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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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Beaudet P, Giunta JC, Agu C, van Rooij F, Saffarini M, Nogier A. Accuracy of Cutaneous Landmarks Compared to Ultrasound to Locate the Calcaneal Footprint of the CFL. J Foot Ankle Surg 2024; 63:353-358. [PMID: 38218343 DOI: 10.1053/j.jfas.2024.01.004] [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: 08/23/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
The purpose was to determine the accuracy of the techniques of Lopes et al. and Michels et al., compared to ultrasound, to locate the center of the calcaneal footprint of the CFL in healthy volunteers. The authors recruited 17 healthy adult volunteers at 1 center with no current ankle pathologies and no previous surgical antecedents on either ankle. The authors recorded the age, sex, height, BMI, and ankle side for each volunteer. Measurements were made on both ankles of the 17 volunteers to increase the sample size and ensure less dispersion of data, independently by 2 surgeons: 1 senior surgeon with 15 years' experience and 1 junior with 3 years' experience. The location of the center of the calcaneal footprint of the CFL was determined by each surgeon using 3 methods: (1) the cutaneous technique of Lopes et al., (2) the cutaneous technique of Michels et al., and (3) ultrasound imaging. The 17 volunteers (34 feet) had a mean age of 26.3 ± 8.7 and a BMI of 21.7 ± 2.9. The Michels point was significantly closer (4.6 ± 3.7 mm) than the Lopes point (11.1 ± 5.4 mm) to the true center of the calcaneal footprint of the CFL determined by ultrasound, notably in the vertical direction. The Michels point was located significantly closer to the true center of the calcaneal footprint of the CFL and demonstrated less dispersion than the Lopes point, indicated by significantly lower absolute mean deviation from the true center of the calcaneal footprint of the CFL, and that ultrasound is therefore preferred to locate the footprint the CFL.
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Olory BCR, Marín Fermín T, D’Hooghe P, Papakostas E, Al-Khelaifi K, Zikria BA. Modified Gracilis Autograft Preparation for Arthroscopic Anterior Talofibular and Calcaneofibular Ligament Anatomic Reconstruction: Technical Tip. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241242780. [PMID: 38766476 PMCID: PMC11102667 DOI: 10.1177/24730114241242780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Abstract
Visual AbstractThis is a visual representation of the abstract.
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Affiliation(s)
| | - Theodorakys Marín Fermín
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Centro Médico Profesional Las Mercedes, Caracas, Venezuela
| | - Pieter D’Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Lee TY, Chen PY, Yang KC, Tzeng IS, Ming Chang C, Wang CC. Comparison of Knot-Tying Techniques During the Arthroscopic Broström-Gould Procedure: Semiconstrained Freehand Versus Knot Pusher Techniques. Orthop J Sports Med 2024; 12:23259671231218649. [PMID: 38274016 PMCID: PMC10809873 DOI: 10.1177/23259671231218649] [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: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 01/27/2024] Open
Abstract
Background The arthroscopic Broström technique with or without Gould modification has been used to treat patients with anterior talofibular ligament injury who failed nonoperative management and progressed to chronic lateral ankle instability. However, some patients develop limited range of motion over the ankle joint postoperatively. Purpose/Hypothesis To compare the clinical outcomes and midterm functional performance of knot-tying techniques between using a knot pusher and a semiconstrained freehand tie during arthroscopic Broström-Gould procedure with inferior extensor retinaculum (IER) augmentation. It was hypothesized that the semiconstrained freehand tie would provide better plantarflexion of the ankle joint compared with the knot pusher. Study Design Cohort study; Level of evidence, 3. Methods Included were 135 consecutive patients with mild-to-moderate lateral ankle instability (mean age, 42.7 years; range, 16-78 years) who underwent an arthroscopic Broström-Gould procedure from March 1, 2016, to April 30, 2022. The patients were divided into 2 groups according to the tying technique used in the Gould modification: surgical tie using a knot pusher (KP group; n = 30) or a semiconstrained freehand tie (FT group; n = 105). Radiographic parameters and ultrasound dynamic testing were examined during the preoperative assessment. Preoperative and 2-year postoperative assessments comprised American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale for pain, and 12-Item Short Form Survey (SF-12) scores. Results The 2 groups had no differences in age, sex, or severity distribution in the preoperative assessment. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale pain, and SF-12 scores were significantly better at the postoperative evaluation (all P < .05) in both groups. No significant difference was noted between groups in outcome scores. In the KP group, however, 7 out of 30 patients (23.3%) developed ankle stiffness with tightness when performing plantarflexion movement. No patients in the FT group reported similar symptoms. Conclusion For mild-to-moderate chronic lateral ankle instability, we propose an arthroscopic Broström procedure with the addition of IER augmentation using a semiconstrained freehand tie to avoid overtightening the IER. This ensures favorable patient satisfaction and clinical outcomes without limitation of plantarflexion of the ankle joint and avoids the possible complication of stiffness with plantarflexion.
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Affiliation(s)
- Tung-Ying Lee
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Pei-Yu Chen
- Department of Orthopedic Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kai-Chiang Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chia Ming Chang
- Department of Orthopedic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
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Hong CC, Tan KJ, Calder J. Chronic lateral ankle ligament instability - Current evidence and recent management advances. J Clin Orthop Trauma 2024; 48:102328. [PMID: 38274643 PMCID: PMC10806209 DOI: 10.1016/j.jcot.2023.102328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Lateral ankle sprain is a common injury with a substantial negative impact on physical function, quality of life and health economic burden. Chronic lateral ankle instability (CLAI) as a sequela of lateral ankle sprain can lead to the development of posttraumatic ankle osteoarthritis in the long term. In this article, we explore the epidemiology, burden and definition of CLAI for the appropriate clinical assessment and imaging evaluation of patients with lateral ankle sprain and CLAI. Following that, recent advances and evidence on management of CLAI is critically distilled and summarized.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Ken Jin Tan
- OrthoSports Clinic for Orthopedic Surgery and Sports Medicine, Mt Elizabeth Novena Specialist Centre, Singapore
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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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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Thès A, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Elkaïm M, Boniface O, Guillo S, Bauer T, Lopes R. Five-year clinical follow-up of arthroscopically treated chronic ankle instability. Orthop Traumatol Surg Res 2023; 109:103649. [PMID: 37364821 DOI: 10.1016/j.otsr.2023.103649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Arthroscopic treatment of lateral ankle instability is a recent innovation. In 2014, a prospective study was initiated by the French Society of Arthroscopy demonstrating the feasibility, morbidity and short-term results of arthroscopic treatment of ankle instability. HYPOTHESIS The functional results of arthroscopic treatment of chronic ankle instability found after one year were maintained in the medium term. MATERIAL AND METHODS The prospective follow-up of the patients included in the initial cohort was continued. The Karlsson and AOFAS scores, as well as patient satisfaction, were assessed. The causes of failure underwent univariate and multivariate analyzes. The results of 172 patients were included (40.2% ligament repairs; 59.7% ligament reconstructions). The average follow-up was 5years. The average satisfaction was 8.6/10, the average Karlsson score was 85 points and the average AOFAS score was 87.5 points. The reoperation rate was 6.4% of patients. The failures were related to an absence of sports practice, a high BMI and female gender. A high BMI and the intense sports practice were associated to ligament repair failure. The absence of sports practice and the intraoperative presence of the anterior talofibular ligament were associated to ligament reconstruction failure. DISCUSSION Arthroscopic treatment of ankle instability confers high satisfaction in the medium term, as well as long-lasting results with a low reoperation rate. A more detailed evaluation of the failure criteria could help guide the choice of treatment between ligament reconstruction or repair. LEVEL OF EVIDENCE II.
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Affiliation(s)
- André Thès
- Hôpital privé d'Eure-et-Loir, 2, rue Roland-Buthier, 28300 Mainvilliers, France
| | - Michael Andrieu
- Clinique Pont-de-Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France
| | - Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - François Molinier
- Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Marc Elkaïm
- Clinique Drouot sport, 20, rue Laffitte, 75009 Paris, France
| | - Olivier Boniface
- Clinique Générale-Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France
| | - Stéphane Guillo
- SOS Pied Cheville Bordeaux, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, groupe hospitalier universitaire Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Francophone Arthroscopic society (SFA), 15, rue Ampère, 92500 Rueil-Malmaison, France
| | - Ronny Lopes
- Francophone Arthroscopic society (SFA), 15, rue Ampère, 92500 Rueil-Malmaison, France; Santé atlantique (Pied Cheville Nantes Atlantique), avenue Claude-Bernard, 44800 Saint-Herblain, France.
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Huang Q, Ji XX, Zhu WH, Cai YH, Cao LH, Wang YC. A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair. Chin J Traumatol 2023; 26:317-322. [PMID: 37926628 PMCID: PMC10755778 DOI: 10.1016/j.cjtee.2023.10.001] [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: 08/24/2023] [Revised: 09/30/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese, and/or with demand for highly intensive sports, and/or with poor-quality ligament remnants. METHODS A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament (ATFL) reconstruction with tensional remnant repair technique from January 2019 to August 2021. General data, including demographics, surgical time, and postoperative adverse events, were recorded. The American Orthopaedic Foot and Ankle Society score (AOFAS), foot and ankle ability measure (FAAM), visual analog scale (VAS), and anterior talar translation were measured preoperatively and at 6 weeks, 3 months, and 2 years postoperatively. Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL. Data were analyzed using SPSS 19.0. F test was used to analyze the pre- and postoperative VAS, FAAM, and AOFAS scores. The significance was set at p < 0.05. RESULTS There were 20 males and 10 females among the patients with a mean age of (30.71 ± 5.81) years. The average surgical time was (40.21 ± 8.59) min. No adverse events were observed after surgery. At 2 years postoperatively, the anterior talar translation test showed grade 0 laxity in all patients. VAS score significantly decreased from preoperatively to 6 weeks, 3 months, and 2 years postoperatively (p < 0.001). Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks, 3 months, and 2 years postoperatively was statistically significant (p < 0.001). At 3 months postoperatively, most patients (23/30) could return to their pre-injured activities of daily living status. At 2 years postoperatively, all patients were able to return to their pre-injured activities of daily living status, and almost every patient (18/19) who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal. The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL. CONCLUSION The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation, and allowed early return to pre-injured activities, which could be a reliable option for patients with chronic lateral ankle instability.
