to 10.0 mm, respectively. Excellent interobserver and intraobserver agreement (all ICCs > 0.9, P < .01) was shown in the anatomic measurements of these distances. CONCLUSION In this cadaveric study, we found that the distal fascicle was a constant structure of the AITFL in the lateral ankle. The distances from the most distal insertion of the AITFL's distal fascicle to the ligamentous footprint centers were reliable and may be used to identify the origins of the ATFL and CFL for lateral ankle ligament reconstruction. CLINICAL RELEVANCE This anatomic study validates the AITFL's distal fascicle as a potential landmark and, more importantly, determines the range of distances from AITFL's distal fascicle to the attachment centers of lateral ankle ligaments by anatomic measurements. The data may be used to identify the ATFL and CFL for lateral ankle stabilization surgery and become particularly valuable for endoscopic or arthroscopic techniques.
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Affiliation(s)
- Anhong 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
| | - Feng Zhao
- 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
| | - Weili Shi
- 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
| | - Chenyu Lian
- 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
| | - Xing Xie
- 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
| | - Lizhong Jing
- Department of Orthopedics, Affiliated Hospital to Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ziming Liu
- 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
| | - Keying Zhang
- 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
| | - Qinwei 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
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Takaba K, Takenaga T, Tsuchiya A, Takeuchi S, Fukuyoshi M, Nakagawa H, Matsumoto Y, Saito M, Futamura H, Futamura R, Sugimoto K, Murakami H, Yoshida M. Plantar flexion with inversion shows highest elastic modulus of calcaneofibular ligament using ultrasound share wave elastography. J Ultrasound 2023; 26:765-770. [PMID: 35513766 PMCID: PMC10632312 DOI: 10.1007/s40477-022-00687-y] [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] [Received: 03/12/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The functional role of the calcaneofibular ligament (CFL) is still controversial. We aimed to investigate the anatomical features of the CFL on sonography and the elastic modulus of the CFL in different ankle positions using ultrasound shear-wave elastography (SWE). METHODS In 14 cadaveric ankles, the angle of the CFL with respect to the long axis of the fibula was measured in the following ankle positions: neutral (N), 30° plantar flexion (PF), and 20° dorsiflexion (DF). In addition, in 24 ankles of healthy adult volunteers, the elastic modulus of the CFL was evaluated with ultrasound SWE in the following ankle positions: neutral (N), 30° plantar flexion with inversion (PI), 30° plantar flexion with eversion (PE), 20° dorsiflexion with inversion (DI), and 20° dorsiflexion with eversion (DE). RESULTS The mean angle of the CFL in N, PF, and DF positions was 139.9° ± 12.7°, 121.3° ± 14.1°, and 158.6° ± 13.1°, respectively. The angle of the CFL in N was significantly greater than that in PF and smaller than that in DF (P < 0.0001, both). The mean elastic modulus of the CFL in the N, PI, PE, DI, and DE positions was: 63.6 ± 50.8, 148.0 ± 39.4, 75.8 ± 40.6, 88.1 ± 31.6, and 61.7 ± 29.4 kPa, respectively. The elastic modulus in PI was significantly higher than in other positions, while the values obtained in DI and DE were also significantly different (P < 0.001, both). CONCLUSIONS The angle of the CFL increased with DF. Moreover, ultrasound SWE showed that the CFL was tensed and likely to be injured in the PI position.
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Affiliation(s)
- Keishi Takaba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Tetsuya Takenaga
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Atsushi Tsuchiya
- Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
- Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | | | | | | | | | | | | | | | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Liu CX, Zhang ZZ, Wang JS, Luo XY, Liu TY, Ma YF, Deng XH, Zhou YF, Xu DZ, Li WP, Wang P, Song B. Optimal fibular tunnel direction for anterior talofibular ligament reconstruction: 45 degrees outperforms 30 and 60 degrees. Knee Surg Sports Traumatol Arthrosc 2023; 31:4546-4550. [PMID: 37308663 DOI: 10.1007/s00167-023-07452-6] [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: 01/22/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel. METHODS Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed. RESULTS The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula. CONCLUSION This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction.
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Affiliation(s)
- Cheng-Xiao Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Zheng-Zheng Zhang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Jing-Song Wang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Xi-Yuan Luo
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tian-Yu Liu
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yu-Fan Ma
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xing-Hao Deng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Yun-Feng Zhou
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Da-Zheng Xu
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wei-Ping Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Peng Wang
- Department of Orthopedics, Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
| | - Bin Song
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China.
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5
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Hou ZC, Ao YF, Hu YL, Jiao C, Guo QW, Li N, Jiang YF, Jiang D. Balance training benefits chronic ankle instability with generalized joint hypermobility: a prospective cohort study. BMC Musculoskelet Disord 2023; 24:71. [PMID: 36707814 PMCID: PMC9881354 DOI: 10.1186/s12891-023-06179-2] [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: 09/21/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Balance training is the first choice of treatment for chronic ankle instability (CAI). However, there is a lack of research on the effects of balance training in CAI with generalized joint hypermobility (GJH). This study is to compare the outcomes of balance training in CAI patients with and without GJH. METHODS Forty CAI patients were assigned into the GJH group (Beighton ≥ 4, 20) and non-GJH group (Beighton < 4, 20) and they received same 3-month supervised balance training. Repeated measure ANOVA and independent t test were used to analyze self-reported questionnaires (Foot and ankle ability measure, FAAM), the number of patients experiencing ankle sprain, isokinetic muscle strength and postural control tests (Star excursion balance test, SEBT and Balance errors system, BES) before training, post-training immediately, and post-training 3 months, respectively. RESULTS At baseline, no differences were found between groups with except for GJH group having poorer SEBT in the posteromedial direction (83.6 ± 10.1 vs 92.8 ± 12.3, %) and in the posterolateral direction (84.7 ± 11.7 vs 95.7 ± 8.7, %). Following the balance training, GJH group demonstrated lower re-sprain ratio (immediately after training, 11.1% vs 23.5%, 3 month after training, 16.7% vs 29.4%) than non-GJH group, as well as greater FAAM-S score, plantarflexion strength and dorsiflexion strength at post-training immediately and 3 months, and both groups improved similarly in the FAAM-A score, muscle strength and balance control (SEBT in the posterior-lateral and posterior-medial directions, and BES scores) compared with baseline. CONCLUSIONS CAI patients with GJH gained equally even better postural stability and muscle strength after the balance training than the non-GJH patients. Balance training could still be an effective treatment for CAI patients with GJH before considering surgery. TRIAL REGISTRATION ChiCTR1900023999, June 21st, 2019.
