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Guyonnet C, Vieira TD, Wackenheim FL, Lopes R. Arthroscopic Modified Broström Repair with Suture-Tape Augmentation of the Calcaneofibular Ligament for Lateral Ankle Instability. Arthrosc Tech 2024; 13:102887. [PMID: 38584641 PMCID: PMC10995735 DOI: 10.1016/j.eats.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/04/2023] [Indexed: 04/09/2024] Open
Abstract
Surgical repair of acute or chronic lateral instability of the ankle may be unsuccessful in the presence of associated anterior fibulotalar ligament (AFTL) and calcaneofibular ligament (CFL) injury. This Technical Note presents an arthroscopic double-row repair technique of the AFTL associated with suture tape augmentation of the CFL. The patient is in the supine position with the ankle hanging over the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon, and the anterolateral portal is created under arthroscopic control. The ATFL is released from the capsule with a beaver blade. The calcaneal tunnel is created percutaneously at the footprint of the CFL. A soft anchor is impacted at the tip of the lateral malleolus with thread and tape. With the foot in the neutral position, the tape is then passed into the calcaneal tunnel and attached with an interference screw to strengthen the CFL. The ATFL is grasped with a Mini-Scorpion suture passer and pressed against the anchor with the foot in neutral position. A knotless anchor is impacted 5 mm above with the threads of the soft anchor, creating double-row fixation. This technique is indicated in proximal tears of the AFTL associated with a stretched CFL.
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Affiliation(s)
- Clément Guyonnet
- Institut Médical Pérignat, Pérignat-lès-Sarliève, France
- Hôpital Privé la Châtaigneraie, Beaumont, France
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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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Usuelli FG, Montagna A, Sangaletti R, Indino C, Maccario C, Grassi FA. Minimally Invasive Reconstruction of the Ankle Lateral Ligament Complex in Chronic Ankle Instability: Clinical Outcomes, Return to Sport and Recurrence Rate at Minimum Follow up of 5 Years. APPLIED SCIENCES 2023; 13:7923. [DOI: 10.3390/app13137923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Chronic ankle instability is a common condition that develops after lateral ankle sprains. Many surgical techniques have been described in case of failure of conservative treatment. The purpose of this paper is to present the results in terms of clinical outcomes, return to sport and recurrence rate after reconstruction of the lateral ligament complex of the ankle with a minimally invasive approach at a minimum follow up of five years. Methods: This retrospective study involved forty-seven patients treated for chronic ankle instability from January 2013 to November 2017. The clinical outcomes were evaluated with the American Orthopedic Foot and Ankle Society ankle and hindfoot score (AOFAS score), the University of California–Los Angeles Rating Scale (UCLA Rating Scale), the Karlsson–Peterson ankle instability score and the Halasi scale at a mean follow up time of 80 months. Results: The mean age of the patients was 42 years (23–63). The mean VAS pain score decreased from 5.6 (2–9) pre-operatively to 0.7 (0–7) post-operatively. The mean UCLA Rating Scale score improved from 7.7 (4–8) before surgical treatment to 9.2 (6–10) afterwards. The AOFAS score increased from a pre-operative mean value of 66.5 (40–95) to a post-operative mean value of 94 (88–100) and the Halasi scale from a pre-injury mean value of 4.3 (2–8) to 4.5 post-operatively (2–8). The mean Karlsson–Peterson ankle instability score increased from 71 (40–90) pre-operatively to 87.9 (70–90) post-operatively. During this period of follow up, the procedure survival rate was 95.7%, with two cases of recurrence of ankle sprain post-operatively after twelve months in one case and forty months in the other case. Conclusions: The described technique of reconstruction of the anterior talofibular and calcaneofibular ligament with a minimally invasive approach with a semitendinosus autograft is a viable treatment option for chronic ankle instability and enables the majority of patients to regain their activity and sport level with a low recurrence rate at a mid-term follow up.