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Affiliation(s)
- Qiu Huang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China; Department of Joint Surgery, People's Hospital of Leshan, Leshan, Sichuan province, 614000, China
| | - Xiao-Xi Ji
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wen-Hui Zhu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Ye-Hua Cai
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Lie-Hu Cao
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai, 200000, China
| | - Yong-Cai Wang
- Department of Joint Surgery, People's Hospital of Leshan, Leshan, Sichuan province, 614000, China
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Inchai C, Vaseenon T, Tanaka Y, Mahakkanukrauh P. The Specific Anatomical Morphology of Lateral Ankle Ligament: Qualitative and Quantitative Cadaveric based Study. Orthop Surg 2023; 15:2683-2688. [PMID: 37620949 PMCID: PMC10549863 DOI: 10.1111/os.13872] [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: 04/25/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE The accurate understanding in morphological features of the lateral ankle ligaments is necessary for the diagnosis and management of ankle instability and other ankle problems. The purpose of this study was to evaluate the anatomical morphology and the attachment areas of lateral ligament complex of ankle joint based on the cadaveric study. METHODS Fifty-four fresh frozen cadaveric ankles were dissected to evaluate the lateral ankle ligaments. Each ligament was separated into two or three small bundles. In the investigated footprint areas, acrylic colors were used as a marker point to locate specific areas of ligament bundle attached to the bone. The Image J software was used to measure and analyze the sizes of the specific footprint areas to achieve descriptive statistical analysis. RESULTS The double bands of anterior talofibular ligament (ATFL) were found as a major type in the present study with 57.41% (31 of 54 ankles) while the single band of ATFL was observed in 42.59% (23 of 54 ankles). The attachment sizes of the ATFL, posterior talofibular ligament (PTFL) and calcaneofibular ligament (CFL) were evaluated into two areas; proximal and distal attachments. The average of proximal or fibular part of ATFL, PTFL and CFL were 85.06, 134.27, 93.91 mm2 respectively. The average of distal part of ATFL, PTFL and CFL were 100.07, 277.61, 249.39 mm2 respectively. CONCLUSION Considering the lateral ankle ligament repaired or reconstruction especially using arthroscopy, the precise understanding in specific detail of the lateral ankle ligament may help both diagnose and select the appropriate treatment for solving the ankle problems. These observations may help the surgeon to perform the surgical procedure for determining the appropriate techniques and avoid complication to patients.
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Affiliation(s)
- Chirapat Inchai
- Department of Anatomy, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Tanawat Vaseenon
- Department of Orthopedics, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Yasuhito Tanaka
- Department of Orthopaedic SurgeryNara Medical UniversityKashiharaJapan
| | - Pasuk Mahakkanukrauh
- Department of Anatomy, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
- Excellence in Osteology Research and Training Center (ORTC), Chiang Mai UniversityChiang MaiThailand
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Veiga Sanhudo JA, Ferkel E, Alencar Mendes de Carvalho K. Chronic Lateral Ankle Instability: Can We Get Even Better with Surgical Treatment? Foot Ankle Clin 2023; 28:321-332. [PMID: 37137626 DOI: 10.1016/j.fcl.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ligament attenuation may occur after repetitive ankle sprains, creating instability. Management of chronic ankle instability requires a comprehensive approach to mechanical and functional instability. Surgical treatment, however, is indicated when conservative treatment is not effective. Ankle ligament reconstruction is the most common surgical procedure to resolve mechanical instability. Anatomic open Broström-Gould reconstruction is the gold standard for repairing affected lateral ligaments and returning athletes to sports. Arthroscopy may also be beneficial for identifying associated injuries. In severe and long-standing instability, reconstruction with tendon augmentation could be necessary.
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Affiliation(s)
- Jose Antonio Veiga Sanhudo
- Foot & Ankle Department, Hospital Moinhos de Vento, Avenida Juca Batista 8000, 18 Porto Alegre RS, Brazil CEP 91781-200.
| | - Eric Ferkel
- Southern California Orthopedic Institute, 6815 Noble Avenue, Suite 200, Van Nuys, CA, USA
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Guyonnet C, Lopes R. Re-injury after arthroscopic anatomical reconstruction of the lateral ankle ligaments treated by a new arthroscopic anatomical reconstruction: A case report. Int J Surg Case Rep 2023; 105:107994. [PMID: 37003231 PMCID: PMC10091021 DOI: 10.1016/j.ijscr.2023.107994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Lateral ankle ligament reconstruction failures are increasingly frequent. To our knowledge no reports of using a new arthroscopic anatomical reconstruction with a gracilis autograft to treat an ankle re-injury have been described. CASE PRESENTATION A 19-year-old man presented with a right ankle injury resulting in isolated lateral ankle instability. The clinical examination showed significant laxity. The MRI confirmed a grade 3 tear of the lateral ligament complex. Arthroscopic anatomical reconstruction with a gracilis autograft was performed and the patient was able to return to all of his activities. Eighteen months after the primary reconstruction, he had another high-energy injury. Despite rehabilitation, he experienced isolated lateral instability. Arthrography confirmed graft failure. The patient underwent a new anatomical reconstruction with the controlateral gracilis autograft, with no difficulties. At 6 months, he had returned to all of his activities, with no limitations or discomfort. CLINICAL DISCUSSION Articular hypermobility, hindfoot varus and/or excess weight should be looked for or treated to explain the graft failure. Other therapeutic options are possible for revision surgery such as non-anatomical tenodesis, allografts or artificial ligaments. CONCLUSION Arthroscopic anatomical reconstruction of the lateral ligaments of the ankle with a new arthroscopic anatomical reconstruction procedure seems to be feasible. Other studies are needed to define the therapeutic strategy for ligament reconstruction graft failures.
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de Rousiers A, Rougereau G, Rousselin B, Langlais T, Rollet ME, Bauer T, Bachy M, Hardy A. Adaptation of the Signal Noise Quotient MRI classification for graft ligamentization analysis following ATFL and CFL anatomical reconstruction: Validation of the SNQA. Foot Ankle Surg 2023; 29:243-248. [PMID: 36774199 DOI: 10.1016/j.fas.2023.01.013] [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: 07/04/2022] [Revised: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic ankle instability is the most frequent clinical sign of an antero tibiofibular (ATFL) and/or calcaneo fibular ligament (CFL) tear. One common surgical technique is to use the distal tendon of the gracilis muscle to reconstruct both the ATFL and CFL. In the knee, the hamstring tendons used in anterior cruciate ligament (ACL) reconstruction may go through structural modifications called "ligamentization ". A noninvasive MRI technique has been developed using the Signal/Noise Quotient to compare the signal of the graft following reconstruction to that of the posterior cruciate ligament. To our knowledge no studies have ever evaluated radiographic changes in the graft over time. The main goal of this study was to develop a specific MRI protocol to evaluate graft remodeling following ATFL and CFL reconstruction over time. METHODS A prospective study of the changes in the MRI signal of the ATFL-CFL graft 3-months postoperatively was performed in 20 patients. The main outcome was a comparison of the graft signal to that of the peroneal fibular tendon and the surrounding noise to determine the Ankle SNQ (SNQA). MRI images were evaluated by two senior radiologists to assess inter-rater reliability and then 2 weeks later for the intra-rater reproducibility. RESULTS The intraclass correlation (ICC) showed excellent inter- and intra rater reliability for the ATFL SNQA (0.96 and 0.91, respectively); and for the CFL SNQA, the ICC was 0.97 and 0.99, respectively. Bland-Altman analysis showed very limited bias in the interpretation of SNQA. CONCLUSION This preliminary study confirmed the inter- and intra- rater reliability of a new tool using the SNQA.
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Affiliation(s)
- Arnaud de Rousiers
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
| | - Grégoire Rougereau
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Benoit Rousselin
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Trousseau Hospital, Sorbonne University, APHP, 26 avenue du Dr. Arnold Netter, 75012 Paris, France
| | - Marie-Eva Rollet
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Thomas Bauer
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Manon Bachy
- Department of Pediatric Orthopedic Surgery, Trousseau Hospital, Sorbonne University, APHP, 26 avenue du Dr. Arnold Netter, 75012 Paris, France; Université de Paris, B3OA, UMR CNRS 7052, INSERM U1271, 10 avenue de Verdun, 75010 Paris, France
| | - Alexandre Hardy
- Clinique du Sport, 28 boulevard Saint Marcel, 75005 Paris, France; GRC33 Sorbonne Université Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26 avenue du Dr Arnold Netter 75012 Paris
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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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14
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Hou H, Zhou M, Zhou X, Guo W, Zhuang R, Yin H, Li J. Comparison arthroscopic reconstruction and percutaneous reconstruction of ankle lateral ligament for chronic ankle lateral instability: A protocol for a meta-analysis of comparative studies. Medicine (Baltimore) 2022; 101:e31926. [PMID: 36397427 PMCID: PMC9666152 DOI: 10.1097/md.0000000000031926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ankle sprains occur very frequently in daily life, but people who do not pay attention to them and do not receive proper diagnosis and treatment are very prone to develop chronic ankle lateral instability (CALI) at a later stage. For CALI where conservative treatment has failed, reconstruction of the lateral collateral ligament of the ankle can achieve satisfactory results, but there are various and controversial ways of ligament reconstruction. While percutaneous reconstruction of ankle lateral ligament (PLCLR) needs to be performed repeatedly under fluoroscopy, total arthroscopic reconstruction of ankle lateral ligament (ALCLR) is increasingly recognized by experts and scholars for its minimally invasive and precise characteristics, and has achieved good clinical results. Therefore, it is imperative that a meta-analysis be performed to provide evidence as to whether there is a difference between ALCLR and PLCLR in the treatment of CALI. METHODS We will search articles in 7 electronic databases including Chinese National Knowledge Infrastructure, Wanfang Data, Chinese Scientific Journals Database, Chinese databases SinoMed, PubMed, Embase, and Cochrane Library databases. All the publications, with no time restrictions, will be searched without any restriction of language and status, the time from the establishment of the database to September 2022.We will apply the risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials to assess the methodological quality. Risk-of-Bias Assessment Tool for Non-randomized Studies was used to evaluate the quality of comparative studies. Statistical analysis will be conducted using RevMan 5.4 software. RESULTS This systematic review will evaluate the functional outcomes and radiographic results of ALCLR in the treatment of CALI. CONCLUSION The conclusion of this study will provide evidence for judging whether ALCLR is superior to PLCLR for treatment of CALI. TRIAL REGISTRATION NUMBER CRD42022362045.