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Affiliation(s)
- Zong-chen Hou
- grid.419897.a0000 0004 0369 313XDepartment of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, No.49 North Garden Road, 100191 Beijing, China
| | - Ying-fang Ao
- grid.419897.a0000 0004 0369 313XDepartment of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, No.49 North Garden Road, 100191 Beijing, China
| | - Yue-lin Hu
- grid.419897.a0000 0004 0369 313XDepartment of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, No.49 North Garden Road, 100191 Beijing, China
| | - Chen Jiao
- grid.419897.a0000 0004 0369 313XDepartment of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, No.49 North Garden Road, 100191 Beijing, China
| | - Qin-wei Guo
- grid.419897.a0000 0004 0369 313XDepartment of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, No.49 North Garden Road, 100191 Beijing, China
| | - Nan Li
- grid.411642.40000 0004 0605 3760Research Center of Clinical Epidemiology, Peking University Third Hospital, No.49 North Garden Road, Beijing, 100191 Haidian China
| | - Yan-fang Jiang
- grid.419897.a0000 0004 0369 313XDepartment of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, No.49 North Garden Road, 100191 Beijing, China
| | - Dong Jiang
- grid.419897.a0000 0004 0369 313XDepartment of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, No.49 North Garden Road, 100191 Beijing, China
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6
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Sit RWS, Wu RWK, Ling SKK, Yung PSH, Wang B, Chan DCC, Yip BHK, Wong SYS, Reeves KD, Rabago D. A protocol for a randomized clinical trial assessing the efficacy of hypertonic dextrose injection (prolotherapy) in chronic ankle instability. Trials 2022; 23:1063. [PMID: 36581935 PMCID: PMC9800057 DOI: 10.1186/s13063-022-07037-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/17/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Lateral ankle sprain (LAS) is a common injury. Conservative care is not uniformly effective. Chronic ankle instability (CAI) results in up to 70% of patients with LAS in the physically active population. LAS, together with subsequent osteochondral lesions and pain in many patients, leads to the development of post-traumatic osteoarthritis, resulting in a substantial direct and indirect personal and societal health burden. Dextrose prolotherapy (DPT) is an injection-based therapy for many chronic musculoskeletal conditions but has not been tested for CAI. This protocol describes a randomized controlled trial to test the efficacy of DPT versus normal saline (NS) injections for chronic ankle instability (CAI). METHODS AND ANALYSIS A single-center, parallel-group, randomized controlled trial will be conducted at a university-based primary care clinic in Hong Kong. A total of 114 patients with CAI will be randomly allocated (1:1) to DPT and NS groups. The primary outcome will be the Cumberland Ankle Instability Tool scores at 1 year. The secondary outcomes will be the number of re-sprains in 1 year, the Star Excursion Balance Test, the 5-level of EuroQol 5-dimension questionnaire, and the Foot and Ankle Ability Measure. All outcomes will be evaluated at baseline and at 16, 26, and 52 weeks using a linear mixed model. DISCUSSION We hypothesized the DPT is a safe, easily accessible, and effective treatment for patients with CAI. This RCT study will inform whether DPT could be a primary non-surgical treatment for CAI. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000040213 . Registered on 25 November 2020.
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Affiliation(s)
- Regina Wing Shan Sit
- The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China.
| | - Ricky Wing Keung Wu
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China ,The Hong Kong Insititute of Musculoskeletal Medicine, Hong Kong, China
| | - Samuel Ka Kin Ling
- grid.10784.3a0000 0004 1937 0482The Department of Orthopedic and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Shu Hang Yung
- grid.10784.3a0000 0004 1937 0482The Department of Orthopedic and Traumatology, Chinese University of Hong Kong, Hong Kong, China
| | - Bo Wang
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Dicken Cheong Chun Chan
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Hon Kei Yip
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung Shan Wong
- grid.10784.3a0000 0004 1937 0482The Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | | | - David Rabago
- grid.29857.310000 0001 2097 4281Department of Family and Community Medicine, Pennsylvania State University, Hershey, USA
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Kim J, Kang S, Kim SJ. A smart insole system capable of identifying proper heel raise posture for chronic ankle instability rehabilitation. Sci Rep 2022; 12:10796. [PMID: 35750787 PMCID: PMC9232603 DOI: 10.1038/s41598-022-14313-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Heel raise is widely prescribed to patients with chronic ankle instability in order to strengthen the Peroneus Longus muscle (PL) which supports the weakened lateral collateral ligaments. While the exercise itself is intuitive, ankle orientation is of particular importance because heel raises performed with inversion do not well recruit the PL. This implies that proper execution is imperative and a means to assess heel raise training sessions is needed. In this study we present a smart insole system capable of identifying heel raise events and its corresponding rise, hold and drop phases, which allows for a more descriptive analysis. The results from our heel raise sessions, which consist of four different variants performed by five healthy subjects, suggest that medial–lateral foot pressure distribution and foot orientation are needed to differentiate heel raises performed with ankle eversion and inversion. We go further and substantiate that proper execution, detected by our system, indeed leads to increased PL activation by analyzing the electromyography signals. We believe that the proposed system may provide clinicians with invaluable information regarding onsite as well as at-home training and possibly, with biofeedback, serve as foundation for software as a medical device.
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Affiliation(s)
- Jaewook Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Seonghyun Kang
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, South Korea
| | - Seung-Jong Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, 02841, South Korea.
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Pereira BS, Andrade R, Espregueira-Mendes J, Marano RPC, Oliva XM, Karlsson J. Current Concepts on Subtalar Instability. Orthop J Sports Med 2021; 9:23259671211021352. [PMID: 34435065 PMCID: PMC8381447 DOI: 10.1177/23259671211021352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
Subtalar instability remains a topic of debate, and its precise cause is still unknown. The mechanism of injury and clinical symptoms of ankle and subtalar instabilities largely overlap, resulting in many cases of isolated or combined subtalar instability that are often misdiagnosed. Neglecting the subtalar instability may lead to failure of conservative or surgical treatment and result in chronic ankle instability. Understanding the accurate anatomy and biomechanics of the subtalar joint, their interplay, and the contributions of the different subtalar soft tissue structures is fundamental to correctly diagnose and manage subtalar instability. An accurate diagnosis is crucial to correctly identify those patients with instability who may require conservative or surgical treatment. Many different nonsurgical and surgical approaches have been proposed to manage combined or isolated subtalar instability, and the clinician should be aware of available treatment options to make an informed decision. In this current concepts narrative review, we provide a comprehensive overview of the current knowledge on the anatomy, biomechanics, clinical and imaging diagnosis, nonsurgical and surgical treatment options, and outcomes after subtalar instability treatment.
