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Vega J, Malagelada F, Guelfi M, Dalmau-Pastor M. Arthroscopic anterior deltoid plication with bone anchor is an effective procedure to control residual talar anterior translation after lateral ligament repair. Knee Surg Sports Traumatol Arthrosc 2024; 32:2178-2183. [PMID: 39031786 DOI: 10.1002/ksa.12328] [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: 02/23/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Residual symptoms can be observed after ankle lateral ligament repairs commonly due to hyperlaxity, severe ankle instability or a failed stabilization. In order to increase joint stability, ligament or capsular-ligament plication has been used in other joints. Given that the anterior portion of the deltoid is a stabilizer against anterior talar translation, it could be used as an augmentation to restrict anterior talar translation. The aim of this study was to describe an arthroscopic anterior deltoid plication with a bony anchor as an augmentation to the lateral stabilization. The results in a series of eight patients were presented. METHODS Eight patients (seven males, median age 31 [range, 22-43] years) presented residual instability after arthroscopic all inside lateral collateral ligament repair. Arthroscopic anterior deltoid ligament plication was performed in these patients. Median follow-up was 22 (range, 15-27) months. Using an automatic suture passer and a knotless anchor, the anterior deltoid was arthroscopically plicated to the anterior aspect of the medial malleolus. RESULTS During the arthroscopic procedure, only an isolated detachment of the anterior talofibular ligament was observed without any deltoid open-book injury in any case. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligament repair and the anterior deltoid plication with a bony anchor. On clinical examination, the anterior drawer test was negative in all patients. The median American Orthopedic Foot and Ankle Society score increased from 68 (range, 64-70) preoperatively to 100 (range, 90-100) at final follow-up. CONCLUSION The arthroscopic anterior deltoid plication is a feasible procedure to augment stability and control anterior talar translation when treating chronic ankle instability in cases of residual excessive talar translation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jordi Vega
- Foot and Ankle Unit, iMove Traumatology, Barcelona, and Olympia, Madrid, Spain
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP, Merignac, France
| | - Francesc Malagelada
- Department of Trauma and Orthopedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Matteo Guelfi
- Casa di Cura Villa Montallegro, Genoa, Italy
- Department of Orthopaedic Surgery "Gruppo Policlinico di Monza", Clinica Salus, Alessandria, Italy
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP, Merignac, France
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Zhang G, Li W, Yao H, Tan R, Li C. The precision of technical aspects in the minimally invasive Broström-Gould procedure: a cadaveric anatomical study. J Orthop Surg Res 2024; 19:450. [PMID: 39080695 PMCID: PMC11289923 DOI: 10.1186/s13018-024-04916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND A comprehensive understanding of the anatomy of the anterolateral ankle joint and its interrelationships is essential for advancing the development of minimally invasive Broström-Gould procedure, thereby enhancing surgical efficacy and minimizing postoperative complications. METHODS Ten fresh human ankle specimens were dissected to observe the shape and trajectory of the lateral bundle of the inferior extensor retinaculum (IER) and its relationship with the deep fascia. To observe the relationship between the ankle capsule and the anterior talofibular ligament (ATFL). The center of the insertion point of ATFL at the lateral malleolus was used as the reference point. The vertical distance from the reference point to the fibula tip, the horizontal distance from the reference point to the lateral branch of the superficial peroneal nerve, the shortest distance from the reference point to IER, the narrowest width of the IER, the angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula were measured. The tension and elasticity of ATFL was understood. To describe the minimally invasive Broström-Gould procedure according to the anatomical characteristics of the anterolateral ankle joint. RESULTS Among the 10 cases, 8 cases (80%) had double bundles of ATFL, 2 cases (20%) had single bundle of ATFL, and no outer superior oblique bundle was observed in IER. The vertical distance from the reference point to the fibula tip was 1.2 ± 0.3 (range 1.1-1.3) mm. The shortest distance from the reference point to the level of the superficial peroneal branch was 28.2 ± 4.3 (range 24.5-32.4) mm. The shortest distance from the reference point to IER was 12.5 ± 0.6 (range 12.1-12.9) mm, and the width of IER at this point was 7.2 ± 0.3 (range 7.0-7.6) mm. The angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula was about 60° ± 2.8° (range 58.1°-62.1°) mm. The space between the anterolateral deep fascia of the ankle joint and the ankle capsule is very small, and only a few fat granules are separated between them. The ATFL is largely fused to the ankle capsule. The ATFL exhibited high tension and poor elasticity after traction with the probe hook. CONCLUSIONS The results showed that in the minimally invasive Broström-Gould technique for lateral ankle stabilization, the Broström procedure actually sutured the insertion of the ATFL together with the ankle capsule to the anterior edge of the lateral malleolus. In the Gould procedure, the deep fascia was mostly reinforced with the ankle capsule. The minimum suture span was obtained when the Gould suture needle direction was at an Angle of 60° to the longitudinal axis of the fibula.
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Affiliation(s)
- Guolei Zhang
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China.
| | - Wenqing Li
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China.
| | - Haibo Yao
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China
| | - Rongzhi Tan
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China
| | - Chuyan Li
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China
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Liu ZF, Su T, Wang ZY, Hu YL, Guo QW, Yang J, Zhang Z, Liu NJ, Jiao C, Jiang D. Both arthroscopic one-step Broström-Gould and Lasso-loop stitch techniques achieved favourable clinical outcomes for chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2024; 32:1622-1630. [PMID: 38586974 DOI: 10.1002/ksa.12167] [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: 10/12/2023] [Revised: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Both the arthroscopic Broström-Gould and Lasso-loop stitch techniques are commonly used to treat chronic lateral ankle instability (CLAI). The purpose of this study is to introduce an arthroscopic one-step outside-in Broström-Gould (AOBG) technique and compare the mid-term outcomes of the AOBG technique and Lasso-loop stitch technique. METHODS All CLAI patients who underwent arthroscopic lateral ankle stabilization surgery in our department from 2018 to 2019 were retrospectively enrolled. The patients were divided into two groups according to the surgical methods employed: the AOBG technique (Group A) and the Lasso-loop technique (Group B). The visual analogue scale pain score, American Orthopaedic Foot and Ankle Society ankle hindfoot score, Tegner activity score and Karlsson-Peterson score were evaluated preoperatively and during the follow-up from June to December 2022. The surgical duration, return to sports, sprain recurrence and surgical complications were also recorded and compared. RESULTS A total of 74 patients (Group A, n = 42; Group B, n = 32) were included in this study with a mean follow-up of 39 months. No statistically significant differences were observed in demographic parameters or follow-up time between the two groups. Postoperative clinical scores indicated a significant improvement (all with p < 0.001) with no significant difference between the two groups (not significant [n.s.]). There was no significant difference in the surgical duration (46.1 vs. 49.7 min, n.s.), return to sports (92.9% vs. 93.8%, n.s.), or sprain recurrence (4.8% vs. 6.3%, n.s.). Only two cases in Group A reported knot irritation (4.8% vs. 0, n.s.), and one case in Group A experienced local skin numbness (0 vs. 3.1%, n.s.), with no significant difference. CONCLUSION Both the AOBG and Lasso-loop stitch techniques yielded comparable favourable mid-term outcomes and return to sports with a low rate of surgical complications. Both procedures could be feasible strategies for CLAI patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Zhuo-Fan 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