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Affiliation(s)
- Huiming Hou
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang City, China
| | - Ming Zhou
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang City, China
| | - Xing Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou City, China
| | - Wenxuan Guo
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou City, China
| | - Rujie Zhuang
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou City, China
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou City, China
| | - Hong Yin
- Kunming University of Science and Technology Hospital, Kunming City, China
| | - Jinlei Li
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, China
- *Correspondence: Jinlei Li, Kunming Municipal Hospital of Traditional Chinese Medicine, No. 25, Dongfeng East Road, Panlong District, Kunming City, Yunnan Province, China (e-mail: )
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15
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Yang KC, Chen PY, Loh C, Tzeng IS, Chang SM, Wang CC. Chronic Lateral Ankle Instability Treated With Tendon Allografting: A Preliminary Comparison of Arthroscopic and Open Anatomic Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221126693. [PMID: 36250031 PMCID: PMC9561677 DOI: 10.1177/23259671221126693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Roughly 30% of patients with chronic lateral ankle instability (CLAI) have
long-lasting painful instability requiring surgical intervention. Ligament
reconstruction with the traditional open method and using tendon allografts
can provide sufficient mechanical stability for severe CLAI. Arthroscopic
ligament reconstruction with tendon allograft has recently been introduced
to treat CLAI. Purpose: In this study, we describe an arthroscopic ligament reconstruction procedure
involving the use of the tendon allograft for patients with CLAI, and we
compare the efficacy of this procedure with open ligament reconstruction
with tendon allograft. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled 10 patients (4 men and 6 women) with CLAI (mean age, 37.3 years;
range, 16-57 years) who underwent arthroscopic ligament reconstruction with
tendon allografting between November 2017 and June 2019. The control group
consisted of 10 patients who received open tendon allograft reconstruction.
Preoperative and 2-year postoperative functional outcomes were evaluated
using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale
(AOFAS), Karlsson Ankle Functional Score (KAFS), pain visual analog scale
(VAS), 12-Item Short Form Health Survey (SF-12), and Tegner activity score
(TAS). Results: The mean operative time was 118 and 110 minutes in the arthroscopic and open
groups, respectively. At 2-year follow-up, scores on the AOFAS improved
significantly compared with preoperatively, from 71.3 to 96.4
(P = .006) in the arthroscopic group, and from 68.6 to
96.7 (P = .005) in the open group. The postoperative AOFAS,
VAS, KAFS, and SF-12 scores did not differ significantly between the 2
groups; however, the TAS score was significantly higher in the arthroscopic
reconstruction group compared with in the open group (7 vs 6.1,
respectively; P = .01). Conclusion: Arthroscopic ligament reconstruction with tendon allografting resulted in
sufficient ankle stability and no donor-site morbidity. This procedure can
yield similar functional outcomes to open reconstruction technique and may
be an option for the management of CLAI.
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Affiliation(s)
- Kai-Chiang Yang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist
Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Dental Technology, College of Oral Medicine, Taipei
Medical University, Taipei, Taiwan
| | - Pei-Yu Chen
- Department of Orthopedic Surgery, National Taiwan University
Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh Loh
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist
Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi
Medical Foundation, New Taipei City, Taiwan
| | - Shun-Min Chang
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital,
Kaohsiung Medical University, Kaohsiung City, Hualien, Taiwan
| | - Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist
Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University,
Hualien, Taiwan.,Chen-Chie Wang, MD, PhD, Department of Orthopedic Surgery,
Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
23142, Taiwan ()
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16
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Wang Y, Zhu JX. Arthroscopic anatomical reconstruction of lateral collateral ligaments with ligament advanced reinforcement system artificial ligament for chronic ankle instability. World J Clin Cases 2022; 10:8893-8905. [PMID: 36157669 PMCID: PMC9477045 DOI: 10.12998/wjcc.v10.i25.8893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/04/2021] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, the use of ligament advanced reinforcement system (LARS) artificial ligament, a new graft which has several unique advantages such as no donor-site morbidity, early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction. Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing. However, the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.
AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.
METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society score (AOFAS score) and Karlsson score were used to evaluate the clinical results before and after surgery.
RESULTS A total of 22 patients (22 ankles) were followed up for a mean of 12 mo. All patients reported significant improvement compared to their preoperative status. The mean AOFAS score improved from 42.3 ± 4.9 preoperatively to 90.4 ± 6.7 postoperatively. The mean Karlsson score improved from 38.5 ± 3.2 preoperatively to 90.1 ± 7.8 postoperatively. The mean VAS score improved from 1.9 ± 2.5 preoperatively to 0.8 ± 1.7 postoperatively.
CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Jun-Xu Zhu
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
- Department of Orthopaedics, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang 441000, Hubei Province, China
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17
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Dias S, Lewis TL, Alkhalfan Y, Ahluwalia R, Ray R. Current concepts in the surgical management of chronic ankle lateral ligament instability. J Orthop 2022; 33:87-94. [PMID: 35874042 PMCID: PMC9305620 DOI: 10.1016/j.jor.2022.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022] Open
Abstract
Background/aims Ankle sprains are common injuries which can lead to chronic lateral ankle ligament instability (CAI). Methods The aim of this review is to provide a comprehensive overview of the epidemiology, pathophysiology, investigation, surgical management and rehabilitation of CAI. Results Investigation of CAI is based on history, clinical examination, and imaging. Surgical management of CAI can be defined as anatomic reconstruction, anatomic and non anatomic repair of ATFL and/or CFL. Anatomic repair has been shown to have better functional outcomes and less secondary osteoarthritis when compared to non anatomic repair. Non-anatomic methods do not replicate the normal anatomical course of ATFL/CFL and may lead to stiffness. The most common surgical treatment for CAI is the open modified Broström repair augmented with the Gould modification. There are arthroscopic techniques being developed which have reported promising clinical results. However, there are considerable areas of further research which should be carried out to improve understanding and effectiveness of current treatment options. Standardised validated patient reported outcome measures and evidence-based protocols in the rehabilitation periods are crucial for positive and reproducible outcomes. Conclusion Surgical repair has proven to show excellent outcomes for patients suffering from CAI, however larger prospective studies should be carried out to evaluate the use of newer surgical techniques.
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Affiliation(s)
- Shiluka Dias
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Thomas L. Lewis
- Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Raju Ahluwalia
- King's College Hospital MTC, London; King's College Hospital Diabetic Foot Unit & King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
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18
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Hanada M, Hotta K, Matsuyama Y. Comparison Between the Simultaneous Reconstructions of the Anterior Talofibular Ligament and Calcaneofibular Ligament and the Single Reconstruction of the Anterior Talofibular Ligament for the Treatment of Chronic Lateral Ankle Instability. J Foot Ankle Surg 2022; 61:533-536. [PMID: 34785128 DOI: 10.1053/j.jfas.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/29/2021] [Accepted: 01/31/2021] [Indexed: 02/03/2023]
Abstract
This study aimed to evaluate the procedures of reconstruction surgery for chronic lateral ankle instability. We compared single anterior talofibular ligament reconstruction to simultaneous reconstructions of the anterior talofibular and calcaneofibular ligaments. From 2015 to 2019, 14 consecutive patients diagnosed with chronic lateral ankle instability underwent arthroscopic anterior talofibular ligament reconstruction with or without calcaneofibular ligament reconstruction after conservative treatment. Seven patients underwent single anterior talofibular ligament reconstruction (group AT), and 7 patients underwent simultaneous reconstructions of the anterior talofibular ligament and calcaneofibular ligament (group AC). The Japanese Society for Surgery of the Foot scale scores and Karlsson scores significantly improved in all patients 1 year postoperatively. The radiographic measurement of the talar tilt angle and the talar anterior drawer distance at 1 year after surgery were also significantly improved compared to preoperative values. The postoperative talar tilt angle was significantly greater in group AT (median 6°, range 3°-7°) than that in group AC (median 3°, range 2°-5°; p = .038). The postoperative talar anterior drawer distance, Japanese Society for Surgery of the Foot scale score, and Karlsson score were not significantly different between the 2 groups. We found that although the clinical outcomes after the anterior talofibular ligament reconstruction with or without the calcaneofibular ligament reconstruction for chronic lateral ankle instability were good, instability of the talar tilt angle at 1 year postoperatively in patients who underwent single anterior talofibular ligament reconstruction was greater than that in patients who underwent simultaneous anterior talofibular and calcaneofibular ligament reconstructions.