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Affiliation(s)
- Bruno S. Pereira
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Hospital Privado de Braga, Lugar da Igreja Nogueira, Braga,
Portugal
| | - Renato Andrade
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports,
University of Porto, Porto, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), University of Porto,
Porto, Portugal
| | - João Espregueira-Mendes
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto,
Portugal
- Dom Henrique Research Centre, Porto, Portugal
- School of Medicine, Minho University, Braga, Portugal
- 3B’s–PT Government Associate Laboratory, Braga/Guimarães,
Portugal
- 3B’s Research Group– Biomaterials, Biodegradables and Biomimetics,
University of Minho, Headquarters of the European Institute of Excellence on Tissue
Engineering and Regenerative Medicine, Barco, Guimarães, Portugal
| | | | - Xavier Martin Oliva
- Facultad de Medicina, University of Barcelona, Casanova, 143, 08036
Barcelona, Spain
- Orthopedic Surgery Department, Clínica Ntra. Sra. Del Remei,
Barcelona, Spain
| | - Jón Karlsson
- Department of Orthopaedics, Sahlgrenska Academy, Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Sweden
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9
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Mollà-Casanova S, Inglés M, Serra-Añó P. Effects of balance training on functionality, ankle instability, and dynamic balance outcomes in people with chronic ankle instability: Systematic review and meta-analysis. Clin Rehabil 2021; 35:1694-1709. [PMID: 34058832 DOI: 10.1177/02692155211022009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To identify the effects of balance and strength training on function, ankle instability and dynamic balance in people with chronic ankle instability. METHOD The search was conducted on randomized controlled trials that investigated the effects of balance training or strength training in people with chronic ankle instability compared to a control group. Therefore, a systematic electronic search was performed until April 2021 in Pubmed/MEDLINE, Cochrane, and Embase databases. Moreover, an additional search was further performed checking the reference lists of the selected articles. The main outcomes were ankle instability, functionality, and dynamic balance. Finally, a qualitative and quantitative synthesis was performed. RESULTS Fifteen randomized controlled trials with 457 volunteers were included. Compared to regular exercise, balance training demonstrated to be more effective in terms of improving functionality (0.81 (0.48, 1.14)), ankle instability (0.77 (0.27, 1.26)), and dynamic balance (0.83 (0.57, 1.10)) outcomes. However, when compared to strength training, the effectiveness of balance training was only greater in terms of the functionality outcome (0.49 (0.06, 0.92)), since no differences were found for instability (0.43 (0.00, 0.85)) and dynamic balance (0.21 (-0.15, 0.58)). CONCLUSIONS Based on fair-to-high quality evidence, balance training significantly improves functionality, instability, and dynamic balance outcomes in people with chronic ankle instability Moreover, results of the comparison between balance training versus strength training suggest that the former achieves greater benefits for functionality, but not for instability and dynamic balance. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42021224179.
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Affiliation(s)
| | - Marta Inglés
- UBIC, Departament de Fisioteràpia, Universitat de València, València, Spain
| | - Pilar Serra-Añó
- UBIC, Departament de Fisioteràpia, Universitat de València, València, Spain
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10
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Wei S, Fan D, Han F, Tang M, Kong C, Xu F, Cai X. Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment. BMC Musculoskelet Disord 2021; 22:289. [PMID: 33736616 PMCID: PMC7977304 DOI: 10.1186/s12891-021-04165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Minimally invasive reconstruction techniques are used for anatomical ligament construction of the lateral collateral ligament complex of the ankle, but the two key elements, the bone tunnel and the appropriate graft tension, for the identification of the anatomic location during the surgery are not clearly stated. Methods The patients with chronic ankle instability who received arthroscopic anatomic lateral ligament complex reconstruction were retrospectively analyzed. The anatomical location of the bone tunnel was performed under arthroscopy combined with fluoroscopy for accurate location of the bone tunnel entrance. The graft tension and routing were controlled under arthroscopic visualization. The clinical outcomes were assessed using the Karlsson-Peterson score, Sefton articular stability scale, and Visual Analogue Scale (VAS). The complications were recorded during the follow-up. Results A total of 18 patients were enrolled in this study. The mean follow-up was 33.33 ± 3.69 (range from 24 to 36) months. No patient had recurrence of ankle instability after the operation. According to the Sefton articular stability scale, 94.5% of the patients had excellent/good function. The mean value of the anterior drawer tests and the talar tilt angle examination were decreased. The mean of the Karlsson-Peterson score and the Visual Analogue Scale(VAS) score were both improved significantly. Conclusions The anatomic reconstruction of the ankle lateral ligament complex to treat chronic ankle instability using the arthroscopy combined with the fluoroscopic technique could improve the clinical functions, satisfaction, and reduced pain of patients.
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Affiliation(s)
- Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China. .,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.
| | - Dongsheng Fan
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Province, People's Republic of China
| | - Fang Han
- Department of Nutrition, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), Wuhan, Hubei Province, People's Republic of China
| | - Ming Tang
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Changwang Kong
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xianhua Cai
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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11
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Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6695096. [PMID: 33575340 PMCID: PMC7861910 DOI: 10.1155/2021/6695096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022]
Abstract
We investigated the therapeutic effect of a postoperative hospital-based systemic rehabilitation protocol on ankle function in chronic ankle instability (CAI) patients. Thirty-five patients who underwent a modified Broström procedure for CAI were recruited in this prospective randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Education-based rehabilitation was conducted at home in the control group. The outcomes were evaluated at baseline (T0), 12 weeks (T1), and 16 weeks (T2). The primary outcome was the foot and ankle outcome score (FAOS). Ankle motor strength and spatiotemporal gait metrics were assessed as secondary outcomes. There were significant time and group interaction effects on the pain, symptoms, activities of daily living, sports activities, and quality of life (QOL) domains of the FAOS (P < 0.05, all). The patients in the intervention group showed larger improvements in all domains of the FAOS than did the control group at both T1 and T2 (P < 0.05, all). The time and group interaction effects on invertor and evertor strength were also significant (P = 0.047 and P = 0.044). Invertor and evertor strength improved significantly more in the intervention group than in the control group at T1 and T2 (P < 0.05, all). The preferred walking velocity, cadence, step length on the affected side, and double stance phase duration tended to improve over time. Postoperative hospital-based rehabilitation helped improve CAI pain, symptoms, independence in activities of daily living, sports activity levels, and QOL more effectively than did conventional rehabilitation at home.
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12
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Diniz P, Sousa DA, Batista JP, Abdelatif N, Pereira H. Diagnosis and treatment of anterior ankle impingement: state of the art. J ISAKOS 2020. [DOI: 10.1136/jisakos-2019-000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Evaluation modalities for the anatomical repair of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:163-176. [PMID: 31646350 DOI: 10.1007/s00167-019-05755-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/07/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Several evaluation modalities are reported in the literature dealing with the operative treatment of chronic ankle instability (CAI) both to establish the CAI diagnosis leading to the surgical indication and to assess the effectiveness of ankle stabilisation procedure. The purpose of this study is to present an overview of the pre- and postoperative evaluation modalities reported in the literature dealing with CAI operative treatment. The comprehensive analysis of the different modalities chosen by researchers is expected to suggest critical points in current evaluation ability of CAI surgical treatment. METHODS Systematic review of the literature on surgical treatment of CAI through anatomic procedures. Pubmed, Embase and Cochrane electronic databases were analysed, from 2004 to 2018. RESULTS One-hundred-and-four studies met inclusion in this systematic review. 88 out of 104 studies analysed preoperative mechanical laxity of the ankle to depict the ligamentous insufficiency related to the subjective feeling of functional instability. Stress radiographs and manual stress examination of the ankle were the two most common modalities to evaluate joint laxity, reported in 67 and 53 studies, respectively. Clinical Outcome Measurement Scales (COMs) is the most common evaluation modality (102 out of 104 studies) to assess CAI surgical outcome. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS) and the Karlsson score are the most frequent COMs, reported in the 66% and 33%, respectively of the included literature. The radiographic analysis of ankle laxity after stabilisation procedures is the second most frequent postoperative evaluation modality, reported in 55 out 104 studies. CONCLUSIONS There is a lack of standardization among researchers related to both the criteria to establish the CAI diagnosis leading to the surgical indication and the modality chosen to evaluate the effectiveness of surgical treatment. Future standardization of evaluation modalities in the CAI population is desirable to increase consistency of reported data. LEVEL OF EVIDENCE Level IV, review of level I, II, III and IV studies.