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhen-Yu 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
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Jie Yang
- 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
| | - Zhu 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
| | - Ning-Jing 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
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
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Lewis TL, Ayathamattam J, Vignaraja V, Dalmau-Pastor M, Ferreira GF, Nunes GA, Ray R. Improvement in clinical outcomes following arthroscopic all-inside medial lateral ligament reconstruction for rotational ankle instability. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38770701 DOI: 10.1002/ksa.12244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/07/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Rotational ankle instability can be diagnosed in up to 18% of cases of chronic lateral ankle instability. It is characterised by an abnormal increase of talar rotation within the tibiofibular mortise, due to an injury in the most anterior component of the deltoid ligament secondary to a chronic deficiency of the lateral collateral ligament. The aim of this prospective observational study was to investigate the clinical outcomes following arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability. METHODS A prospective observational study of consecutive patients undergoing arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability with minimum 6-month follow-up. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire. Secondary outcomes included the EQ-5D, European Foot and Ankle Society score and complications. RESULTS Between 2020 and 2023, 12 patients underwent primary arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability with pre- and post-operative PROMs available for all 12 patients. The mean ± standard deviation age was 33.9 ± 7.2 years and the mean follow-up was 1.9 ± 1.2 (range: 0.5-3.8, interquartile range: 0.9-3.0) years. There was a significant improvement in all Manchester-Oxford Foot Questionnaire domain scores (p < 0.05): Index 53.1 ± 19.1 to 26.4 ± 27.6, Pain 46.7 ± 20.3 to 26.2 ± 26.8, Walking/Standing 58.7 ± 26.0 to 27.0 ± 30.0 and Social Interaction 51.2 ± 19.5 to 25.6 ± 30.1. There were improvements in EQ-5D-5L Index, VAS and VAS Pain; however, these were not statistically significant. There was one complication-a superficial peroneal nerve injury which resolved with a corticosteroid injection. CONCLUSION The arthroscopic all-inside medial and lateral ligament reconstruction technique is a reliable and safe method for treating rotational ankle instability, demonstrating significant improvement in PROMs at a mean 1.9-year follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- T L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - J Ayathamattam
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - V Vignaraja
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - M Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - G F Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | - G A Nunes
- COTE Brasília Clinic, Foot and Ankle Unit, Brasília, Distrito Federal, Brazil
| | - R Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
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Zhang G, Li W, Yao H, Tan R, Li C. A modified "outside-in" Broström-Gould procedure yielding favorable outcomes for the management of chronic lateral ankle instability-a retrospective study with mid-term follow-up. J Orthop Surg (Hong Kong) 2024; 32:10225536241257760. [PMID: 38773724 DOI: 10.1177/10225536241257760] [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: 05/24/2024] Open
Abstract
Purpose: There are various surgical interventions available for the management of Chronic lateral ankle instability (CLAI). The Broström-Gould procedure has gained widespread recognition among foot and ankle specialists for its favorable surgical outcomes. However, with advancements in anatomical understanding and medical technology, further enhancements to the effectiveness of the Gould procedure are warranted. This study introduces a all-inside modified "outside-in" Broström -Gould procedure as an alternative approach for addressing lateral ankle instability. Methods: From August 2020 to October 2022, 40 patients with lateral ankle instability who underwent arthroscopic repair of the modified "outside-in" Broström-Gould procedure were retrospectively analyzed. All patients received standard non-surgical treatment before surgery for more than 6 months without symptom relief. Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson score were used to evaluate the postoperative effect. Results: All patients were followed up for (14.62 ± 2.04) months. One year after operation, all patients could walk normally, ankle instability sensation disappeared, varus stress test and anterior drawer test were negative. The VAS , AOFAS and Karlsson-Peterson scores of all patients were significantly better compared with those before operation, and the difference between before and after operation was statistically significant. Conclusions: The modified "outside-in" Broström-Gould procedure can effectively treat CLAI, which can obtain satisfactory results. The procedure is straightforward, the impact is minimal, and the aesthetics are pleasing.
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Affiliation(s)
- Guolei Zhang
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Wenqing Li
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Haibo Yao
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Rongzhi Tan
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Chuyan Li
- Department of Hand, Foot and Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
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Mangone PG. Arthroscopic Lateral Ligament Reconstruction: To Infinity and Beyond. Foot Ankle Int 2023; 44:1229-1230. [PMID: 38006255 DOI: 10.1177/10711007231210804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
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Guiraud K, Nunes GA, Vega J, Cordier G. High body mass index is not a contraindication for an arthroscopic ligament repair with biological augmentation in case of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2023; 31:5222-5227. [PMID: 37713126 DOI: 10.1007/s00167-023-07557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Obesity remains frequently mentioned as a contraindication for lateral ankle ligament repair. The aim of the study was to compare the clinical results of an arthroscopic lateral ligament repair with biological augmentation between patients with a body mass index (BMI) of more than 30 and less than 30. METHODS Sixty-nine patients with an isolated lateral ankle instability were treated with an arthroscopic anterior talofibular ligament (ATFL) repair with biological augmentation using the inferior extensor retinaculum (IER). Patients were divided into two groups according to their BMI: ≥ 30 (Group A; n = 26) and < 30 (Group B; n = 43). Patients were pre-and post-operatively evaluated, with a minimum of 2 years follow-up, and using the Karlsson Score. Characteristics of the patients, complications, ankle instability symptoms recurrence, and satisfaction score were recorded. RESULTS In group A, the median Karlsson Score increased from 43.5 (Range 22-72) to 85 (Range 37-100) at follow-up. Complications were observed in seven patients (27%). Nineteen patients (73%) reported that they were "very satisfied". One patient (4%) described persistent ankle instability symptoms. In group B, the median Karlsson Score increased from 65 (Range 42-80) to 95 (Range 50-100) at follow-up. Complications were observed in four patients (9%). Thirty-three patients (77%) reported that they were "very satisfied". Two patients (5%) described persistent ankle instability symptoms. Pre-operative and at last follow-up Karlsson Score, results were significantly different between the two groups. There was no significant statistical difference in favour of satisfaction score, complications and recurrence of ankle instability between the two groups. CONCLUSION ATFL repair with biological augmentation using IER gives excellent results for patients with BMI ≥ 30. Compared to patients with BMI < 30, they present a slightly lower preoperative and postoperative Karlsson score, however, with a similar satisfaction rate, but are at higher risk of transient superficial peroneal nerve dysesthesia. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kevin Guiraud
- Pôle de Santé du Villeneuvois, Villeneuve-sur-Lot, France.