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Affiliation(s)
- Mitsuru Hanada
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
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19
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Lopes R, Andrieu M, Molinier F, Colin F, Morin V. PT4: New arthroscopic technique for isolated reconstruction of the anterior talofibular ligament using a quadrupled plantaris tendon. Orthop Traumatol Surg Res 2021; 107:102995. [PMID: 34198006 DOI: 10.1016/j.otsr.2021.102995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 02/03/2023]
Abstract
The strategy for surgical treatment of chronic ankle instability is becoming increasingly refined. In instances of isolated symptomatic non-repairable anterior talofibular ligament (ATFL) injury, there is a surgical indication for isolated ATFL reconstruction. However, we feel that the typical gracilis tendon graft is not always appropriate. Interest in using the plantaris tendon as a graft has picked up since a biomechanics study found the tensile strength of a quadrupled plantaris tendon is comparable to that of the ATFL. Here, we describe an original arthroscopic technique for isolated ATFL reconstruction using a quadrupled plantaris tendon (PT4) graft.
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Affiliation(s)
- Rony Lopes
- Clinique Brétéché, 3, rue de la Béraudière, 44000 Nantes, France; Santé Atlantique, Avenue Claude Bernard, 44800 Saint-Herblain, France.
| | - Mickaël Andrieu
- Clinique du Pont de Chaume, 330 Avenue Marcel Unal, 82017 Montauban cedex, France
| | | | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis Mouillard, 66000 Perpignan, France
| | - Vincent Morin
- Clinique Médipôle de Savoie, 300, Avenue des Massettes, 73190 Challes-les-Eaux, France
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20
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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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21
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Takao M, Lowe D, Ozeki S, Oliva XM, Inokuchi R, Yamazaki T, Takeuchi Y, Kubo M, Matsui K, Katakura M, Glazebrook M. Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study. BMC Musculoskelet Disord 2021; 22:558. [PMID: 34144675 PMCID: PMC8214304 DOI: 10.1186/s12891-021-04444-w] [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: 02/01/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022] Open
Abstract
Background Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system. Methods The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex. Results The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion. Conclusion Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.
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Affiliation(s)
- Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.
| | - Danielle Lowe
- Department of Orthopaedic Surgery, Lions Gate Hospital, North Vancouver, BC, Canada
| | - Satoru Ozeki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Xavier M Oliva
- Department of Human Anatomy, University of Barcelona, Calle Casanova, 143, 08038, Barcelona, Spain
| | - Ryota Inokuchi
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan
| | - Takayuki Yamazaki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Yoshitaka Takeuchi
- Tokyo National College of Technology, 1220-2, Kunugida-machi, Hachioji, Tokyo, Japan
| | - Maya Kubo
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Mai Katakura
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), 1796 Summer Street, Halifax, NS, B3H3A7, Canada
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22
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Michels F, Matricali G, Wastyn H, Vereecke E, Stockmans F. A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity. Knee Surg Sports Traumatol Arthrosc 2021; 29:1325-1331. [PMID: 32613335 DOI: 10.1007/s00167-020-06134-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/26/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Anatomical reconstruction of the calcaneofibular ligament (CFL) is a common technique to treat chronic lateral ankle instability. A bone tunnel is used to fix the graft in the calcaneus. The purpose of this study is to provide some recommendations about tunnel entrance and tunnel direction based on anatomical landmarks. METHODS The study consisted of two parts. The first part assessed the lateral tunnel entrance for location and safety. The second part addressed the tunnel direction and safety upon exiting the calcaneum on the medial side. In the first part, 29 specimens were used to locate the anatomical insertion of the CFL based on the intersection of two lines related to the fibular axis and specific landmarks on the lateral malleolus. In the second part, 22 specimens were dissected to determine the position of the neurovascular structures at risk during tunnel drilling. Therefore, a method based on four imaginary squares using external anatomical landmarks was developed. RESULTS For the tunnel entrance on the lateral side, the mean distance to the centre of the CFL footprint was 2.8 ± 3.0 mm (0-10.4 mm). The mean distance between both observers was 4.2 ± 3.2 mm (0-10.3 mm). The mean distance to the sural nerve was 1.4 ± 2 mm (0-5.8 mm). The mean distance to the peroneal tendons was 7.3 ± 3.1 mm (1.2-12.4 mm). For the tunnel exit on the medial side, the two anterior squares always contained the neurovascular bundle. A safe zone without important neurovascular structures was found and corresponded to the two posterior squares. CONCLUSION Lateral landmarks enabled to locate the CFL footprint. Precautions should be taken to protect the nearby sural nerve. A safe zone on the medial side could be determined to guide safe tunnel direction. A calcaneal tunnel should be directed to the posterior inferior medial edge of the calcaneal tuberosity.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium. .,GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France. .,ESSKA-AFAS Ankle Instability Group, Luxembourg, Luxembourg. .,Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium.
| | - Giovanni Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium
| | - Heline Wastyn
- Department Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
| | - Evie Vereecke
- Department Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium.,Department Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
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23
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The Location of the Fibular Tunnel for Anatomically Accurate Reconstruction of the Lateral Ankle Ligament: A Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5575524. [PMID: 33791364 PMCID: PMC7997753 DOI: 10.1155/2021/5575524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/08/2021] [Accepted: 03/09/2021] [Indexed: 11/18/2022]
Abstract
We aimed to describe the location of fibular footprint of each anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), as well as their common origin in relation to bony landmarks of the fibula in order to determine the location of the fibular tunnel. In 105 ankle specimens, the center of the footprints of the ATFL and CFL (cATFL and cCFL, respectively) and the intersection point of their origin (intATFL-CFL) were investigated, and the distances from selected bony landmarks (the articular tip (AT) and the inferior tip (IT) of the fibula) were measured. Forty-two (40%) specimens had single-bundle ATFL, and 63 (60%) had double-bundle patterns. The distance between intATFL-CFL and IT was 12.0 ± 2.5 mm, and a significant difference was observed between the two groups (p = 0.001). Moreover, the ratio of the intATFL-CFL location based on the anterior fibular border for all cadavers was 0.386. The present study suggests a reference ratio that can help surgeons locate the fibular tunnel for a more anatomically accurate reconstruction of the lateral ankle ligament. Also, it may be necessary to make a difference in the location of the fibular tunnel according to the number of ATFL bundles during surgery.
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24
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Iwashita K, Jujo Y, Inokuchi R, Glazebrook M, Stone J, Takao M. Hybrid Ankle Reconstruction of Lateral Ligaments. Arthrosc Tech 2021; 10:e931-e939. [PMID: 33738235 PMCID: PMC7953423 DOI: 10.1016/j.eats.2020.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023] Open
Abstract
Open anatomic reconstruction of the lateral ligament (AntiRoLL) of the ankle with a gracilis Y graft and the inside-out technique are commonly used and have evolved to minimally invasive surgery, including arthroscopic AntiRoLL (A-AntiRoLL) and percutaneous AntiRoLL procedures. A-AntiRoLL allows assessment and treatment of intra-articular pathologies of the ankle concurrently with stabilization. However, the A-AntiRoLL technique is technically demanding, especially in the process of calcaneofibular ligament reconstruction under subtalar arthroscopy. In contrast, the percutaneous AntiRoLL procedure is a simple concept that does not require the skill of an experienced arthroscopist but requires an extra skin incision to assess and treat intra-articular pathologies of the ankle. This study describes the application of a minimally invasive anatomic reconstruction technique-hybrid AntiRoLL-for chronic instability of the ankle that does not require advanced arthroscopic technique to assess and treat intra-articular pathology simultaneously.
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Affiliation(s)
- Kosui Iwashita
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan
| | - Yasuyuki Jujo
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan
| | - Ryota Inokuchi
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax Infirmary, Halifax, Nova Scotia, Canada
| | - James Stone
- Midwest Orthopedic Specialty Hospital, Milwaukee, Wisconsin, U.S.A
| | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Japan,Address correspondence to Masato Takao, M.D., Ph.D., Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.
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25
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Lateral Hind-Foot Endoscopic Anterolateral/Posterolateral (LEAP) Subtalar Arthrodesis: An Effective Minimally Invasive Technique to Achieve Subtalar Fusion and Deformity Correction. Arthrosc Tech 2021; 10:e423-e429. [PMID: 33680775 PMCID: PMC7917142 DOI: 10.1016/j.eats.2020.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023] Open
Abstract
Arthrodesis surgery aims to provide relief for chronic joint pain and correct limb alignment by achieving a stable union between articulating bones. The key factors to achieving sound arthrodesis is adequate debridement of arthritic cartilage and creating well-apposed bleeding subchondral bone surfaces without compromising the surrounding soft tissue envelope. Arthroscopic subtalar arthrodesis is technically demanding but provides better visualization of the articular surfaces and is safer for the surrounding soft tissues compared to the open approach. Early published reports of the arthroscopic subtalar arthrodesis from the lateral sinus tarsi approach and posterior approach have shown promising results with high rates of union and less wound healing complications. However, there are concerns about access to all facets of subtalar joint, nerve injury, and deformity correction. In this technique, the article authors describe the lateral endoscopic anterolateral/posterolateral (LEAP) approach for subtalar arthrodesis to improve visualization and access to all facets of the subtalar joint to ensure adequate preparation of apposing surfaces, sound union, and facilitate deformity correction of hind-foot. Strategic portal placement also avoids injury to sural nerve. This is a safe and effective minimally invasive technique for subtalar arthrodesis.
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26
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Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence. J Am Acad Orthop Surg 2021; 29:3-16. [PMID: 33347006 DOI: 10.5435/jaaos-d-20-00145] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023] Open
Abstract
Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. Current data suggest that accurate assessment of ligament integrity during physical examination requires the ankle to ideally be held in 16° of plantar flexion when performing the anterior drawer test and 18° of dorsiflexion when performing the talar tilt test, respectively. Stress radiographs are limited by their low sensitivity, and MRI is limited by its static nature. Surgically, both arthroscopic and open repair techniques appear biomechanically equivalent in their ability to restore ankle stability, although sufficient evidence is still lacking for any particular procedure to be considered a superior construct. When performing reconstruction, grafts should be tensioned at 10 N and use of nonabsorbable augmentations lacking viscoelastic creep must factor in the potential for overtensioning. Anatomic lateral ligament surgery provides sufficient biomechanical strength to safely enable immediate postoperative weight bearing if lateral ankle stress is neutralized with a boot. Further research and comparative clinical trials will be necessary to define which of these ever-increasing procedural options actually optimizes patient outcome for chronic lateral ankle instability.