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Akhbari B, Dickinson MH, Louie EG, Shalhoub S, Maletsky LP. Characterization of Ankle Kinematics and Constraint Following Ligament Rupture in a Cadaveric Model. J Biomech Eng 2019; 141:2738795. [PMID: 31314890 DOI: 10.1115/1.4044234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Indexed: 12/25/2022]
Abstract
Ankle sprains are a common injury that may need reconstruction and extensive physical therapy. The purpose of this study was to provide a description of the biomechanics of the ankle joint complex after anterior talofibular (ATFL) and calcaneofibular (CFL) ligament rupture to better understand severe ankle injuries. Envelope of motion of ten cadaveric ankles was examined by manual manipulations that served as training data for a radial basis function used to interpolate ankle mobility at flexion angles under load and torque combinations. Moreover, ankle kinematics were examined while tendons were loaded to identify how their performance is altered by ligament rupture. The force required to plantarflex the ankle following ligament rupture was measured by calculating the load through the Achilles. Following ATFL injury, the largest changes were to internal rotation (5°) in deep plantarflexion and anterior translation (1.5mm) in early plantarflexion. The combined ATFL and CFL rupture changed the internal/external rotation (3°), anterior/posterior translation (1mm), and inversion (5°) throughout flexion relative to the isolated ATFL rupture. The Achilles' load increased by 24% after the rupture of ligaments indicating a reduction in its efficiency. This study suggests that if patients demonstrate a primarily an increased laxity in internal rotation, the damage has solely occurred to the ATFL; however, if the constraint is reduced across multiple motions, there is likely damage to both ligaments. Higher loads in the Achilles suggest that it is overloaded after the injury; hence, targeting the calf muscles in rehabilitation exercises may reduce patients' pain.
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Affiliation(s)
- Bardiya Akhbari
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS, USA
| | | | - Ednah G Louie
- Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA
| | - Sami Shalhoub
- Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA
| | - Lorin P Maletsky
- Department of Mechanical Engineering, University of Kansas, Lawrence, KS 66045-2234, USA; Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA
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15
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[The periosteal flap augmentation technique in chronic lateral ankle instability]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:180-190. [PMID: 31037329 DOI: 10.1007/s00064-019-0600-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Anatomic repair of the lateral ligament complex of the ankle joint and augmentation with an autologous pedicled periosteal flap of the distal fibula following identification and concomitant treatment of intra-articular pathologies. INDICATIONS Symptomatic chronic mechanical lateral ankle instability. As a modular step in the treatment of osteochondral lesions in conjunction with lateral ankle instability. CONTRAINDICATIONS Higher degree osteoarthritis of the ankle joint (>Kellgren/Lawrence 2 and 4 or Outerbridge 3 and 4) and/or hindfoot deformity; mechanical incompetence of both the fibulotalar anterior ligament and the fibulocalcaneal ligament preventing anatomical reinsertion; general risk factors. SURGICAL TECHNIQUE Diagnostic arthroscopy for identification and treatment of intraarticular pathologies; verification and grading of ligamentous instability (medial, lateral, combined). Open exposure of the distal fibula and the ruptured components of the lateral ankle ligament complex. Anatomic reinsertion of the original ligaments and assessment of their mechanical competence. Apart from the situation in the juvenile patient with a thick periosteal layer a doubled and pedicled periosteal strip of the distal fibular periosteum will suffice for the augmentation in one ligamentous component, only. Fixation in the talus or calcaneus is achieved via suture anchors, screws with a washer or transosseous fixation via interference screw. POSTOPERATIVE MANAGEMENT Postoperative immobilization in a lower leg split cast or a splint until wound healing (5-8 days), mobilization in a walker or an ankle orthosis with consecutive full weight-bearing for further 4-5 weeks. Proprioceptive and pronator muscle training, optionally insole or lateral wedge at the shoe sole for 6 months postoperatively. Avoidance of contact sports for 4-6 months. RESULTS Several studies have reported reliable restoration of ligamentous ankle stability with overall success rates >90% and good to excellent total results in >90% of patients with limited minor complications. In view of the heterogeneous data from previous studies, some recent studies have demonstrated that the outcome after periosteal augmentation is comparable to that after techniques employing free tendon graft for anatomic restoration of ligamentous ankle stability. The technique has been applied successfully in cases of poor mechanical properties of the formerly ruptured ligaments and in patients with a high functional demand.
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Cao Y, Hong Y, Xu Y, Zhu Y, Xu X. Surgical management of chronic lateral ankle instability: a meta-analysis. J Orthop Surg Res 2018; 13:159. [PMID: 29940985 PMCID: PMC6019311 DOI: 10.1186/s13018-018-0870-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 12/26/2022] Open
Abstract
Background A key point to surgical treatment of chronic lateral ankle instability is choosing a suitable surgical procedure. The purpose of this meta-analysis was to compare different surgical techniques for management of chronic lateral ankle instability. Methods We searched the Cochrane Library, MEDLINE, and EMBASE. All identified randomized and quasi-randomized controlled trials of operative treatment for chronic lateral ankle instability were included. Two review authors independently extracted data from each study and assessed risk of bias. Where appropriate, results of comparable studies were pooled. Results Seven randomized controlled trials were included for analysis. They fell in five clearly distinct groups. One study comparing two different kinds of non-anatomic reconstruction procedures (dynamic and static tenodesis) found two clinical outcomes favoring static tenodesis: better clinical satisfaction and fewer subsequent sprains. Two studies compared non-anatomic reconstruction versus anatomic repairment. In one study, nerve damage was more frequent in non-anatomic reconstruction group; the other one reported that radiological measurement of ankle laxity showed that non-anatomic reconstruction provided higher reduction of talar tilt angle. Two studies comparing two anatomic repairment surgical techniques (transosseous suture versus imbrication) showed no significant difference in any clinical outcome at the follow-up except operation time. One study compared two different anatomic repairment techniques. They found that the double anchor technique was superior with respect to the reduction of talar tilt than single anchor technique. One study compared an anatomic reconstruction procedure with a modified Brostrom technique. Primary reconstruction combined with ligament advanced reinforcement system results in better patient-scored clinical outcome, at 2 years post-surgery, than the modified Brostrom procedure. Conclusions There is limited evidence to support any one surgical technique over another surgical technique for chronic lateral ankle instability, but based on the evidence, we could still get some conclusions: (1) There are limitations to the use of dynamic tenodesis, which obtained poor clinical satisfaction and more subsequent sprains. (2) Non-anatomic reconstruction abnormally increased inversion stiffness at the subtalar level as compare with anatomic repairment. (3) Multiple types of modified Brostrom procedures could acquire good clinical results. (4) Anatomic reconstruction is a better procedure for some specific patients. Electronic supplementary material The online version of this article (10.1186/s13018-018-0870-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yongxing Cao
- Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Hong
- Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Xu
- Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Zhu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiangyang Xu
- Department of Orthopedics, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Cao S, Wang C, Ma X, Wang X, Huang J, Zhang C. Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis. J Orthop Surg Res 2018; 13:122. [PMID: 29788978 PMCID: PMC5964890 DOI: 10.1186/s13018-018-0811-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/11/2018] [Indexed: 12/23/2022] Open
Abstract
Background Various imaging techniques have been utilized for the diagnosis of chronic lateral ankle ligament injury. This systemic review will explore the effectiveness of different imaging techniques in diagnosing chronic lateral ankle ligament injury. Methods Relative studies were retrieved after searching 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trails). Eligible studies were summarized. Data were extracted to calculate pooled sensitivity and specificity of magnetic resonance imaging (MRI), ultrasonography (US), stress radiography, and arthrography. Results Fifteen studies met our inclusion and exclusion criteria. A total of 695 participants were included. The pooled sensitivities in diagnosing chronic ATFL injury were 0.83 [0.78, 0.87] for MRI, 0.99 [0.96, 1.00] for US, and 0.81 [0.68, 0.90] for stress radiography. The pooled specificities in diagnosing chronic ATFL injury were 0.79 [0.69, 0.87] for MRI, 0.91 [0.82, 0.97] for US, and 0.92 [0.79, 0.98] for stress radiography. The pooled sensitivities in diagnosing chronic CFL injury were 0.56 [0.46, 0.66] for MRI, 0.94 [0.85, 0.98] for US, and 0.90 [0.73, 0.98] for arthrography. The pooled specificities in diagnosing chronic CFL injury were 0.88 [0.82, 0.93] for MRI, 0.91 [0.80, 0.97] for US, and 0.90 [0.77, 0.97] for arthrography. Conclusion This systematic review with meta-analysis investigated the accuracy of imaging for the diagnosis of chronic lateral ankle ligament injury. Ultrasound manifested high diagnostic accuracy in diagnosing chronic lateral ankle ligament injury. Clinicians should be aware of the limitations of MRI in detecting chronic CFL injuries.