| | - Gustavo Araujo Nunes
- COTE Brasília Clinic, Brasília, Distrito Federal, Brazil
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- Foot and Ankle Unit, iMove Traumatology-Clinica Tres Torres, Barcelona, Spain
- Chirurgie du Sport - Clinique du Sport - Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by Grecmip (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- Foot and Ankle Unit, iMove Traumatology-Clinica Tres Torres, Barcelona, Spain
- Chirurgie du Sport - Clinique du Sport - Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by Grecmip (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Guillaume Cordier
- Chirurgie du Sport - Clinique du Sport - Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by Grecmip (Minimally Invasive Foot and Ankle Society), Merignac, France
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Wang AH, Su T, Jiang YF, Zhu YC, Jiao C, Hu YL, Guo QW, Jiang D. Arthroscopic modified Broström procedure achieved similar favorable short term outcomes to open procedure for chronic lateral ankle instability cases with generalized joint laxity. Knee Surg Sports Traumatol Arthrosc 2023; 31:4043-4051. [PMID: 37162539 DOI: 10.1007/s00167-023-07431-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To compare the short-term clinical outcomes of the open versus arthroscopic modified Broström procedure in generalized joint laxity (GJL) patients. METHODS From January 2018 to January 2020, 64 consecutive patients with chronic lateral ankle instability (CLAI) and GJL (Beighton score ≥ 4) were prospectively enrolled into two groups: those who underwent the open modified Broström procedure (open group, n = 32) and those who underwent the arthroscopic modified Broström procedure (arthroscopic group, n = 32). Patients underwent an open or arthroscopic modified Broström procedure based on the time when they attended the clinic for consultation. All patients were followed-up at 3, 6, 12, and 24 months postoperatively. The clinical outcomes were evaluated using the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and Karlsson score, and the radiographic outcomes were assessed using stress radiography at 24 months postoperatively. The time to return to work and the failure rate were also evaluated and compared. RESULTS Follow-up was completed for 31 patients in the open group and 30 patients in the arthroscopic group. No significant differences were found between the two groups in terms of demographic characteristics, Beighton score (6.2 ± 1.9 vs. 5.5 ± 1.4, n.s.), or duration of symptoms. There were no significant differences in the functional scores before surgery and at 6, 12 and 24 months postoperatively or in the mean anterior translation of the talus and talar tilt angle on stress radiography at 24 months postoperatively between the open and arthroscopic groups. Compared to the open group, the arthroscopic group showed a significantly earlier return to work (6.8 ± 2.1 vs. 8.1 ± 2.4 weeks, p = 0.006). There was no significant difference in terms of the failure rate between the open and arthroscopic groups (16.1% vs. 23.3%, n.s.). CONCLUSION Arthroscopic modified Broström procedure achieved similar short-term outcomes to the open procedure for GJL patients. Arthroscopic modified Broström procedure showed an earlier return to work than the open modified Broström procedure and was an alternative to open surgery for CLAI patients with GJL. LEVEL OF EVIDENCE III. CLINICAL TRIAL REGISTRATION This study is a prospective study NCT05284188.
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Affiliation(s)
- An-Hong Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yi-Chuan Zhu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Lopes R, Bauer T. Lateral endoscopy of the sinus tarsi: Anatomy, technique and current indications. Orthop Traumatol Surg Res 2022; 108:103383. [PMID: 35926723 DOI: 10.1016/j.otsr.2022.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 02/03/2023]
Abstract
Numerous pathologies are reported in the lateral mid- and hind-foot. Access to the sinus tarsi is difficult, making lateral endoscopy the preferred approach. The present technical note describes the anatomy, technique and current indications for lateral endoscopy of the sinus tarsi.
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Affiliation(s)
- Ronny Lopes
- Clinique Brétéché, 3, Rue de la Béraudière, 44000 Nantes, France; Polyclinique de l'Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France.
| | - Thomas Bauer
- Service de chirurgie orthopédique, hôpital Ambroise-Paré, hôpitaux Universitaires Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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Yang Y, Han J, Wu H, Zhi X, Lian J, Xu F, Cai X, Wei S. Arthro-Broström with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques. BMC Musculoskelet Disord 2022; 23:795. [PMID: 35987668 PMCID: PMC9392268 DOI: 10.1186/s12891-022-05709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background There is still some controversy about the augmentation of the inferior extensor retinaculum after arthroscopic anterior talofibular ligament repair. The aim of this study was to evaluate the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques for chronic lateral ankle instability. Methods Thirty-four cases with grade-2 or grade-3 chronic anterior talofibular ligament lesions who underwent the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques were assessed retrospectively. A total of 30 cases (30 ankles) were followed up for a mean of 26.67 ± 4.19 months (range, 24—36 months). four cases were excluded due to insufficient medical records or loss of follow-up reports. The Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were evaluated before surgery and at the final follow-up time. Also, the results of stress fluoroscopic tests and complications were recorded. Results At the final follow-up, the average of the Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were 86.63 ± 6.69 (range, 77—100), 90.17 ± 4.64 (range, 85—100) and 0.53 ± 0.63 (range, 0—2), respectively. Moreover, the results of stress fluoroscopic tests were improved significantly after surgery. Mild keloid formation and/or knot irritation were observed in four cases. No wound infections, nerve injuries and recurrent instability were recorded. Also, no stiffness or arthritis of the subtalar joint was encountered. Conclusions The arthro-Broström procedure combined with endoscopic retinaculum augmentation using all-inside lasso-loop techniques is reliable and safe due to the advantage of direct endoscopic visualization.
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Cao S, Wang C, Wang X, Ma X. Percutaneous Inferior Extensor Retinaculum Augmentation Technique for Chronic Ankle Instability. Orthop Surg 2022; 14:977-983. [PMID: 35434967 PMCID: PMC9087451 DOI: 10.1111/os.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To specify indications and contraindications of the modified percutaneous inferior extensor retinaculum augmentation (PIERA) technique for chronic ankle instability cases, and to introduce technique details and report surgical outcomes and complications. METHODS The PIERA technique was performed on seven patients with chronic ankle instability (four females and three males, 36.4 ± 15.1 years of age, and course of symptoms of 33.7 ± 8.8 months) from June to October 2018 in this retrospective study of case series. All patients demonstrated attenuated ligamentous tissue quality, which was confirmed using preoperative ankle MRI. IER were drew up to the distal fibula using suture anchors with the ankle in neutral position for all cases, to engage the entire IER in reconstructing the stability of the ankle. Patients were assessed using American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) score and Cumberland Ankle Instability Tool (CAIT) scores pre- and postoperatively at the last follow-up examination. Preoperative and postoperative outcome scores of patients were compared using paired t-test. A p value of less than 0.05 was regarded statistically significant. RESULTS Mean follow-up duration was 16.7 ± 1.6 months. The mean AOFAS score significantly improved from 66.9 ± 11.2 preoperatively to 93.7 ± 8.5 postoperatively (P = 0.001). Mean CAIT score significantly improved from 13.1 ± 4.7 preoperatively to 26.3 ± 1.8 postoperatively (P = 0.001). Patients did not report any wound healing problem, numbness, swelling, or instability at the last follow-up examination, except for one patient who reported pain and minimal stiffness, and presented an AOFAS score of less than 80 and a CAIT score below 24. All patients returned to at least recreational sport activity level. CONCLUSION The PIERA technique can improve the functional outcomes of patients with chronic ankle instability with few complications.