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27
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The effectiveness of lateral ankle ligament reconstruction when treating chronic ankle instability: A systematic review and meta-analysis. Injury 2020; 51:1726-1732. [PMID: 32534817 DOI: 10.1016/j.injury.2020.05.031] [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: 02/21/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 02/02/2023]
Abstract
UNLABELLED Chronic ankle instability predominantly occurs due to multiple exercise-related diseases. Conservative treatment methods regarding this condition have not effectively improved in recent years, which is why more focus has been put on exploring different novel reconstruction procedures of the lateral ankle ligament for the treatment of chronic ankle instability. OBJECTIVES This study aims to obtain the overall effectiveness of various lateral ankle ligament reconstruction methods for chronic ankle ligament instability. METHODS We gathered data from PubMed and EMBASE databases using the keywords: ankle, malleolar, and reconstruction. Newcastle - Ottawa quality assessment was carried out for the obtained studies; effect volume combination and image drawing were performed by Stata14, and Excel was used for data statistics. RESULTS A total of 12 articles were included in the quantitative analysis by performing full-text reading and data inclusion. Among them, 476 patients (485 ankle joints) were treated. The results showed that the overall valid efficiency of "excellent" was 59% and "good" lateral ligament reconstruction was 26%, I2=87.3%, P = 0.000; the subgroup analysis anatomic reconstruction group I2=0.0%, P = 0.993; the autograft group I2=0.0%, P = 1.000; allograft group I2=0.0%, P = 0.993. CONCLUSION Reconstruction of the lateral ankle ligament is a relatively stable treatment for chronic ankle instability.
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28
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Arthroscopic Reconstruction of the Anterior Tibiotalar Ligament Using a Free Tendon Graft. Arthrosc Tech 2020; 9:e541-e547. [PMID: 32368476 PMCID: PMC7189568 DOI: 10.1016/j.eats.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/02/2020] [Indexed: 02/03/2023] Open
Abstract
Deltoid ligament injuries account for 5.1% to 15.8% of ankle sprains and occur with concomitant lateral ankle sprains. The anterior tibiotalar ligament (ATTL), located within the deep layer of the deltoid ligament complex, connects the talus and the tibia on the medial side of the ankle and controls ankle eversion and rotation. If conservative treatment for chronic medial ankle instability after an ankle sprain fails, ATTL repair or reconstruction might be necessary. Arthroscopic reconstruction techniques of the lateral ankle ligaments recently have been reported. Here, we describe arthroscopic reconstruction of the ATTL using a free tendon graft (ARATTL). This technique is less invasive than other treatments and results in a more stable medial ankle joint.
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29
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Higashiyama R, Sekiguchi H, Takata K, Endo T, Takaso M. Arthroscopic Reconstruction of the Anterior Talofibular Ligament, Lateral Talocalcaneal Ligament, and Calcaneofibular Ligament Using a Triangle-Shaped Tendon Graft (ALC-Triangle). Arthrosc Tech 2020; 9:e217-e223. [PMID: 32099775 PMCID: PMC7029097 DOI: 10.1016/j.eats.2019.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/30/2019] [Indexed: 02/03/2023] Open
Abstract
The lateral talocalcaneal ligament (LTCL) connects the talus and calcaneus on the lateral side of the hindfoot. Although its function remains has not yet been clearly elucidated, the LTCL is thought to be important for the stabilization of the subtalar joint. Ankle sprains often include not only the talocrural joint but also the subtalar joint; therefore, LTCL injuries occur at a certain rate. Moreover, surgeons often encounter and reluctantly dissect the LTCL during arthroscopic anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) reconstruction because the LTCL connects to the ATFL at the talus in 42% of people and connects to the CFL at the calcaneus in 18% of people. As a result, LTCL reconstruction might be necessary for those patients. We describe the arthroscopic reconstruction technique of the ATFL, LTCL, and CFL using a triangle-shaped tendon graft (ALC-triangle). This technique provides a possible advantage of an anatomical and stable talocrural joint and subtalar joint.
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Affiliation(s)
- Reiji Higashiyama
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Kanagawa, Japan,Address correspondence to Reiji Higashiyama, Department of Orthopaedic Surgery, Shonantobu General Hospital, 500, Nishikubo, Chigasaki, Kanagawa, 253-0083, Japan.
| | - Hiroyuki Sekiguchi
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Kanagawa, Japan
| | - Ken Takata
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Tachio Endo
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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30
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Dalmau-Pastor M, Malagelada F, Kerkhoffs GM, Karlsson J, Guelfi M, Vega J. Redefining anterior ankle arthroscopic anatomy: medial and lateral ankle collateral ligaments are visible through dorsiflexion and non-distraction anterior ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 2020; 28:18-23. [PMID: 31292688 DOI: 10.1007/s00167-019-05603-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/24/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE A thorough understanding of the arthroscopic anatomy is important to recognise pathological conditions. Although some ankle ligaments have been described as intra-articular structures, no studies have assessed the full visibility of these structures. The purpose of this study was to assess arthroscopic visibility of medial and lateral ankle collateral ligaments. METHODS Arthroscopy was performed in 20 fresh frozen ankles. The arthroscope was introduced through the anteromedial portal and the anterior compartment was explored in ankle dorsiflexion without distraction. Intra-articular structures were tagged using a suture-passer introduced percutaneously and they were listed in a table according to the surgeon's identification. After the arthroscopic procedure, the ankles were dissected to identify the suture-tagged structures. RESULTS According to the suture-tagged structures, 100% correlation was found between arthroscopy and dissection. In the anterior compartment, the superior fascicle of the anterior talofibular ligament, the distal fascicle of the anterior tibiofibular ligament and the anterior tibiotalar ligament on the medial side were observed. The deep fascicle of the posterior tibiofibular ligament and the intermalleolar ligament were tagged at the posterior compartment. CONCLUSION Ankle dorsiflexion and non-distraction arthroscopic technique allows full visualisation of the medial and lateral ankle collateral ligaments: the superior fascicle of the anterior talofibular ligament, the distal fascicle of the anterior tibiofibular ligament and the anterior tibiotalar ligament. When using distraction, posterior structures as the deep fascicle of the posterior tibiofibular ligament and the intermalleolar ligament can be observed with anterior arthroscopy.
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Affiliation(s)
- Miki Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain. .,GRECMIP-MIFAS (Groupe de Recherche et d'Étude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France. .,Vilamèdic Medical Center, Santa Coloma de Gramanet, Barcelona, Spain.
| | - 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
| | - G M 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, Göteborg, Sweden
| | - M Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy.,Human Anatomy and Embryology Unit, Department of Morphological Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Vega
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.,GRECMIP-MIFAS (Groupe de Recherche et d'Étude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.,Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
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31
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Dalmau-Pastor M, Malagelada F, Calder J, Manzanares MC, Vega J. The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Knee Surg Sports Traumatol Arthrosc 2020; 28:34-39. [PMID: 31754730 DOI: 10.1007/s00167-019-05794-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE A deep knowledge of lateral ankle ligaments is necessary to understand its function, pathophysiology and treatment options. The ankle lateral collateral ligament is formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL). Although previous studies have reported connections between these ligaments on its lateral side, no studies have specifically assessed connections on the medial side. The aim of this study was to assess the morphology and consistency of the medial connections between the components of the lateral collateral ligament complex of the ankle. METHODS Forty fresh-frozen ankle specimens were dissected to look for connections between the three lateral ankle ligaments. After visualization of the lateral ligaments was achieved, the fibula was amputated and ligament insertions were released at the talar and calcaneal insertion points. Observation of the connections and video analysis of the dynamic relationships of ligament connections were performed. RESULTS Connections were found in all cases between the ATFL and PTFL, the ATFL and CFL, and the CFL and PTFL. Connections between ATFL and PTFL were not homogeneous. Although connections between the ATFLif and PTFL were noted in all cases (40), only 17 ankles (42.5%) had connections between the ATFLsf and PTFL. The amount of fibres of connection was also variable. CONCLUSION Connections between the three components of the lateral collateral ligament of the ankle may be observed from the medial aspect of the ankle, and this may have important implications for arthroscopic lateral ligament repair.