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Affiliation(s)
- Shengxuan Cao
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Chen Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Xin Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China.
| | - Xu Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Jiazhang Huang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
| | - Chao Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China
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Lopes R, Noailles T, Brulefert K, Geffroy L, Decante C. Anatomic validation of the lateral malleolus as a cutaneous marker for the distal insertion of the calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 2018; 26:869-874. [PMID: 27497693 DOI: 10.1007/s00167-016-4250-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE An anatomic study was performed to confirm whether the lateral malleolus could serve as a simple and reproducible anatomic reference for the distal insertion of the calcaneofibular ligament (CFL). METHODS Dissection was performed after placement of a Kirschner wire to simulate the calcaneal tunnel for the distal insertion of the CFL. The skin was penetrated 1 cm distal and posterior to the tip of the lateral malleolus. The main information recorded was the distance from the Kirschner wire to the centre of the distal insertion of the CFL. Other elements were noted (characteristics of the CFL, distance between the distal insertion of the CFL-peroneal tubercle, nerve or tendon injuries). RESULTS Thirty ankles were dissected. The mean distance from the Kirschner wire to the centre of the distal insertion of the CFL was 2.4 ± 1.8 mm. Only one case of peroneal injury was noted. The sural nerve was usually located a mean 1.8 ± 1.1 mm from the Kirschner wire. The posterior tibial vascular pedicle was a mean 27.8 ± 3.5 mm from the point of exit of the Kirschner wire. CONCLUSION Using the lateral malleolus as the cutaneous reference for the distal insertion of the CFL seems to be more reliable than the pure arthroscopic technique. This study describes a percutaneous technique to obtain a calcaneal tunnel for distal insertion of the CFL. The sural nerve is at the greatest risk of injury with this technique and requires careful subcutaneous incision to prevent injury. This new percutaneous technique is less invasive than a purely arthroscopic technique and more accurately identifies the location of the tunnel. It can be used to do calcaneal tunnel in clinical practice during anatomic ligament reconstruction for chronic ankle instability.
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Affiliation(s)
- R Lopes
- Department of Orthopaedic Surgery, Breteche Clinic, 3 rue de la Béraudière, 44000, Nantes, France.
| | - T Noailles
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - K Brulefert
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - L Geffroy
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - C Decante
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
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Vuurberg G, Pereira H, Blankevoort L, van Dijk CN. Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc 2018; 26:2183-2195. [PMID: 29138918 PMCID: PMC6061442 DOI: 10.1007/s00167-017-4730-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/25/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine the best surgical treatment for chronic ankle instability (CAI) a systematic review was performed to compare the functional outcomes between various surgical stabilization methods. METHODS A systematic search was performed from 1950 up to April 2016 using PubMed, EMBASE, Medline and the Cochrane Library. Inclusion criteria were a minimum age of 18 years, persistent lateral ankle instability, treatment by some form of surgical stabilization, described functional outcome measures. Exclusion criteria were case reports, (systematic) reviews, articles not published in English, description of only acute instability or only conservative treatment, medial ankle instability and concomitant injuries, deformities or previous surgical treatment for ankle instability. After inclusion, studies were critically appraised using the Modified Coleman Methodology Score. RESULTS The search resulted in a total of 19 articles, including 882 patients, which were included in this review. The Modified Coleman Methodology Score ranged from 30 to 73 points on a scale from 0 to 90 points. The AOFAS and Karlsson Score were the most commonly used patient-reported outcome measures to assess functional outcome after surgery. Anatomic repair showed the highest post-operative scores [AOFAS 93.8 (SD ± 2.7; n = 119); Karlsson 95.1 (SD ± 3.6, n = 121)], compared to anatomic reconstruction [AOFAS 90.2 (SD ± 10.9, n = 128); Karlsson 90.1 (SD ± 7.8, n = 35)] and tenodesis [AOFAS 86.5 (SD ± 12.0, n = 10); Karlsson 85.3 (SD ± 2.5, n = 39)]. Anatomic reconstruction showed the highest score increase after surgery (AOFAS 37.0 (SD ± 6.8, n = 128); Karlsson 51.6 (SD ± 5.5, n = 35) compared to anatomic repair [AOFAS 31.8 (SD ± 5.3, n = 119); Karlsson 40.9 (SD ± 2.9, n = 121)] and tenodesis [AOFAS 19.5 (SD ± 13.7, n = 10); Karlsson 29.4 (SD ± 6.3, n = 39)] (p < 0.005). CONCLUSION Anatomic reconstruction and anatomic repair provide better functional outcome after surgical treatment of patients with CAI compared to tenodesis reconstruction. These results further discourage the use of tenodesis reconstruction and other non-anatomic surgical techniques. Future studies may be required to indicate potential value of tenodesis reconstruction when used as a salvage procedure. Not optimal, but the latter still provides an increase in functional outcome post-operatively. Anatomic reconstruction seems to give the best results, but may be more invasive than anatomic repair. This has to be kept in mind when choosing between reconstruction and repair in the treatment of CAI. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- G. Vuurberg
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - H. Pereira
- Centro Hospitalar Póvoa de Varzim – Vila do Conde, Póvoa de Varzim, Portugal ,ICVS/3B’s—PT Government Associated Laboratory, University of Minho, Braga, Guimarães, Portugal ,Ripoll y De Prado Sports Clinic: Murcia-Madrid—FIFA Medical Center of Excellence, Madrid, Spain
| | - L. Blankevoort
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - C. N. van Dijk
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands ,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands ,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands ,Ripoll y De Prado Sports Clinic: Murcia-Madrid—FIFA Medical Center of Excellence, Madrid, Spain
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What Does Cochrane Say about … the Rehabilitation of Ankle Injuries? Physiother Can 2018; 70:198. [PMID: 29755176 PMCID: PMC5938083 DOI: 10.3138/ptc.70.2.cochrane] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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22
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Tenenbaum S, Chechik O, Bariteau J, Bruck N, Beer Y, Falah M, Segal G, Mor A, Elbaz A. Gait abnormalities in patients with chronic ankle instability can improve following a non-invasive biomechanical therapy: a retrospective analysis. J Phys Ther Sci 2017; 29:677-684. [PMID: 28533609 PMCID: PMC5430272 DOI: 10.1589/jpts.29.677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/10/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to evaluate the changes in gait patterns and clinical outcomes of patients with chronic ankle instability (CAI) following treatment with a home-based non-invasive biomechanical device. [Subjects and Methods] Thirty-three patients with CAI were compared with 43 healthy controls. Patients underwent a spatiotemporal gait assessment before and three months following treatment. Clinical evaluation was recorded with SF-36 Health Survey and the Foot and Ankle Outcome Score (FAOS). [Results] Significant baseline differences were found between groups. Patients with CAI showed a statistically significant improvement in velocity, cadence, symptomatic limb step length and single limb support over time. Significant improvements in SF-36 PCS and FAOS outcome scores were found in patients with CAI. [Conclusion] Patients with CAI have baseline spatiotemporal gait abnormalities as compared with healthy controls. However, clinical and gait metrics improvement can be expected after 12 weeks of perturbation training using a non-invasive biomechanical device.