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Affiliation(s)
- Shengxuan Cao
- Department of OrthopedicsHuashan Hospital, Fudan UniversityShanghaiChina
| | - Chen Wang
- Department of OrthopedicsHuashan Hospital, Fudan UniversityShanghaiChina
| | - Xu Wang
- Department of OrthopedicsHuashan Hospital, Fudan UniversityShanghaiChina
| | - Xin Ma
- Department of OrthopedicsHuashan Hospital, Fudan UniversityShanghaiChina
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Comparative Analysis of Subtalar Ligaments Between Patients With Talocalcaneal Coalition and Control Subjects Using 3-Dimensional Magnetic Resonance Imaging. J Comput Assist Tomogr 2022; 46:440-446. [DOI: 10.1097/rct.0000000000001290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Anatomical and biomechanical study of the inferior extensor retinaculum by shear-wave elastography in healthy adults. Surg Radiol Anat 2022; 44:245-252. [DOI: 10.1007/s00276-022-02884-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
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14
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Anatomical study of the inferior extensor retinaculum and the oblique superolateral band: implications for the Brostrom-Gould procedure. BMC Musculoskelet Disord 2022; 23:28. [PMID: 34983476 PMCID: PMC8729066 DOI: 10.1186/s12891-021-04932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose The Brostrom-Gould procedure is currently the gold standard surgical choice for the treatment of chronic ankle instability; it can significantly improve ankle function and stability in patients. However, recent studies have reported doubts regarding the feasibility of the inferior extensor retinaculum (IER) after Brostrom-Gould and therapeutic effects compared with the Brostrom procedure. The purpose of the present study was to observe the anatomical characteristics of the lateral part of the IER using cadaveric bodies in order to guide the surgical operation of chronic ankle instability. Methods Twenty-three cadaveric ankles were dissected. The morphology of the IER and its internal structure was observed and recorded for each ankle. The shortest distance between the Stem ligament of the IER and the anterior fibular periosteum (AFP) was measured and recorded, then attempts were made to suture the Stem to the AFP. Results Twelve of the cadaveric ankles were observed as having an oblique superolateral band (OSLB) that had a tough texture upward of the lateral IER connecting with SL, as are the characteristics of the oblique superolateral band (OSLB) reported in previous studies. The inner and outer membrane of the OSLB were connected with inner and outer membrane of Stem. The average value of the distance between the Stem and AFP was 11.60 ± 2.71 mm, and the maximum and the minimum distance were 19.04 mm and 6.53 mm, respectively. The P -value (P = 0.2) resulting from a single sample K-S test confirmed that the distribution of distances conformed to normality. None of the SL in the study could be sutured to the AFP. Conclusion The OSLB of the IER has a tough texture and connects with the Stem, and has the potential be utilised in the Brostrom-Gould procedure. However, we do not recommend utilization of the Stem in this operation regardless of the distance between the AFP and the Stem. When the Stem cannot be used to enhance repair in this operation, other solutions can be used for strengthening and to protect the repaired ATFL.
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Jo J, Lee JW, Kim HJ, Suh DH, Kim WS, Choi GW. Arthroscopic All-Inside Anterior Talofibular Ligament Repair with and without Inferior Extensor Retinacular Reinforcement: A Prospective Randomized Study. J Bone Joint Surg Am 2021; 103:1578-1587. [PMID: 34228677 DOI: 10.2106/jbjs.20.01696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The utility of inferior extensor retinacular (IER) reinforcement for arthroscopic repair of a lateral ankle injury is debatable. We hypothesized that the outcomes would not differ significantly between arthroscopic all-inside anterior talofibular ligament (ATFL) repair with and without IER reinforcement. METHODS We prospectively randomized 73 patients who had arthroscopic all-inside ATFL repair into 2 groups: those who had IER reinforcement (37 patients) and those who had no IER reinforcement (36 patients). The primary outcome was the Karlsson Ankle Functional Score (KAFS). The secondary outcomes included the Foot and Ankle Outcome Score (FAOS), Tegner activity score (TAS), ankle range of motion, and radiographic parameters. The functional outcomes were evaluated preoperatively and at 6 and 12 months postoperatively. Stress radiographs were obtained preoperatively and at 12 months postoperatively. RESULTS The KAFS, all FAOS subscale scores, and TAS improved significantly at 1 year postoperatively in both groups, with no significant differences between the groups with respect to the preoperative and postoperative values. Significant differences were not observed between the ankle range of motion values recorded preoperatively and at 1 year postoperatively in both groups; the preoperative and postoperative range of motion values did not differ significantly between the groups. The mean talar tilt and talar anterior translation decreased significantly at 1 year postoperatively in both groups, with no significant differences between the groups preoperatively and postoperatively. One patient in each group had neuralgia of the superficial peroneal nerve; 2 patients in the IER reinforcement group had knot irritation causing mild discomfort. CONCLUSIONS Arthroscopic all-inside ATFL repair with and without IER reinforcement showed comparable functional and stress radiographic outcomes at 1 year. Performing IER reinforcement in addition to all-inside arthroscopic direct ATFL remnant repair is not necessary. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joon Jo
- Gangbukyonsei Hospital, Seoul, Republic of Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong Hun Suh
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Won Seok Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea
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Guillo S, Odagiri H, van Rooij F, Bauer T, Hardy A. All-inside endoscopic anatomic reconstruction leads to satisfactory functional outcomes in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2021; 29:1318-1324. [PMID: 32607815 DOI: 10.1007/s00167-020-06130-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Ankle sprain is a common injury that can be treated conservatively, though many injured patients do not seek treatment or are not adequately managed, both of which can lead to subsequent chronic ankle instability (CAI). The purpose of this study was to evaluate the functional scores and complication rates of an all-inside anatomic reconstruction technique to treat CAI at a minimum follow-up of 24 months. METHODS The authors retrospectively collected the records of 41 patients that underwent all-inside endoscopic anatomic reconstruction of the ATFL and CFL including demographics, complications, satisfaction, American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson score, and ankle activity score (AAS), at a minimum follow-up of 24 months. RESULTS The study cohort, comprised 34 patients aged 35.6 ± 10.8 years, were assessed at 48.7 ± 19.0 months. AOFAS scores improved from 60.3 ± 11.9 to 94.3 ± 6.2 postoperatively. Karlsson scores improved from 49.0 ± 10.9 to 87.2 ± 10.1 postoperatively. Thirty-three (97%) patients returned to the same AAS (5.6 ± 3.1) and rated their overall satisfaction ≥ 7. One patient (3%) was reoperated to treat a hematoma, while five patients (15%) were reoperated to remove the cortical fixation device that caused discomfort. CONCLUSION The novel all-inside endoscopic technique for anatomic reconstruction of the ATFL and CFL grants satisfactory functional outcomes at a minimum of 24 months, and the improvements in AOFAS and Karlsson scores compared favourably to those reported for other techniques in the literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - Haruki Odagiri
- Clinique du Sport de Bordeaux-Merignac, Mérignac, France
| | | | - Thomas Bauer
- Ambroise Paré Hospital, Boulogne-Billancourt, France
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Abstract
In the past several years, arthroscopic repair of the lateral ankle ligaments has grown because it has shown comparable results with the traditional open Brostrom-Gould procedure. In addition, arthroscopic repair allows reduced swelling and cosmesis. This article discusses the authors' technique for lateral ankle instability, with published data supporting biomechanical equivalency to the standard open Brostrom-Gould procedure. An optional internal brace can provide further strength to the repair and lead to a quicker recovery. Arthroscopic repair both with and without the internal brace have shown positive clinical outcomes for patients as well as high satisfaction rates.