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Affiliation(s)
- M Dalmau-Pastor
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain. .,GRECMIP, MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Minimally Invasive Foot and Ankle Society), Merignac, France. .,Vilamèdic Medical Center, Santa Coloma de Gramanet, Barcelona, Spain.
| | - F Malagelada
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain.,Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - J Calder
- Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK
| | - M C Manzanares
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain
| | - J Vega
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, University of Barcelona, Barcelona, Spain.,GRECMIP, MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied, Minimally Invasive Foot and Ankle Society), Merignac, France.,Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
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32
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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: 29] [Impact Index Per Article: 7.3] [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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33
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Vega J, Malagelada F, Dalmau-Pastor M. Arthroscopic all-inside ATFL and CFL repair is feasible and provides excellent results in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:116-123. [PMID: 31432243 DOI: 10.1007/s00167-019-05676-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 08/09/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Chronic ankle instability has been described as presenting with complete tears of both the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in 20% of cases. Arthroscopic techniques to treat chronic ankle instability are increasingly being reported and in some instances they can be technically demanding. The aim of this study was to describe an arthroscopic all-inside repair of both the ATFL and CFL, and to report the outcomes of a group of patients with chronic ankle instability that underwent the technique. METHODS Twenty-four patients [22 male and 2 female, median age 41 (range 22-56) years] with chronic ankle instability and torn ATFL and CFL were treated arthroscopically after failing non-operative management. Median follow-up was 35 (mean 34.7, and range 18-55) months. Through an arthroscopic all-inside technique, and using a suture passer and two knotless anchors, both fascicles of the ATFL and the CFL were repaired. RESULTS Arthroscopic examination demonstrated ATFL and CFL injuries in all patients. Subjective improvement in their ankle instability was observed postoperatively. The anterior drawer and the talar tilt tests were negative at follow-up. The median AOFAS score increased from 65 (mean 65, range 52-85) preoperatively to 97 (mean 97, range 85-100) at final follow-up. CONCLUSION Chronic ankle instability with concomitant injury of both the ATFL and CFL, can be successfully treated by an arthroscopic all-inside repair. The clinical relevance of the study is the description of the first arthroscopic all-inside ATFL and CFL anatomic repair technique, which offers excellent clinical results and the inherent benefits from minimally invasive surgery. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- 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 Traumatología Clínica Tres Torres, Hospital Quirón Barcelona, Plaza Alfonso Comín 5, 08023, Barcelona, Spain. .,GRECMIP (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied) Soon MIFAS (Minimally Invasive Foot and Ankle Society), Merignac, France.
| | - Francesc Malagelada
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.,Vilamèdic, Santa Coloma de Gramanet, Barcelona, Spain
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Vega J, Montesinos E, Malagelada F, Baduell A, Guelfi M, Dalmau-Pastor M. Arthroscopic all-inside anterior talo-fibular ligament repair with suture augmentation gives excellent results in case of poor ligament tissue remnant quality. Knee Surg Sports Traumatol Arthrosc 2020; 28:100-107. [PMID: 30128684 DOI: 10.1007/s00167-018-5117-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 08/14/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE An increasing role of arthroscopy as the definitive treatment for ankle instability has been reported, and assisted or all-arthroscopic techniques have been developed. However, treatment of chronic ankle instability with poor remnant ligament-tissue quality is still challenging. The aim of this study was to describe the technique and report the results of the arthroscopic ATFL all-inside repair with suture augmentation to treat patients with poor remnant ligament-tissue quality. METHODS Fifteen patients [9 men and 6 women, median age 30 (19-47) years] with chronic ankle instability and poor remnant ligament-tissue quality were treated by arthroscopic means after failing non-operative management. Median follow-up was 18 (12-23) months. Through an arthroscopic all-inside technique, and using a suture passer and two knotless anchors, the ligament was repaired. Then, the anchor's residual suture limbs were not cut, but were recycled and used for augmentation of the ligament repair. RESULTS Arthroscopic examination demonstrated an isolated anterior talofibular ligament (ATFL) injury with poor remnant ligament tissue in the 15 patients. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligaments repair and suture augmentation. The median AOFAS score increased from 66 (44-87) preoperatively to 100 (85-100) at the final follow-up. CONCLUSION Chronic ankle instability with poor remnant ligament-tissue quality can be successfully treated by an arthroscopic all-inside repair and suture augmentation of the ligament. The clinical relevance of the study is the description of the first arthroscopic all-inside anatomic ATFL repair with suture augmentation that offers the benefit of maintaining the native ligament while reinforcing the repair, especially in patients with poor remnant ligament-tissue quality. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- 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, Hospital Quirón Barcelona, and iMove Tres Torres, Barcelona, Spain. .,Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.
| | - Erik Montesinos
- Orthopaedic and Trauma Surgery, Clinique CIC Riviera, Clarens, Vaud, Switzerland
| | - Francesc Malagelada
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Albert Baduell
- Foot and Ankle Unit, Hospital Quirón Barcelona, and iMove Tres Torres, Barcelona, Spain.,Department of Orthopaedic and Traumatology, Hospital of Figueres-Fundació Salut Empordà, Figueres, Girona, Spain
| | - Matteo Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.,Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.,Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain
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Michels F, Matricali G, Guillo S, Vanrietvelde F, Pottel H, Stockmans F. An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL. Knee Surg Sports Traumatol Arthrosc 2020; 28:124-131. [PMID: 31240379 DOI: 10.1007/s00167-019-05583-3] [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: 02/06/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE A bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm-diameter tunnel and surrounding bone. METHODS Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30°, 45°, 60° and 90° in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface. RESULTS A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30° offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm-diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region. CONCLUSION An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend drilling an oblique fibular tunnel when reconstructing the ATFL and CFL.
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Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | - Giovanni Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium
| | - Stephane Guillo
- Orthopaedic Department, Mérignac Sports Clinic, 2, Rue Georges Negrevergne, 33700, Mérignac, France
| | - Frederik Vanrietvelde
- Radiology Department, AZ Groeninge Kortrijk, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care, Catholic University Leuven, Kortrijk, Belgium
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium.,Department of Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
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Malinowski K, Paszkowski J, Góralczyk A, Giza E, Hermanowicz K. Arthroscopic Anatomic Anterior Talofibular Ligament Repair for Anterolateral Ankle Instability. Arthrosc Tech 2019; 9:e29-e33. [PMID: 32021770 PMCID: PMC6993110 DOI: 10.1016/j.eats.2019.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/24/2019] [Indexed: 02/03/2023] Open
Abstract
Ankle instability is due to repetitive inversion injuries and is usually treated conservatively; however, after repeated sprains, chronic instability occurs and usually requires a surgical procedure. Recently, arthroscopic repair of a torn anterior talofibular ligament (ATFL) has become more popular owing to its minimal invasiveness and high efficacy. An all-inside technique allows for anatomic restoration of the injured ATFL, provides stability to the ankle joint, prevents a limitation of ankle range of motion, and may prevent arthritic development. We present an all-inside arthroscopic ATFL repair technique.
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Affiliation(s)
- Konrad Malinowski
- Artromedical Orthopaedic Clinic, Belchatów, Poland, U.S.A.,Address correspondence to Konrad Malinowski, M.D., Ph.D., Artromedical Orthopaedic Clinic, Chrobrego 24, 97-400 Belchatów, Poland.
| | - Jan Paszkowski
- Artromedical Orthopaedic Clinic, Belchatów, Poland, U.S.A
| | | | - Eric Giza
- Department of Orthopaedics, University of California, Davis, Sacramento, California, U.S.A
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Higashiyama R, Sekiguchi H, Takata K, Katagiri A, Inoue G, Takaso M. Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon. Arthrosc Tech 2019; 9:e21-e28. [PMID: 32021769 PMCID: PMC6993106 DOI: 10.1016/j.eats.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/23/2019] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic techniques for anterior talofibular ligament (ATFL) repair and reconstruction have been developed in recent years. We simultaneously performed anatomical arthroscopic ATFL repair and reconstruction using a free tendon graft. The ATFL remnant is carefully dissected only at the footprint of the superior limb of the ATFL, and a bone tunnel is created on each side of the fibula and talus. A soft suture anchor with 2 sets of threads is inserted into the fibular tunnel. One set of threads is used to grab the ATFL remnant via a lasso-loop technique, whereas the other set of threads is used to introduce the ATFL graft. The graft is first fixed with a screw in the talar tunnel. Subsequently, the ATFL remnant and the graft are tightened simultaneously by pulling the 2 sets of suture anchor threads at the fibular tunnel and are fixed with a screw. This technique provides the possible advantages of remnant preservation and promotion of load sharing by the repaired ATFL remnant and the reconstructed ATFL graft.
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Affiliation(s)
- Reiji Higashiyama
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Chigasaki,Address correspondence to Reiji Higashiyama, M.D., Ph.D., Department of Orthopaedic Surgery, Shonantobu General Hospital, 500, Nishikubo, Chigasaki, Kanagawa, 253-0083, Japan.
| | - Hiroyuki Sekiguchi
- Department of Orthopaedic Surgery, Shonantobu General Hospital, Chigasaki
| | - Ken Takata
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara
| | - Akira Katagiri
- Department of Orthopaedic Surgery, Fuji Orthopaedic Surgery Hospital, Fuji, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara
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The distance from the peroneal tendons sheath to the sural nerve at the posterior tip of the fibula decreases from proximal to distal. Knee Surg Sports Traumatol Arthrosc 2019; 27:2852-2857. [PMID: 30888450 DOI: 10.1007/s00167-019-05438-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/22/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of this study is to compare the distance from the peroneal tendons sheath to the sural nerve in different points proximally and distally to the tip of the fibula. METHODS Ten fresh-frozen lower extremities were dissected to expose the nerves and tendons. Having the posterior tip of the fibula as a reference, the distance between the tendons sheath and the sural nerve was measured in each point with a tachometer with three independent different observers. Two measures were taken distally at 1.5 and 2 cm from fibula tip and 3 measures were performed proximally at 2, 3, and 5 cm from fibula tip. Data were described using means, standard deviations, medians, and minimum and maximum values. RESULTS The average distance between distance between the fibula tip and sural nerve is 16.6 ± 4.4 mm. The average distance between peroneal tendons sheath and the sural nerve at 5 cm, 3 cm, and 2 cm from the proximal fibular tip was 29.6 ± 3.2 mm, 24.2 ± 3.6 mm, and 19.7 ± 2.7 mm, respectively. The average distance between the peroneal tendons sheath and the sural nerve at 2 cm and 1.5 cm distal to fibular tip was 9.1 ± 3.5 mm and 7.8 ± 3.3 mm, respectively. CONCLUSION The distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. As the distance between the peroneal tendons sheath and the sural nerve decreases from proximal to distal, performing the tendoscopy portal more distally would increase the risk of nerve iatrogenic injury.