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Affiliation(s)
- Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical
Center at TEL: Hashomer, affiliated to the Sackler Faculty of Medicine TEL: Aviv
University, Israel
| | - Ofir Chechik
- Department of Orthopedic Surgery, Sourasky Medical Center,
Israel
| | - Jason Bariteau
- Department of Orthopedics, Emory University School of
Medicine, USA
| | - Nathan Bruck
- Department of Orthopedic Surgery, Chaim Sheba Medical
Center at TEL: Hashomer, affiliated to the Sackler Faculty of Medicine TEL: Aviv
University, Israel
| | - Yiftah Beer
- Department of Orthopedic Surgery, Assaf Harofeh Medical
Center, Israel
| | - Mazen Falah
- Department of Orthopedic Surgery, Rambam Health Care
Campus, Israel
| | | | - Amit Mor
- AposTherapy Research Group, Israel
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23
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Willegger M, Benca E, Hirtler L, Hradecky K, Holinka J, Windhager R, Schuh R. Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL. Knee Surg Sports Traumatol Arthrosc 2016; 24:1015-21. [PMID: 26878851 PMCID: PMC4823330 DOI: 10.1007/s00167-016-4048-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 01/21/2016] [Indexed: 10/29/2022]
Abstract
PURPOSE Current methods of anterior talofibular ligament (ATFL) reconstruction fail to restore the stability of the native ATFL. Therefore, augmented anatomic ATFL reconstruction gained popularity in patients with attenuated tissue and additional stress on the lateral ankle ligament complex. The aim of the present study was to evaluate the biomechanical stability of the InternalBrace (Arthrex Inc., Naples, FL, USA), a tape augmentation designed to augment the traditional Broström procedure. METHODS Twelve (12) fresh-frozen human anatomic lower leg specimens were randomized into two groups: a native ATFL (ATFL) and a tape augmentation group (IB). Dual-energy X-ray absorptiometry (DEXA) scans were carried out to determine bone mineral density (BMD) of the specimens. The ligaments were stressed by internally rotating the tibia against the inverted fixated hindfoot. Torque at failure (Nm) and angle at failure (°) were recorded. RESULTS The ATFL group failed at an angle of 33 ± 10°. In the IB group, construct failure occurred at an angle of 46 ± 16°. Failure torque reached 8.3 ± 4.5 Nm in the ATFL group, whereas the IB group achieved 11.2 ± 7.1 Nm. There was no correlation between angle at ATFL or IB construct failure or torque at failure, respectively, and BMD for both groups. CONCLUSION This study reveals that tape augmentation for ATFL reconstruction shows similar biomechanical stability compared to an intact native ATFL in terms of torque at failure and angle at failure. BMD did not influence the construct stability. Tape augmentation proved an enhanced initial stability in ATFL reconstruction which may allow for an accelerated rehabilitation process. LEVEL OF EVIDENCE II.
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Affiliation(s)
- M Willegger
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - E Benca
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - L Hirtler
- Institute of Anatomy, Medical University of Vienna, Vienna, Austria
| | - K Hradecky
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - J Holinka
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - R Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - R Schuh
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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24
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Pearce CJ, Tourné Y, Zellers J, Terrier R, Toschi P, Silbernagel KG. Rehabilitation after anatomical ankle ligament repair or reconstruction. Knee Surg Sports Traumatol Arthrosc 2016; 24:1130-9. [PMID: 26905066 DOI: 10.1007/s00167-016-4051-z] [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] [Received: 10/03/2015] [Accepted: 02/05/2016] [Indexed: 01/08/2023]
Abstract
The selection, implementation of and adherence to a post-operative regimen are all essential in order to achieve the best outcomes after ankle ligament surgery. The purpose of this paper is to present a best-evidence approach to this, with grounding in basic science and a consensus opinion from the members of the ESSKA-AFAS Ankle Instability Group. Basic science and clinical evidence surrounding tissue healing after surgical repair or reconstruction of the ligaments as well as around the re-establishment of sensorimotor control are reviewed. A consensus opinion based on this evidence as to the recommended rehabilitation protocol after ankle ligament surgery was then obtained from the members of the ESSKA-AFAS Ankle Instability Group. Rehabilitation recommendations are presented for the initial post-operative period, the early recovery phase and a goal-orientated late rehabilitation and return-to-sport phase. This paper presents practical, evidenced-based guidelines for rehabilitation and return to activity after lateral ankle ligament surgery.
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Affiliation(s)
| | - Yves Tourné
- Centre Osteo-Articulaire des Cèdres, Parc Galaxie SUD, 5 rue des tropiques, 38130, Echirolles, France
| | - Jennifer Zellers
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Romain Terrier
- Laboratoire de Physiologie de l'Exercice (EA 4338), Université Savoie Mont-Blanc, 73377, Le Bourget du Lac, France
| | - Pascal Toschi
- CEVRES Santé Savoie Technolac, 30 allée du lac d' Aiguebelette, BP 322, 73377, Le Bourget du Lac, France
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25
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Pearce CJ, Tourné Y, Zellers J, Terrier R, Toschi P, Silbernagel KG. Rehabilitation after anatomical ankle ligament repair or reconstruction. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2016. [PMID: 26905066 DOI: 10.1007/s00167-016-4051-z.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The selection, implementation of and adherence to a post-operative regimen are all essential in order to achieve the best outcomes after ankle ligament surgery. The purpose of this paper is to present a best-evidence approach to this, with grounding in basic science and a consensus opinion from the members of the ESSKA-AFAS Ankle Instability Group. Basic science and clinical evidence surrounding tissue healing after surgical repair or reconstruction of the ligaments as well as around the re-establishment of sensorimotor control are reviewed. A consensus opinion based on this evidence as to the recommended rehabilitation protocol after ankle ligament surgery was then obtained from the members of the ESSKA-AFAS Ankle Instability Group. Rehabilitation recommendations are presented for the initial post-operative period, the early recovery phase and a goal-orientated late rehabilitation and return-to-sport phase. This paper presents practical, evidenced-based guidelines for rehabilitation and return to activity after lateral ankle ligament surgery.