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Affiliation(s)
- Jorge I Acevedo
- Department of Orthopedics, Southeast Orthopedic Specialists, Foot and Ankle Center, 6500 Bowden Road, Suite 103, Jacksonville, FL 32216, USA.
| | - Peter G Mangone
- Department of Orthopedics, Blue Ridge Division of EmergeOrtho, Foot and Ankle Center, 2585 Hendersonville Road, Arden, NC 28704, USA
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18
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Su BY, Yi SY, Peng T, Yi G, Zhang L. Comparison of Arthroscopic Surgery Versus Open Surgical Repair of the Anterior Talofibular Ligament: A Retrospective Study of 80 Patients from a Single Center. Med Sci Monit 2021; 27:e928526. [PMID: 33587726 PMCID: PMC7893828 DOI: 10.12659/msm.928526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This retrospective study from a single center aimed to compare the safety and clinical outcomes of arthroscopic surgery vs open surgical repair of the anterior talofibular ligament (ATFL). Material/Methods We randomly divided 80 patients with ATFL injury divided into 2 groups: an open surgery group and an arthroscopic group. The operation time, intraoperative bleeding volume, and the postoperative recovery time of all patients were analyzed. The anterior displacement and talus tilt angle, the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), the Jersey Shore Science Fair (JSSF) ankle-hindfoot scale score, and the Karlsson Ankle Functional Score (KAFS) were compared at 6 months, 1 year, and 2 years after surgery. We collected data on the incidence of postoperative complications during follow-up. All significant results were supported with a P value. Results The operation time, intraoperative bleeding volume, and postoperative recovery time in the arthroscopic group were better than in the open group (P<0.05). The AOFAS, JSSF, and KAFS in the arthroscopic group were better than in the open group at 6 months after the operation (P<0.05). The AOFAS, JSSF, and KAFS scale scores were not significantly different between the 2 groups at 1 year and 2 years after the operation (P<0.05). Conclusions The findings from this retrospective study showed that the use of arthroscopic surgical repair of the ATFL is a safe minimally invasive technique with reduced blood loss and surgical duration and good clinical outcomes.
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Affiliation(s)
- Bo-Yuan Su
- Department of Orthopedics, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, Guangdong, China (mainland)
| | - Shu-Yun Yi
- Department of Orthopedics, Zengcheng Branch of South Hospital of Southern Medical University, Guangzhou, Guangdong, China (mainland)
| | - Ting Peng
- Clinical Medical College of Southwest Medical University, Luzhou, Sichuan, China (mainland)
| | - Gang Yi
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Expert Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, Sichuan, China (mainland)
| | - Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Center for Orthopedic Diseases Research, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan, China (mainland).,Expert Workstation in Luzhou, Luzhou, Sichuan, China (mainland).,Clinical Base of Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Guangdong Province Medical 3D Printing Application Transformation Engineering Technology Research Center, Luzhou, Sichuan, China (mainland)
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19
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Vega J, Dalmau-Pastor M. Editorial Commentary: Arthroscopic Treatment of Ankle Instability Is the Emerging Gold Standard. Arthroscopy 2021; 37:280-281. [PMID: 33384088 DOI: 10.1016/j.arthro.2020.10.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 02/02/2023]
Abstract
Arthroscopic techniques for the treatment of ankle instability are increasing. The possibility of treating concomitant ankle pathology and ankle instability in the same procedure with similar outcomes and minor complications is making foot and ankle surgeons rethink the role of the current gold standard technique, the open Broström-Gould procedure. The improvement of arthroscopic procedures in the ankle joint, as has happened before in other joints, is forcing the evolution of the classic open gold standard techniques toward an arthroscopic approach. A nondistraction and ankle dorsiflexion procedure is the key arthroscopic technique. The anterior talofibular ligament's superior fascicle, an intra-articular structure, is located on the floor of the lateral gutter, and distraction detrimentally narrows the view and access to this space.
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20
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Abstract
The interaction between hypermobility and hallux valgus remains both contemporary and incendiary. The difficulty in setting clinical and radiological parameters to diagnose and the complexity of questions that circumnutate the philosophy among etiology and denouement, fires up the debate regarding these conditions. Outcomes among procedures that address or neglect ray instability are still used as argument for any group of believers or nonbelievers. Through proving the true existence of hypermobility and its relationship with bunions, our colleges and professors have produced an incredible amount of excellent data that helped us better comprehend the hallux valgus syndrome in a general manner.
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Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Sao Paulo Federal University, 715 Napoleao de Barros Street-1st Floor, Vila Clementino, São Paulo, São Paulo 04038002, Brazil.
| | - Caio Augusto de Souza Nery
- Department of Orthopedics and Traumatology, Escola Paulista de Medicina, Sao Paulo Federal University, 715 Napoleao de Barros Street-1st Floor, Vila Clementino, São Paulo, São Paulo 04038002, Brazil
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21
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Malagelada F, Vega J, Guelfi M, Kerkhoffs G, Karlsson J, Dalmau-Pastor M. Anatomic lectures on structures at risk prior to cadaveric courses reduce injury to the superficial peroneal nerve, the commonest complication in ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 2020; 28:79-85. [PMID: 30729253 DOI: 10.1007/s00167-019-05373-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/24/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess the effectiveness of cadaveric ankle arthroscopy courses in reducing iatrogenic injuries. METHODS A total of 60 novice surgeons enrolled in a basic cadaveric ankle arthroscopy course were divided into two groups. Group A (n = 32) was lectured on portal placement and use of the arthroscope, whereas group B (n = 28) was in addition lectured on specific portal-related complications. Following the performance of anterior ankle arthroscopy and hindfoot endoscopy, the specimens were dissected and carefully assessed for detection of any iatrogenic injuries. RESULTS The rate of injury to the superficial peroneal nerve (SPN) was reduced from 25 to 3.6%, in group A compared with B (p = 0.033). Injuries to the peroneus tertius or extensor digitorum longus, the flexor hallucis longus and the tibial nerve or the Achilles tendon were also reduced in group B. Overall, the number of uninjured specimens was 50% (n = 30) and higher in group B (57%) than group A (44%). Lesions to the plantaris tendon, the sural nerve or the posterior tibial artery were more common in group B, however, without reaching statistical significance. Overall, 25 (13.9%) anatomic structures were injured in anterior arthroscopy compared to 18 (5%) in hindfoot endoscopy, out of a potential total of 180 and 360, respectively (p = 0.001). CONCLUSION Dedicated lectures on portal-related complications have proven useful in reducing the risk of injury to the SPN, the commonest iatrogenic injury encountered in ankle arthroscopy. Hindfoot endoscopy is significantly safer than anterior ankle arthroscopy in terms of injury to anatomical structures.