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The distance from the peroneal tendons sheath to the sural nerve at the posterior tip of the fibula decreases from proximal to distal. KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY : OFFICIAL JOURNAL OF THE ESSKA 2019. [PMID: 30888450 DOI: 10.1007/s00167-019-05438-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE The aim of this study is to compare the distance from the peroneal tendons sheath to the sural nerve in different points proximally and distally to the tip of the fibula. METHODS Ten fresh-frozen lower extremities were dissected to expose the nerves and tendons. Having the posterior tip of the fibula as a reference, the distance between the tendons sheath and the sural nerve was measured in each point with a tachometer with three independent different observers. Two measures were taken distally at 1.5 and 2 cm from fibula tip and 3 measures were performed proximally at 2, 3, and 5 cm from fibula tip. Data were described using means, standard deviations, medians, and minimum and maximum values. RESULTS The average distance between distance between the fibula tip and sural nerve is 16.6 ± 4.4 mm. The average distance between peroneal tendons sheath and the sural nerve at 5 cm, 3 cm, and 2 cm from the proximal fibular tip was 29.6 ± 3.2 mm, 24.2 ± 3.6 mm, and 19.7 ± 2.7 mm, respectively. The average distance between the peroneal tendons sheath and the sural nerve at 2 cm and 1.5 cm distal to fibular tip was 9.1 ± 3.5 mm and 7.8 ± 3.3 mm, respectively. CONCLUSION The distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. As the distance between the peroneal tendons sheath and the sural nerve decreases from proximal to distal, performing the tendoscopy portal more distally would increase the risk of nerve iatrogenic injury.
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No Difference between Percutaneous and Arthroscopic Techniques in Identifying the Calcaneal Insertion during Ankle Lateral Ligament Reconstruction: A Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2128960. [PMID: 30834256 PMCID: PMC6375008 DOI: 10.1155/2019/2128960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/07/2019] [Accepted: 01/17/2019] [Indexed: 11/17/2022]
Abstract
Background. Both percutaneous and arthroscopic techniques have been introduced in anatomic ankle lateral ligaments reconstruction. The purpose of this study was to compare these two techniques in identifying the calcaneal insertion of the calcaneofibular ligament (CFL). Methods. Fifteen fresh-frozen human ankle cadaver specimens were used in this study. Each specimen was tested in three stages. For stage 1, each specimen was evaluated under arthroscopy. After debridement was performed, the insertion of the CFL on the calcaneus was identified, and a 1.5mm Kirschner wire was drilled at the center of the insertion. For stage 2, a percutaneous technique was used to identify the center of the insertion of the CFL. A second 1.5 mm Kirschner wire was drilled through the skin marker. For stage 3, the ankle was dissected, the footprint of the CFL was identified under direct vision, and the distances between the center of the CFL insertion on the calcaneus and the two Kirschner wires were measured, respectively. Results. In the arthroscopic technique group, the mean distance from the Kirschner wire to the center of the CFL insertion in the calcaneus was 3.4 ± 1.3 mm. In the percutaneous technique group, the mean distance from the Kirschner wire to the center of the CFL insertion was 3.2 ± 1.4 mm. No significant difference was found between the two groups. Conclusion. No difference in identifying the calcaneal insertion of the CFL was found between the percutaneous and the arthroscopic ankle lateral ligaments reconstruction technique. Both techniques can be used during anatomic ligaments reconstruction in treatment of chronic ankle instability.
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Anatomical Arthroscopic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction Using an Autogenic Hamstring Tendon: Safe Creation of Anatomical Fibular Tunnel. Arthrosc Tech 2019; 8:e215-e222. [PMID: 31016124 PMCID: PMC6470364 DOI: 10.1016/j.eats.2018.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/19/2018] [Indexed: 02/03/2023] Open
Abstract
Ankle sprains are the most common lower extremity injuries associated with sports activity. Although ligament repair techniques are popular, reconstruction methods using free tendons are considered when the ligament remnant is insufficiently strong, when high-demand athletes sustain repeat ankle sprains, or in revision cases after repair. Recently, some arthroscopic reconstruction techniques have been reported. The distal fibular end is thin; therefore, surgeons must be careful while drilling the fibular tunnel. This report indicates the safe creation method of an anatomical fibular tunnel during anatomical arthroscopic reconstruction of the anterior talofibular ligament and calcaneofibular ligament. This also provides a stronger reconstruction using a 2-strand tendon graft for the anterior talofibular ligament substitute, which is thought to have less risk for postoperative graft failure.
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All-inside arthroscopic allograft reconstruction of the anterior talo-fibular ligament using an accesory transfibular portal. Foot Ankle Surg 2019; 25:24-30. [PMID: 29409174 DOI: 10.1016/j.fas.2017.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anatomic graft reconstruction of the anterior talo-fibular ligament is an alternative for patients who are bad candidates for standard procedures such as a Broström-Gould reconstruction (high-demand athletes, obesity, hyperlaxity or collagen disorders, capsular insufficiency or talar avulsions). The purpose of this study is to describe an all-inside arthroscopic technique for ATFL reconstruction, and the results in a series of patients with chronic ankle instability. METHODS We reviewed patients with chronic ATFL ruptures treated with an all-inside arthroscopic allograft reconstruction of the ATFL, with a minimum 2-year follow-up. Twenty-two patients with lateral ankle instability were included. Mean follow-up was 34±2.5 months. RESULTS The mean AOFAS score improved from 62.3±6.7 points preoperatively to 97.2±3.2 points at final follow-up. Three patients suffered complications: one case each of ankle rigidity, superficial peroneal nerve injury and fibular fracture. CONCLUSIONS Chronic ATFL injuries are amenable to all-inside arthroscopic allograft reconstruction fixed with tenodesis screws. This procedure simplifies other reported techniques in that it facilitates identification and bone tunnel placement of the talar ATFL insertion.
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Lee DW, Park IK, Kim MJ, Kim WJ, Kwon MS, Kang SJ, Kim JG, Yi Y. Three-Dimensional computed tomography tunnel assessment of allograft anatomic reconstruction in chronic ankle instability: 33 cases. Orthop Traumatol Surg Res 2019; 105:145-152. [PMID: 30502025 DOI: 10.1016/j.otsr.2018.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although clinical results of anatomic reconstruction using allograft are reportedly good, studies on how accurately the tunnel has been made after surgery are very rare. The purpose of this study was to analyze the postoperative locations of the tunnels through 3-dimensional computed tomography (3D-CT) after anatomic ligament reconstruction and to evaluate its clinical results. HYPOTHESIS We hypothesized that anatomic lateral ligament reconstruction could lead to excellent results in clinical outcomes by repositioning anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) accurately. MATERIALS AND METHODS Thirty-three special forces of soldiers who were diagnosed as chronic ankle instability (CAI) were included. Visual analogue scale (VAS), American orthopaedic foot and ankle society (AOFAS) ankle-hind foot functional scores, and Tegner activity scale were comparatively analyzed before the surgery and at final follow-up. The locations of the talar, fibular and calcaneal tunnels were evaluated with 3D-CT taken after the surgery. Talar tilt and anterior drawer displacement were measured on stress radiographs. RESULTS The mean follow-up period was 26.8±3.6 months. The VAS decreased from 6.9±1.6 to 1.7±1.3, AOFAS ankle-hindfoot functional score increased from 61.3±14.8 to 88.7±9.2, and Tegner activity scale improved from 5.3±1.2 to 6.4±1.3 (p<0.001). Talar tunnel for ATFL was located about68% of the way from the lateral talar process, and fibular tunnels for ATFL and CFL were approximately 52% and 20% of the way from the fibular tip. The calcaneus tunnel was approximately 17mm posterosuperior from the peroneal tubercle on 3D-CT. Talar tilt decreased from 15.8±4.8 to 3.9±2.1 degrees (p<0.001). There were excellent inter-observer agreements for CT evaluation (Kappa values were from 0.83 to 0.92). There was no relapse of lateral instability. DISCUSSION Anatomic reconstruction of the lateral ligaments using allograft and the interference screw for CAI showed good results in postoperative stability and subjective clinical evaluation by repositioning the location of ATFL and CFL accurately on radiological determination. LEVEL OF EVIDENCE IV, Case-series.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopedic Surgery, KonKuk University Medical Center, Seoul, Korea
| | - In Keun Park
- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Min Jeong Kim
- Department of Radiology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Woo Jong Kim
- Department of Orthopedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Min Soo Kwon
- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Sung Jin Kang
- Department of Orthopedic Surgery, KonKuk University Medical Center, Seoul, Korea
| | - Jin Goo Kim
- Department of Orthopedic Surgery, KonKuk University Medical Center, Seoul, Korea
| | - Young Yi
- Department of Orthopedic Surgery, Inje University Seoul Paik Hospital, Seoul, Korea.
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Glazebrook M, Eid M, Alhadhoud M, Stone J, Matsui K, Takao M. Percutaneous Ankle Reconstruction of Lateral Ligaments. Foot Ankle Clin 2018; 23:581-592. [PMID: 30414654 DOI: 10.1016/j.fcl.2018.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Chronic ankle instability following ankle sprains causes pain and functional problems such as recurrent giving way. Within the 3 ligaments of the lateral ligament complex, 80% of patients tear the anterior talofibular ligament (ATFL), whereas the other 20% of patients tear the ATFL and calcaneofibular ligament (CFL). Rarely, the posterior talofibular ligament is involved. An incidence of 10% to 30% of patients will fail conservative treatment and result in chronic ankle instability that may require surgical treatment. To date, numerous open surgical procedures for anatomic repair or reconstruction of ATFL and/or CFL provide good clinical results.