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Affiliation(s)
| | - Yves Tourné
- Centre Osteo-Articulaire des Cèdres, Parc Galaxie SUD, 5 rue des tropiques, 38130, Echirolles, France
| | - Jennifer Zellers
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Romain Terrier
- Laboratoire de Physiologie de l'Exercice (EA 4338), Université Savoie Mont-Blanc, 73377, Le Bourget du Lac, France
| | - Pascal Toschi
- CEVRES Santé Savoie Technolac, 30 allée du lac d' Aiguebelette, BP 322, 73377, Le Bourget du Lac, France
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26
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Pereira H, Vuurberg G, Gomes N, Oliveira JM, Ripoll PL, Reis RL, Espregueira-Mendes J, Niek van Dijk C. Arthroscopic Repair of Ankle Instability With All-Soft Knotless Anchors. Arthrosc Tech 2016; 5:e99-e107. [PMID: 27073785 PMCID: PMC4811205 DOI: 10.1016/j.eats.2015.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/27/2015] [Indexed: 02/03/2023] Open
Abstract
In recent years, arthroscopic and arthroscopically assisted techniques have been increasingly used to reconstruct the lateral ligaments of the ankle. Besides permitting the treatment of several comorbidities, arthroscopic techniques are envisioned to lower the amount of surgical aggression and to improve the assessment of anatomic structures. We describe our surgical technique for arthroscopic, two-portal ankle ligament repair using an all-soft knotless anchor, which is made exclusively of suture material. This technique avoids the need for classic knot-tying methods. Thus it diminishes the chance of knot migration caused by pendulum movements. Moreover, it avoids some complications that have been related to the use of metallic anchors and some currently available biomaterials. It also prevents prominent knots, which have been described as a possible cause of secondary complaints.
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Affiliation(s)
- Hélder Pereira
- Orthopedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal,3B's Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal,ICVS/3B's–PT Government Associated Laboratory, Portugal,Clínica do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Center of Excellence, Murcia, Spain,Ripoll y De Prado Sports Clinic, FIFA Medical Center of Excellence, Murcia, Spain,Address correspondence to Hélder Pereira, M.D., Rua do Visconde n.161, Touguinhó 4480-582, Vila do Conde, Portugal.
| | - Gwen Vuurberg
- Orthopedic Department, Amsterdam Medical Centre, Amsterdam, The Netherlands
| | - Nuno Gomes
- Orthopedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Joaquim Miguel Oliveira
- 3B's Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal,ICVS/3B's–PT Government Associated Laboratory, Portugal,Clínica do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Center of Excellence, Murcia, Spain,Ripoll y De Prado Sports Clinic, FIFA Medical Center of Excellence, Murcia, Spain
| | - Pedro L. Ripoll
- Ripoll y De Prado Sports Clinic, FIFA Medical Center of Excellence, Murcia, Spain
| | - Rui Luís Reis
- 3B's Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal,ICVS/3B's–PT Government Associated Laboratory, Portugal,Clínica do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Center of Excellence, Murcia, Spain
| | - João Espregueira-Mendes
- 3B's Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal,ICVS/3B's–PT Government Associated Laboratory, Portugal,Clínica do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Center of Excellence, Murcia, Spain
| | - C. Niek van Dijk
- Clínica do Dragão, Espregueira-Mendes Sports Center, FIFA Medical Center of Excellence, Murcia, Spain,Orthopedic Department, Amsterdam Medical Centre, Amsterdam, The Netherlands
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Knupp M, Lang TH, Zwicky L, Lötscher P, Hintermann B. Chronic Ankle Instability (Medial and Lateral). Clin Sports Med 2015; 34:679-88. [PMID: 26409589 DOI: 10.1016/j.csm.2015.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ankle ligament injuries are among the most frequent reasons for emergency consultations of athletes. A majority of these can be treated conservatively; however, up to 40% develop chronic ankle instability requiring surgical reconstruction to restore functionality.
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Affiliation(s)
- Markus Knupp
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland.
| | - Tamara Horn Lang
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
| | - Lukas Zwicky
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
| | - Patrick Lötscher
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
| | - Beat Hintermann
- Department of Orthopaedic Surgery, Kantonsspital Baselland, Rheinstrasse 26, Liestal CH-4410, Switzerland
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28
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McLeod MM, Gribble PA, Pietrosimone BG. Chronic Ankle Instability and Neural Excitability of the Lower Extremity. J Athl Train 2015; 50:847-53. [PMID: 26090710 DOI: 10.4085/1062-6050-50.4.06] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Neuromuscular dysfunction of the leg and thigh musculature, including decreased strength and postural control, is common in patients with chronic ankle instability (CAI). Understanding how CAI affects specific neural pathways may provide valuable information for targeted therapies. OBJECTIVE To investigate differences in spinal reflexive and corticospinal excitability of the fibularis longus and vastus medialis between limbs in patients with unilateral CAI and between CAI patients and participants serving as healthy controls. DESIGN Case-control study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 56 participants volunteered, and complete data for 21 CAI patients (9 men, 12 women; age = 20.81 ± 1.63 years, height = 171.57 ± 11.44 cm, mass = 68.84 ± 11.93 kg) and 24 healthy participants serving as controls (7 men, 17 women; age = 22.54 ± 2.92 years, height = 172.35 ± 10.85 cm, mass = 69.15 ± 12.30 kg) were included in the final analyses. Control participants were matched to CAI patients on sex, age, and limb dominance. We assigned "involved" limbs, which corresponded with the involved limbs of the CAI patients, to control participants. MAIN OUTCOME MEASURE(S) Spinal reflexive excitability was assessed via the Hoffmann reflex and normalized to a maximal muscle response. Corticospinal excitability was assessed using transcranial magnetic stimulation. Active motor threshold (AMT) was defined as the lowest transcranial magnetic stimulation intensity required to elicit motor-evoked potentials equal to or greater than 100 μV in 5 of 10 consecutive stimuli. We obtained motor-evoked potentials (MEPs) at percentages ranging from 100% to 140% of AMT. RESULTS Fibularis longus MEP amplitudes were greater in control participants than in CAI patients bilaterally at 100% AMT (control involved limb: 0.023 ± 0.031; CAI involved limb: 0.014 ± 0.008; control uninvolved limb: 0.021 ± 0.022; CAI uninvolved limb: 0.015 ± 0.007; F1,41 = 4.551, P = .04) and 105% AMT (control involved limb: 0.029 ± 0.026; CAI involved limb: 0.021 ± 0.009; control uninvolved limb: 0.034 ± 0.037; CAI uninvolved limb: 0.023 ± 0.013; F1,35 = 4.782, P = .04). We observed no differences in fibularis longus MEP amplitudes greater than 110% AMT and no differences in vastus medialis corticospinal excitability (P > .05). We noted no differences in the Hoffmann reflex between groups for the vastus medialis (F1,37 = 0.103, P = .75) or the fibularis longus (F1,41 = 1.139, P = .29). CONCLUSIONS Fibularis longus corticospinal excitability was greater in control participants than in CAI patients.