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Affiliation(s)
- F Malagelada
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain. .,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - J Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied), Merignac, France.,Foot and Ankle Unit, Hospital Quirón and Clinica Tres Torres, Barcelona, Spain
| | - M Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy.,Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitad Autònoma de Barcelona, Barcelona, Spain
| | - G Kerkhoffs
- Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Academic Center for Evidence-Based Sports medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands.,Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - J Karlsson
- Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - M Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied), Merignac, France
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22
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Cordier G, Lebecque J, Vega J, Dalmau-Pastor M. Arthroscopic ankle lateral ligament repair with biological augmentation gives excellent results in case of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:108-115. [PMID: 31388694 DOI: 10.1007/s00167-019-05650-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/26/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE The open "Broström-Gould" procedure has become the gold standard technique for the treatment of chronic ankle instability. Although arthroscopic techniques treating ankle instability have significantly evolved in the last years, no all arthroscopic Broström-Gould has been described. The aim of the study was to describe the all-arthroscopic Broström-Gould technique [anterior talofibular ligament (ATFL) repair with biological augmentation using the inferior extensor retinaculum (IER)], and to evaluate the clinical results in a group of patients. METHODS Fifty-five patients with isolated lateral ankle instability were arthroscopically treated. Arthroscopic ATFL repair with biological augmentation was performed through a two-step procedure. First, the ligament is reattached through an arthroscopic procedure. Next, the ligament is augmented with the IER that is endoscopically grasped. Both the ligament repair and its augmentation with IER were performed with the help of an automatic suture passer and two soft anchors. Characteristics of the patients, and pre- and postoperatively AOFAS and Karlsson scores were recorded. RESULTS The median preoperative AOFAS score increased from 74 (range 48-84) to 90 (range 63-100). According to the Karlsson score, the median preoperative average increased from 65 (range 42-82) to 95 (range 65-100). No major complications were reported. Only one case (1.8%) required a revision surgery at 23 months of follow-up. CONCLUSION The arthroscopic all-inside ATFL repair with biological augmentation using the IER is a reproducible technique. Excellent clinical results were obtained. The technique has the advantage of its minimally invasive approach and the potential to treat concomitant ankle intra-articular pathology. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, Institut du Sport, 2 rue negrevergne, 33700, Merignac, France. .,Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.
| | - Johan Lebecque
- Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.,Groupe Hospitalier Pellegrin, Bordeaux, France
| | - Jordi Vega
- Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.,Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), Laboratory of Arthroscopic and Surgical Anatomy, University of Barcelona, Barcelona, Spain.,Foot and Ankle Unit, Hospital Quirón and Clinica Tres Torres, Barcelona, Barcelona, Spain
| | - Miki Dalmau-Pastor
- Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.,Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), Laboratory of Arthroscopic and Surgical Anatomy, University of Barcelona, Barcelona, Spain.,Vilamèdic, Santa Coloma de Gramanet, Barcelona, Spain
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23
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Park S, Kim T, Lee M, Park Y. Absence of ATFL remnant does not affect the clinical outcomes of the modified broström operation for chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:213-220. [PMID: 30887064 DOI: 10.1007/s00167-019-05464-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/04/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The modified Broström operation for chronic ankle instability has demonstrated good clinical results. Absence of ligamentous tissue is a risk factor for recurrence of ankle instability after surgery. This study evaluated the effect of quality of ligament tissue (anterior talofibular ligament, ATFL) on prognosis, in a cohort of patients with chronic ankle instability after the modified Broström operation. METHODS This was a retrospective case series. Overall, 60 patients underwent the modified Broström operation for chronic ankle instability (mean follow-up, 30.1 [range, 24-47] months). Presence of ATFL remnant was assessed on ultrasound, magnetic resonance imaging, and arthroscopy in all patients. Foot and ankle outcome score (FAOS) was used to evaluate functional outcomes. Clinical outcomes were compared by the condition of the ligament remnant. Association with other risk factors was evaluated using multiple linear regression analysis. RESULTS ATFL was visible in 51/60 cases on ultrasound. Thirty, 22, and eight patients had thin or absent; normal thickness; and thick ATFL on magnetic resonance imaging, respectively. ATFL was visible in 15 patients on arthroscopy and nonvisible or not clear in 45. No significant differences occurred in FAOS with the presence of ATFL remnant on ultrasound, arthroscopy, and the grade of ATFL thickness on magnetic resonance imaging. No correlation was found between FAOS and the thickness of ATFL. CONCLUSION The results suggest that the modified Broström operation for patients with chronic ankle instability was good, regardless of the presence or absence of ATFL remnant. LEVEL OF EVIDENCE III, Retrospective cohort study.
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Affiliation(s)
- Sunghoon Park
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Taehun Kim
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Myungsub Lee
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Younguk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
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Ko KR, Lee WY, Lee H, Park HS, Sung KS. Repair of only anterior talofibular ligament resulted in similar outcomes to those of repair of both anterior talofibular and calcaneofibular ligaments. Knee Surg Sports Traumatol Arthrosc 2020; 28:155-162. [PMID: 30083968 DOI: 10.1007/s00167-018-5091-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/31/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare the surgical outcomes of the two different ankle stabilization techniques. METHODS This randomized controlled trial aimed to compare the outcomes of the modified Broström procedure with [calcaneofibular ligament (CFL) group] or without CFL repair [anterior talofibular ligament (ATFL) only group]. Of the 50 patients randomly assigned to two groups, 43 were followed up prospectively for ≥ 2 years (CFL group: 22 patients, 36.6 ± 13.1 months; ATFL Only group: 21 patients, 35.3 ± 11.9 months). Functional outcomes were assessed using the Karlsson-Peterson and Tegner activity level scoring systems. Anterior talar translation (ATT), talar tilt angle (TTA), and degrees of displacement of the calcaneus against the talus on stress radiographs were measured. All parameters were compared between the two groups. Multiple regression analysis setting the postoperative Karlsson-Peterson score as the dependent variable was performed to determine the significant variable. RESULTS There were no significant differences between the two groups in functional (Karlsson-Peterson and Tegner activity level) scores at the last follow-up and their changes. There were no significant differences between the two groups in the ATT, TTA, their differences compared with the contralateral ankles, and degrees of displacement of the calcaneus against the talus at the last follow-up. Osteochondral lesion of the talus rather than CFL repair was the significant variable related to functional outcome. CONCLUSION The modified Broström procedure with additional CFL repair did not result in a significant advantage in any measured outcome at 3 years. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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Affiliation(s)
- Kyung Rae Ko
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Won-Young Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hyobeom Lee
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Hee Seol Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Ki-Sun Sung
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, South Korea.
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Bianchi S, Becciolini M. Ultrasound Features of Ankle Retinacula: Normal Appearance and Pathologic Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3321-3334. [PMID: 31119773 DOI: 10.1002/jum.15026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/28/2019] [Indexed: 06/09/2023]
Abstract
Disorders of retinacula are frequent in acute and repetitive microtrauma of the ankle. Ultrasound (US), thanks to its spatial resolution and dynamic capabilities, is routinely used in the evaluation of the posttraumatic ankle for accurate delineation of ligaments and tendons. In addition, US can provide a depiction of normal retinacula and a detailed assessment of their pathologic changes. An accurate US assessment of ankle retinacula is helpful in choosing the proper treatment. In this pictorial essay, we briefly review the normal anatomy of ankle retinacula, describe their normal US appearance, and present a wide range of US pathologic abnormalities.
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Bu P, Li C, Li J, Zhu M. [Development and clinical application of ankle prosthesis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1370-1373. [PMID: 31650750 PMCID: PMC8337445 DOI: 10.7507/1002-1892.201902014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To review the development and clinical application of ankle prosthesis. METHODS The recent literature on ankle prosthesis design and clinical application was reviewed and analyzed. RESULTS Compared with the hip and knee prostheses, the ankle prosthesis develops slowly and has been developed to the third generation. The ankle joint has a special structure of multi-axis movement. The design of the first and second generations of prostheses is not conformed to the biomechanics of the ankle. The third generation of prosthesis is more conform to the characteristics of ankle biomechanics, with high postoperative survival rate and satisfactory clinical outcome. CONCLUSION At present, the survival rate of ankle prosthesis is low, and there is still much room for improvement in biomechanics, materials, and other aspects.