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Affiliation(s)
- Mark Glazebrook
- Division of Orthopedic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, Room 4867, Halifax Infirmary, 1796 Summer Street, B3H3A7, Halifax, Nova Scotia B3H 3A6, Canada.
| | - Mohammad Eid
- Division of Orthopedic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, Room 4867, Halifax Infirmary, 1796 Summer Street, B3H3A7, Halifax, Nova Scotia B3H 3A6, Canada
| | - Meshal Alhadhoud
- Division of Orthopedic Surgery, Department of Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center, Room 4867, Halifax Infirmary, 1796 Summer Street, B3H3A7, Halifax, Nova Scotia B3H 3A6, Canada
| | - James Stone
- Orthopedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kentaro Matsui
- Department of Orthopaedic surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo 173-8605, Japan
| | - Masato Takao
- Department of Orthopaedic Surgery, Teikyo Institute of Sports Science & Medicine, Tokyo, Japan; Department of Sport and Medical Science, Teikyo Institute of Sports Science & Medicine, Tokyo, Japan
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Thès A, Odagiri H, Elkaïm M, Lopes R, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Boniface O, Guillo S, Bauer T. Arthroscopic classification of chronic anterior talo-fibular ligament lesions in chronic ankle instability. Orthop Traumatol Surg Res 2018; 104:S207-S211. [PMID: 30243676 DOI: 10.1016/j.otsr.2018.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The surgical treatment of chronic ankle instability (CAI) relies chiefly on anterior talo-fibular ligament (ATFL) repair (with or without augmentation) or anatomical reconstruction with a tendon graft. Arthroscopy enables not only a complete assessment and the same-stage treatment of concomitant articular lesions, but also an accurate assessment of ligament lesions. Pre-operative imaging studies (MRI, CT, US) may fail to provide sufficient detail about chronic ATFL lesions to guide the decision between repair and reconstruction. The aim of this study was to develop an arthroscopic classification of chronic ATFL lesions designed to assist in selecting the optimal surgical technique. MATERIAL AND METHODS Sixty-nine anterior ankle arthroscopy videos recorded before surgery for CAI were studied retrospectively. ATFL dissection was performed in all patients. Based on the video analysis, five ATFL grades were identified: 0, normal ATFL thickness and tension; 1, ATFL distension with normal thickness; 2, ATFL avulsion with normal thickness; 3, thin ATFL with no resistance during the hook test; and 4, no ATFL, with a bald malleolus. Intra- and interobserver reproducibility of the arthroscopic classification of chronic ATFL lesions was evaluated by computing the kappa coefficients (κ) after assessment by two independent observers. RESULTS All 69 ATFLs were classified as abnormal (none was grade 0). Each ATFL could be matched to a grade. Intra-observer agreement was good for both observers: κ was 0.67 with 75% of agreement for one observer and 0.68 with 76% of agreement for the other observer. Inter-observer agreement was fair to good, with κ values ranging from 0.59 to 0.88 and agreement from 70% to 91%. DISCUSSION Arthroscopic ATFL dissection is a simple procedure that provides a highly accurate assessment of ATFL lesions and mechanical resistance, focussing chiefly on the superior ATFL. Grade 1 and 2 lesions can be repaired using the Broström-Gould procedure, whereas grade 3 and 4 lesions require anatomic reconstruction with grafting. CONCLUSION This arthroscopic classification of chronic ATFL lesions confirms the diagnostic role for arthroscopy in assessing the ligaments in patients with CAI. It is helpful for determining the best surgical technique for stabilising the ankle. These results must be confirmed in a larger study.
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Affiliation(s)
- André Thès
- Service de chirurgie orthopédique et traumatologique, groupe hospitalier universitaire Paris Ile-de-France Ouest, AP-HP, CHU Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France; Hôpital privé d'Eure et Loir, 2, rue Roland Buthier, 28300 Mainvilliers, France
| | - Haruki Odagiri
- Department of Orthopedic Surgery, Hotakubo Orthopedic Hospital, 862-0929 Hotakubo, Higashi-Ku, Kumamoto, Japan
| | - Marc Elkaïm
- Clinique de Tournan, 2, rue Jules-Lefebvre, 77220 Tournan-en-Brie, France
| | - Ronny Lopes
- PCNA, Polyclinique de l'Atlantique, avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Michael Andrieu
- Clinique Pont de Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France
| | - Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - François Molinier
- Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France
| | - Jonathan Benoist
- CHP Saint Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis Mouillard, 66000 Perpignan, France
| | - Olivier Boniface
- Clinique Générale Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France
| | - Stéphane Guillo
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, groupe hospitalier universitaire Paris Ile-de-France Ouest, AP-HP, CHU Ambroise Paré, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
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- 15 rue Ampère, 92500 Rueil-Malmaison, France
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Abstract
Inversion ankle sprains represent one of the most common traumatic injuries in the active sports population. Although most respond well to conservative treatment, some hide important lesions. Lateral ankle ligament injuries occur in more than 80% of all ankle sprains, with one-third of these developing chronic ankle instability (CAI). Lateral ankle ligament repair or reconstruction procedures aim to restore normal ankle anatomy and function in patients with CAI. Arthroscopic reconstruction techniques allow the surgeon to reach surgery objectives with minimal soft tissue injury. When the indications and surgical steps are respected, this arthroscopic technique seems to be safe and reproducible.
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Affiliation(s)
- João Teixeira
- Departament of Orthopaedics and Traumatology, Centro Hospitalar de Entre o Douro e Vouga, rua Dr. Cândido de Pinho, Santa Maria da Feira 4520-211, Portugal
| | - Stephane Guillo
- Clinique du Sport, 2 rue Negrevergne, Bordeuax-Mérignac 33700, France.
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All arthroscopic remnant-preserving reconstruction of the lateral ligaments of the ankle: A biomechanical study and clinical application. Biochem Biophys Res Commun 2018; 505:985-990. [DOI: 10.1016/j.bbrc.2018.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/29/2022]
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Vega J, Guelfi M, Malagelada F, Peña F, Dalmau-Pastor M. Arthroscopic All-Inside Anterior Talofibular Ligament Repair Through a Three-Portal and No-Ankle-Distraction Technique. JBJS Essent Surg Tech 2018; 8:e25. [PMID: 30588370 DOI: 10.2106/jbjs.st.18.00026] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Ankle instability is a common consequence of ankle sprains. Injury of the anterior talofibular ligament (ATFL) is the most common cause of ankle instability1. Arthroscopic treatment of ankle instability is an emerging field attracting increased interest among surgeons2-10. The arthroscopic all-inside ATFL repair allows the surgeon to explore the ankle joint, treat concomitant pathology when encountered, and reattach the injured ATFL to its fibular anatomical location. The aim of this article is to describe the arthroscopic all-inside ATFL repair through a 3-portal no-ankle-distraction technique. Description After patient positioning, anteromedial and anterolateral portals are created. An accessory anterolateral portal is created just anterior to the fibula and about 1 cm proximal to the tip of the lateral malleolus. The arthroscope is introduced through the anteromedial portal, and the instruments are introduced through the anterolateral portal. Recognition of the ligament and evaluation of the ligament tear with a probe are required. The footprint for the fibular attachment of the ATFL is debrided. The ligament is penetrated with a suture passer. A nitinol loop is pushed and then is pulled out through the accessory portal. The nitinol wire is replaced by a double high-resistance suture. The limbs of the suture located in the accessory portal are passed through the anterolateral portal. Next, one or both limbs of the suture are passed through the loop suture. Pulling of the suture limbs introduces the loop into the joint and the ligament is grasped by the suture. The tunnel for the anchor is drilled. The knotless anchor is loaded with the suture, and the anchor and suture are introduced with the ankle in dorsiflexion and valgus. Postoperatively, the ankle is immobilized with a removable walking boot for 4 weeks. Once use of the walking boot is discontinued, physical therapy is started. Alternatives Nonoperative treatment with physiotherapy or sports restriction can be an alternative for patients with surgical contraindications or as a first step of treatment. Open techniques (repair or reconstruction) or other arthroscopic-assisted techniques (arthroscopic introduction of anchors and percutaneous passage of sutures, or arthroscopic-assisted reconstruction) are possible surgical alternatives to the described technique to treat ankle instability. Rationale The described technique has the advantage of being done with a minimally invasive approach and providing an anatomical repair of the ligament. Concomitant intra-articular pathology can be addressed during the procedure through the same arthroscopic approaches. Early rehabilitation and the lack of intra-articular knots are additional benefits of the technique.
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Affiliation(s)
- 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, Hospital Quirón Barcelona and iMove Tres Torres, Barcelona, Spain.,Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France
| | - Matteo Guelfi
- Orthopaedic and Traumatology Unit, Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Chieti, Italy
| | - Francesc Malagelada
- Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Fernando Peña
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain.,Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied (GRECMIP), Merignac, France.,Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain
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Endoscopic Harvest of Autogenous Gracilis and Semitendinosus Tendons. Arthrosc Tech 2018; 7:e1019-e1024. [PMID: 30377581 PMCID: PMC6203230 DOI: 10.1016/j.eats.2018.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 06/18/2018] [Indexed: 02/03/2023] Open
Abstract
The hamstring autograft is one of the most popular grafts for anterior cruciate ligament (ACL) reconstruction. Although many techniques for arthroscopic ACL reconstruction using hamstring autografts have been invented, hamstring harvest techniques have not been focused. Hamstrings are harvested using an open technique that requires a 2- to 5-cm skin incision. In this Technical Note, we describe an endoscopic harvest technique of autogenous gracilis and semitendinosus tendon. This technique needs only a 1- to 1.5-cm skin incision and provides surgeons a sufficient view to safely harvest the hamstrings.
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Roward Z, Latt LD. Fracture Through a Distal Fibular Tunnel Used for an Anatomic Lateral Ankle Ligament Reconstruction. FOOT & ANKLE ORTHOPAEDICS 2018. [DOI: 10.1177/2473011418763593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has become a popular technique for revision reconstruction of the lateral ankle ligaments. With the procedure’s burgeoning popularity, an accompanying increase in postoperative complications is likely to occur. We report on one such complication: traumatic distal fibula fracture through the transosseous tunnels.
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Affiliation(s)
- Zachary Roward
- Department of Orthopaedic Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ, USA
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