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Affiliation(s)
| | - Phillip A Gribble
- Department of Rehabilitation Sciences, University of Kentucky, Lexington
| | - Brian G Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill. Dr McLeod is now with the Department of Health and Human Performance, College of Charleston, SC
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29
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Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sánchez-Milá Z, Fernández-de-las-Peñas C, Alburquerque-Sendín F. Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:790209. [PMID: 26064172 PMCID: PMC4430654 DOI: 10.1155/2015/790209] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/07/2015] [Accepted: 04/09/2015] [Indexed: 01/31/2023]
Abstract
Objective. To compare the effects of combined trigger point dry needling (TrP-DN) and proprioceptive/strengthening exercises to proprioceptive/strengthening exercises on pain and function in ankle instability. Methods. Twenty-seven (44% female, mean age: 33 ± 3 years) individuals with unilateral ankle instability were randomly assigned to an experimental group who received proprioceptive/strengthening exercises combined with TrP-DN into the lateral peroneus muscle and a comparison group receiving the same proprioceptive/strengthening exercise program alone. Outcome included function assessed with the Foot and Ankle Ability Measure (FAAM) and ankle pain intensity assessed with a numerical pain rate scale (NPRS). They were captured at baseline and 1-month follow-up after the intervention. Results. The ANOVAs found significant Group ∗ Time Interactions for both subscales of the FAAM (ADL: F = 8.211; P = 0.008; SPORTS: F = 13.943; P < 0.001) and for pain (F = 44.420; P < 0.001): patients receiving TrP-DN plus proprioceptive/strengthening exercises experienced greater improvements in function and pain than those receiving the exercise program alone. Between-groups effect sizes were large in all outcomes (SMD > 2.1) in favor of the TrP-DN group. Conclusions. This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the therapy in ankle instability.
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Affiliation(s)
- Jaime Salom-Moreno
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Grupo de Excelencia Investigadora URJC-Banco de Santander: Investigación Traslacional en el Proceso de Salud-Enfermedad (ITPSE), Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | - Blanca Ayuso-Casado
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | - Beatriz Tamaral-Costa
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
| | | | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
- Grupo de Excelencia Investigadora URJC-Banco de Santander: Investigación Traslacional en el Proceso de Salud-Enfermedad (ITPSE), Avenida de Atenas s/n, Alcorcón, 28922 Madrid, Spain
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30
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31
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McCriskin BJ, Cameron KL, Orr JD, Waterman BR. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations. World J Orthop 2015; 6:161-171. [PMID: 25793157 PMCID: PMC4363799 DOI: 10.5312/wjo.v6.i2.161] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 11/16/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.
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32
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Abstract
Over the last 50 years, the surgical management of chronic lateral ankle ligament insufficiency has focused on 2 main categories: local soft-tissue reconstruction and tendon grafts/transfer procedures. There is an increasing interest in the arthroscopic solutions for chronic instability of the ankle. Recent biomechanical studies suggest the at least one of the arthroscopic techniques can provide equivalent results to current open local soft-tissue reconstruction (such as the modified Brostrom technique). Arthroscopic lateral ankle ligament reconstruction is becoming an increasingly acceptable method for the surgical management of chronic lateral ankle instability.
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Affiliation(s)
- Jorge I Acevedo
- Southeast Orthopedic Specialists, Jacksonville, 2627 Riverside Avenue, suite 300, FL 32204, USA.
| | - Peter Mangone
- Foot and Ankle Services, Foot and Ankle Center, Blue Ridge Bone and Joint Clinic, Mission Hospital, 60 Livingston Street, Asheville, NC 28801, USA
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33
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Guillo S, Archbold P, Perera A, Bauer T, Sonnery-Cottet B. Arthroscopic anatomic reconstruction of the lateral ligaments of the ankle with gracilis autograft. Arthrosc Tech 2014; 3:e593-8. [PMID: 25473613 PMCID: PMC4246413 DOI: 10.1016/j.eats.2014.06.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/26/2014] [Indexed: 02/03/2023] Open
Abstract
Lateral ankle sprains are common; if conservative treatment fails and chronic instability develops, stabilization surgery is indicated. Numerous surgical procedures have been described, but those that most closely reproduce normal ankle lateral ligament anatomy and kinematics have been shown to have the best outcomes. Arthroscopy is a common adjunct to open ligament surgery, but it is traditionally only used to improve the diagnosis and the management of any associated intra-articular lesions. The stabilization itself is performed open because standard anterior ankle arthroscopy provides only partial visualization of the anterior talofibular ligament from above and the calcaneofibular ligament attachments cannot be seen at all. However, lateral ankle endoscopy can provide a view of this area that is superior to open surgery. We have developed a technique of ankle endoscopy that enables anatomic positioning of the repair or fixation of the graft. In this article we describe a safe and reproducible arthroscopic anatomic reconstruction of the lateral ligaments of the ankle using a gracilis autograft. The aim of this procedure is to obtain a more physiological reconstruction while maintaining all the advantages of an arthroscopic approach.
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Affiliation(s)
- Stéphane Guillo
- Centre for Orthopaedic Sports Surgery, Bordeaux-Mérignac, France,Address correspondence to Stéphane Guillo, M.D., Centre de Chirurgie Orthopédique et Sportive, Bordeaux-Mérignac 33700, France.
| | | | - Anthony Perera
- University Hospital of Wales, Cardiff, Wales,Spire Cardiff Hospital, Cardiff, Wales,Department of Orthopaedic Surgery, London Foot and Ankle Centre, London, England
| | - Thomas Bauer
- Ambroise Paré Hospital, Boulogne-Billancourt, France
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34
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Abstract
Ankle injuries are among the most common injuries presenting to primary care providers and emergency departments and may cause considerable time lost to injury and long-term disability. Inversion injuries about the ankle involve about 25% of all injuries of the musculoskeletal system and 50% of all sports-related injuries. Medial-sided ankle sprains occur less frequently than those on the lateral side. High ankle sprains occur less frequently in the general population, but do occur commonly in collision sports. Providers should apply the Ottawa ankle rules when radiography is indicated and refer fractures and more severe injuries to orthopedic surgery as needed.
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Affiliation(s)
- Cory M Czajka
- Division of Orthopaedic Surgery, Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA.
| | - Elaine Tran
- Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - Andrew N Cai
- Albany Medical College, 43 New Scotland Avenue, Albany, NY 12208, USA
| | - John A DiPreta
- Division of Orthopaedic Surgery, Capital Region Orthopaedic Group, Albany Medical College, 1367 Washington Avenue, Suite 200, Albany, NY 12206, USA
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35
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Abstract
This article is based on educating readers and physicians about the use of footwear and orthotics for themselves and their patients, to treat diseases and enhance functionality in sports and daily life.
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Affiliation(s)
- Muhammad Nausherwan Khan
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey Medical Group, 121 Nyes Road, Suite A, Family Medicine Offices, Harrisburg, PA 17112, USA.
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