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Affiliation(s)
- Pengfei Bu
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100,
| | - Chuan Li
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China
| | - Jun Li
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China
| | - Min Zhu
- Department of Orthopedics, the 920th Hospital of Joint Logistic Support Force of Chinese PLA, Kunming Yunnan, 650100, P.R.China
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Sarcon AK, Heyrani N, Giza E, Kreulen C. Lateral Ankle Sprain and Chronic Ankle Instability. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011419846938. [PMID: 35097325 PMCID: PMC8696766 DOI: 10.1177/2473011419846938] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A select 10-30% of patients with recurrent lateral ankle sprains develop chronic ankle instability (CAI). Patients with chronic ankle instability describe a history of the ankle “giving way” with or without pathological laxity on examination. Evaluation includes history, identification of predisposing risk factors for recurrent sprains, and the combination of clinical tests (eg, laxity tests) with imaging to establish the diagnosis. There are a variety of nonoperative strategies to address chronic ankle instability, which include rehabilitation and taping or bracing to prevent future sprains. Patients who fail conservative treatment are candidates for surgery. The anatomic approaches (eg, modified Broström) are preferred to nonanatomic procedures since they recreate the ankle’s biomechanics and natural course of the attenuated ligaments. There is a growing interest in minimally invasive procedures via ankle arthroscopy that also address the associated intra-articular disorders. This article provides a review of chronic lateral ankle instability consisting of relevant anatomy, associated disorders, evaluation, treatment methods, and complications.
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Affiliation(s)
- Aida K. Sarcon
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Nasser Heyrani
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
| | - Christopher Kreulen
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA, USA
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Tourné Y, Peruzzi M. Lateral collateral ligament repair. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:169-179. [DOI: 10.1007/s00064-019-0599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Over the last 10 years, significant advances have been made and successful techniques have now been developed that effectively treat ankle instability via the arthroscope.Currently arthroscopic lateral ligament repair techniques can be grouped into "arthroscopic-assisted techniques," "all-arthroscopic techniques," and "all-inside techniques." Recent studies have proven these arthroscopic techniques to be a simple, safe, and biomechanically equivalent, stable alternative to open Brostrom Gould lateral ligament reconstruction.
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Affiliation(s)
- Jorge I Acevedo
- Department of Orthopedics, Southeast Orthopedic Specialists, 6500 Bowden Road, Suite 103, Jacksonville, FL 32216, USA.
| | - Robert C Palmer
- Department of Orthopedics, University of Florida, 2nd Floor ACC Ortho Department, 655 W 8th Street, Jacksonville, FL 32209, USA
| | - Peter G Mangone
- Department of Orthopedics, Blue Ridge Division of Emergeortho, Foot and Ankle Center, 2585 Hendersonville Road, Arden, NC 28704, USA
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Abstract
Open surgical reconstruction for chronic lateral ankle instability is a proven and effective means of providing renewed stability. Ankle arthroscopy is recommended before reconstruction to address intra-articular pathology. The open procedure discussed is well researched and proven to restore stability and the ability to return to sport and daily activity. Anatomic shortening with reattachment into a bony trough allows return to full motion, reliable stability, and return to an active lifestyle without sacrificing any tendons or requiring a tenodesis. The authors' aggressive rehabilitation protocol is provided; the approach to athletes/patients with ligament laxity or cavovarus alignment is also addressed.
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Affiliation(s)
- David A Porter
- Methodist Sports Medicine, Volunteer Clinical Faculty, Department of Orthopedics, Indiana University, 201 Pennsylvania Parkway, Suite 100, Indianapolis, IN 46280, USA.
| | - Kreigh A Kamman
- Department of Orthopedics, IU Health University Hospital, 550 N. University Boulevard, Suite 6201, Indianapolis, IN, USA
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Dalmau-Pastor M, Malagelada F, Kerkhoffs GMMJ, Manzanares MC, Vega J. X-shaped inferior extensor retinaculum and its doubtful use in the Bröstrom-Gould procedure. Knee Surg Sports Traumatol Arthrosc 2018; 26:2171-2176. [PMID: 28710509 DOI: 10.1007/s00167-017-4647-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The inferior extensor retinaculum (IER) is an aponeurotic structure located in the anterior aspect of the ankle. According to the literature, it can be used to reinforce a repair of the anterior talofibular ligament in ankle instability. Despite its usual description as an Y-shaped structure, it is still unclear which part of the retinaculum is used for this purpose, or if it is instead the crural fascia that is being used. The purpose of this study is to define the anatomical characteristics of the IER to better understand its role in the Broström-Gould procedure. METHODS Twenty-one ankles were dissected. The morphology of the IER and its relationship with neighbouring structures were recorded. RESULTS Seventeen (81%) of the IER in this study had an X-shaped morphology, with the presence of an additional oblique superolateral band. This band, by far the thinnest of the retinaculum, is supposed to be used to reinforce the repair of the anterior talofibular ligament. The intermediate dorsal cutaneous nerve (lateral branch of the superficial peroneal nerve) was found to cross the retinaculum in all cases. CONCLUSIONS The IER is most commonly seen as an X-shaped structure, but the fact that the oblique superolateral band is a thin band of tissue probably indicates that it may not add significant strength to ankle stability. Furthermore, the close relationship of the retinaculum with the superficial peroneal nerve is another factor to consider before deciding to perform a Broström-Gould procedure. These anatomical findings advise against the use of the Gould augmentation.
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Affiliation(s)
- M Dalmau-Pastor
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, C/FeixaLlarga, s/n, 09806, Hospitalet de Llobregat, Barcelona, Spain. .,Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain.
| | - F Malagelada
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, C/FeixaLlarga, s/n, 09806, Hospitalet de Llobregat, Barcelona, Spain.,Foot and Ankle Unit, Orthopaedic and Trauma Surgery, Heatherwood and Wexham Park Hospitals, Frimley Health NHS Trust, Ascot, Berkshire, UK
| | - G M M J Kerkhoffs
- Chair Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Chair Academic Center for Evidence Based Sports Medicine (ACES), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Co-Chair Amsterdam Collaboration for Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands
| | - M C Manzanares
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, C/FeixaLlarga, s/n, 09806, Hospitalet de Llobregat, Barcelona, Spain
| | - J Vega
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, C/FeixaLlarga, s/n, 09806, Hospitalet de Llobregat, Barcelona, Spain.,Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain
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Jorge JT, Gomes TM, Oliva XM. An anatomical study about the arthroscopic repair of the lateral ligament of the ankle. Foot Ankle Surg 2018; 24:143-148. [PMID: 29409223 DOI: 10.1016/j.fas.2017.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/14/2016] [Accepted: 01/11/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this anatomical study to was to determine the relationship of the structures involved in the arthroscopic repair of the anterior talofibular ligament. METHODS Dissection of fifteen lower leg cadaveric specimens was made and distances in the anterior direction from the reference-point at the lateral malleolus origin of the anterior talofibular ligament were measured, to the talar insertion of the ligament, to the superficial peroneal nerve at 60° and 90° in relation to the lateral malleolus axis in the sagittal plane, and to the inferior extensor retinaculum. RESULTS The mean±SD distance to superficial peroneal nerve from the reference-point was 25±6 (range 17-35) mm at 60°, and 32±9 (range 24-48) mm at 90° in relation to the lateral malleolus axis. The mean±SD distance to the inferior extensor retinaculum was 20±5 (range 14-29) mm. The mean±SD length of the anterior talofibular ligament was 21±4 (range 13-29) mm. CONCLUSIONS The superficial peroneal nerve demonstrated the greatest variance in its anatomy. An accessory incision to include the inferior extensor retinaculum in the repair should not surpass the 22mm distance from the lateral malleolus in the anterior direction, due to the risk of damaging the nerve.
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Affiliation(s)
- João Torrinha Jorge
- Department of Orthopedic Surgery, Hospital Curry Cabral - CHLC, Rua da Beneficência no. 8, 1069-166 Lisboa, Portugal.
| | - Tiago Mota Gomes
- University of Barcelona, Calle Casanova, 143, 08038 Barcelona, Spain
| | - Xavier Martin Oliva
- Department of Human Anatomy, Dissection Room, Faculty of Medicine, University of Barcelona, Calle Casanova, 143, 08038 Barcelona, Spain; Foot and Ankle Surgery, Remei Hospital, Barcelona, Spain
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Abstract
Surgical procedures for managing chronic lateral ankle instability include anatomic direct repair, anatomic reconstruction with an autograft or allograft, and arthroscopic repair. Open direct repair is commonly used for patients with sufficient ligament quality. Reconstruction incorporating either an autograft or an allograft is another promising option in the short term, although the longevity of this procedure remains unclear. Use of an allograft avoids donor site morbidity, but it comes with inherent risks. Arthroscopic repair of chronic lateral ankle instability can provide good to excellent short- and long-term clinical outcomes, but the evidence supporting this technique is limited. Deterioration of the ankle joint after surgery is also a concern. Studies are needed on not only treating ligament insufficiency but also on reducing the risk of ankle joint deterioration.
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Dalmau-Pastor M, Vega J, Malagelada F, Peña F, Manzanares-Céspedes MC. An Anatomical Study of Nerves at Risk During Minimally Invasive Hallux Valgus Surgery. J Vis Exp 2018:56232. [PMID: 29553550 PMCID: PMC5931310 DOI: 10.3791/56232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The growing popularity of minimally invasive surgical (MIS) procedures makes it necessary that new anatomical references arise, to aid in tridimensional orientation and localization of structures that are not directly visible to the surgeon. This is especially critical for structures at risk like nerves or blood vessels. Optimization of the handling of cadaveric material and the combination of multiple techniques compensate for the limited availability of adequate specimens. The described protocol combines anatomical plane-by-plane dissection and sectional anatomy of fresh-frozen specimens to help localize relevant structures, such as nerves, arteries, veins and to correctly position the portals during MIS procedures. Depiction of these structures in anatomy textbooks can differ from what is encountered in the surgical field; and for this reason, new anatomical studies with a surgical orientation are needed. However, this is a complex, time-consuming technique requiring specific training. The anatomical references described with the so-called 'clock method' provide the surgeon with an easy and reproducible system to locate the path of the nerves at risk in Hallux Valgus MIS procedures. This model can be extrapolated to many other minimally invasive surgical procedures.
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Affiliation(s)
- Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona; Health Sciences Faculty of Manresa, University of Vic-Central University of Catalunya; Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, GRECMIP;
| | - Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona; Foot and Ankle Unit, Hospital Quirón Barcelona
| | - Francesc Malagelada
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona; Foot and Ankle Unit, Orthopedic and Trauma Surgery, Royal London Hospital, Barts Health NHS Trust
| | - Fernando Peña
- Department of Orthopedic Surgery, Foot and Ankle Unit, University of Minnesota
| | - Maria Cristina Manzanares-Céspedes
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy and Embryology Unit), University of Barcelona
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Yeo ED, Park JY, Kim JH, Lee YK. Comparison of Outcomes in Patients With Generalized Ligamentous Laxity and Without Generalized Laxity in the Arthroscopic Modified Broström Operation for Chronic Lateral Ankle Instability. Foot Ankle Int 2017; 38:1318-1323. [PMID: 29034742 DOI: 10.1177/1071100717730336] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The arthroscopic modified Broström operation (MBO) has been frequently used to treat chronic lateral ankle instability (CLAI). However, no reports comparing the clinical outcomes between patients with or without generalized ligamentous laxity (laxity or no laxity, respectively) currently exist. The purpose of this study was to compare the clinical outcomes of the 2 groups with CLAI. METHODS Between January 2013 and November 2015, arthroscopic MBO was performed on 99 patients with CLAI. Patients were divided into 2 groups: the laxity group (24 ankles) and no laxity group (75 ankles). Generalized ligamentous laxity was defined as a Beighton score of 4 or more points. Evaluation tools included the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot ankle score, a pain visual analog scale (VAS), and talar tilt angle. RESULTS The change in talar tilt angle from preoperative to 12 months postoperative was significantly greater in the laxity group (-6.9 ± 5.2) compared with the no-laxity group (-4.2 ± 4.2) ( P = .03). The final follow-up AOFAS hindfoot ankle score and pain VAS in both groups showed improvement compared with the preoperative values. CONCLUSION All groups achieved successful clinical and radiological final follow-up outcomes. Arthroscopic MBO should be considered a reasonable method in patients who have chronic lateral ankle instability, regardless of generalized ligamentous laxity. LEVEL OF EVIDENCE III, comparative study.
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Affiliation(s)
- Eui Dong Yeo
- 1 Department of Orthopaedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Ji Young Park
- 2 Departments of Orthopedic Surgery, Soonchunhyang University Hospital, Bucheon-Si, Gyeonggi-Do, Republic of Korea
| | - Jin Hyeung Kim
- 3 Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Young Koo Lee
- 2 Departments of Orthopedic Surgery, Soonchunhyang University Hospital, Bucheon-Si, Gyeonggi-Do, Republic of Korea
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Abstract
PURPOSE OF REVIEW Ankle sprains, which account for 40% of sports injuries in the USA, can lead to chronic ankle instability. Chronic ankle instability can be classified as functional, mechanical, or a combination of both and is diagnosed using a combination of a physical exam, an MRI, and stress radiographs. This review focuses on different approaches to treatment, including non-operative and operative techniques, of chronic ankle instability, including reviewing traditional procedures as well as more novel and newer techniques. RECENT FINDINGS Based on existing literature, non-operative treatment should always precede operative treatment of chronic ankle instability. If rehabilitation fails, Brostrom-Gould type ankle stabilization has been the preferred surgical option. Recent literature suggests that arthroscopic repair might reduce recovery time and improve outcomes in certain populations; however, there are higher rates of complication following these surgeries. In more high-risk populations, some literature reports that ligament repair with peroneus brevis transfer could be a more effective treatment option. Currently, varying surgical techniques exist for the treatment of chronic ankle instability. While the more recently reported techniques show promise, it is important to note that there is little evidence showing they are more successful than traditional techniques. It is imperative that future studies focus on outcomes and complication rates of these newer procedures.
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Affiliation(s)
- Rachel J Shakked
- Rothman Institute, 3300 Tillman Drive, 2nd Floor, Bensalem, Philadelphia, PA, 19020-2071, USA.
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