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Affiliation(s)
| | - Alice Montagna
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124 Brescia, Italy
| | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Camilla Maccario
- Ankle and Foot Unit, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Federico Alberto Grassi
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Ghasemi SA, Murray BC, Lipphardt M, Yin C, Shaffer G, Raphael J, Vaupel Z, Fortin P. Accuracy of radiographic techniques in detection of the calcaneofibular ligament calcaneal insertion for lateral ankle ligament complex surgery. Surg Radiol Anat 2023:10.1007/s00276-023-03162-3. [PMID: 37198438 DOI: 10.1007/s00276-023-03162-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Grade III ankle sprains that fail conservative treatment can require surgical management. Anatomic procedures have been shown to properly restore joint mechanics, and precise localization of insertion sites of the lateral ankle complex ligaments can be determined through radiographic techniques. Ideally, radiographic techniques that are easily reproducible intraoperatively will lead to a consistently well-placed CFL reconstruction in lateral ankle ligament surgery. PURPOSE To determine the most accurate method to locate the calcaneofibular ligament (CFL) insertion radiographically. METHODS MRIs of 25 ankles were utilized to identify the "true" insertion of the CFL. Distances between the true insertion and three bony landmarks were measured. Three proposed methods (Best, Lopes, and Taser) for determining the CFL insertion were applied to lateral ankle radiographs. X and Y coordinate distances were measured from the insertion found on each proposed method to the three bony landmarks: the most superior point of the postero-superior surface of the calcaneus, the posterior most aspect of the sinus tarsi, and the distal tip of the fibula. X and Y distances were compared to the true insertion found on MRI. All measurements were made using a picture archiving and communication system. The average, standard deviation, minimum, and maximum were obtained. Statistical analysis was performed using repeated measures ANOVA, and a post hoc analysis was performed with the Bonferroni test. RESULTS The Best and Taser techniques were found to be closest to the true CFL insertion when combining X and Y distances. For distance in the X direction, there was no significant difference between techniques (P = 0.264). For distance in the Y direction, there was a significant difference between techniques (P = 0.015). For distance in the combined XY direction, there was a significant difference between techniques (P = 0.001). The CFL insertion as determined by the Best method was significantly closer to the true insertion compared to the Lopes method in the Y (P = 0.042) and XY (P = 0.004) directions. The CFL insertion as determined by the Taser method was significantly closer to the true insertion compared to the Lopes method in the XY direction (P = 0.017). There was no significant difference between the Best and Taser methods. CONCLUSION If the Best and Taser techniques can be readily used in the operating room, they would likely prove the most reliable for finding the true CFL insertion.
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Affiliation(s)
- S Ali Ghasemi
- Department of Orthopaedic Surgery, Albert Einstein Healthcare Network, Philadelphia, PA, USA.
| | | | - Matthew Lipphardt
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Clark Yin
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Gene Shaffer
- Department of Orthopaedic Surgery, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - James Raphael
- Department of Orthopaedic Surgery, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Zachary Vaupel
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, MI, USA
| | - Paul Fortin
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, MI, USA
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Puri A. Lateral ankle instability - repair/ reconstruct what's new. J Orthop Surg (Hong Kong) 2023; 31:10225536231182348. [PMID: 37449536 DOI: 10.1177/10225536231182348] [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: 07/18/2023] Open
Abstract
Lateral ankle instability is a common condition which responds well to non-surgical management. However, the chronic symptomatic instability may require surgical intervention. The acceptable and practiced procedure is the Brostom Gould modification and it has a high patient satisfaction score. However, the current understanding and newer techniques for stabilising the lateral ligament complex has resulted in arthroscopic repairs, augmentation and tendon graft reconstructions. The literature does not provide an answer to the efficacy of these new techniques but there is some preliminary information favouring some of the latest procedures. It is now accepted practise to include ankle arthroscopy as a pre repair step. Augmentation of anatomical repair is also favoured in a select group of patients. This article provides an up to date account of the newer techniques for lateral ankle stabilisation.
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Affiliation(s)
- Arvind Puri
- Department of Orthopaedics, Cairns Hospital, Queensland, Australia
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Zhang Y, Wang X, Wang X, Cao J, Wang H, Zhang F. Allogeneic tendons in the treatment of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability. BMC Musculoskelet Disord 2023; 24:273. [PMID: 37038121 PMCID: PMC10084655 DOI: 10.1186/s12891-023-06390-1] [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: 08/13/2022] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The aim of this study is to report our institution's experience regarding the application of allogeneic tendons for the reconstruction of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability. METHODS This retrospective study included 34 (34 ankles) patients surgically treated for malunited lateral malleolar avulsion fractures with chronic lateral ankle instability from January 2016 to December 2019. All patients underwent allogeneic tendon reconstruction. The pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores、Karlsson Ankle Functional Scores (KAFS) and visual analogue scale (VAS) scores were used to evaluate the functional recovery of the ankle joint. The final follow-up, based on radiographic assessment, including talar tilt and anterior talar translation, was performed to evaluate the stability of the postoperative ankle joints. RESULTS Thirty-two patients (32 ankles) returned for final clinical and radiologic follow-up at an average of 29 (range 24-35) months and 2 patients (2 ankles) were lost to follow-up. The preoperative talus inclination angle (13.6 ± 1.9°) and anterior displacement (9.6 ± 2.8 mm) were re-examined under X-ray and found to be reduced to 3.4 ± 1.2° and 3.8 ± 1.1 mm, respectively (p<0.01). The AOFAS scores increased from 58.5 ± 4.0 to 90.9 ± 3.8 and the Karlsson scores improved from 52.2 ± 3.6 to 89.8 ± 4.5, which was obviously better and the difference was statistically significant (P < 0.01). The VAS scores were significantly reduced from a preoperative mean of 6.8 ± 1.0 to 2.8 ± 0.9 postoperatively (p<0.01). CONCLUSION In this population and with this follow-up, the application of allogeneic tendons to treat malunited lateral malleolar avulsion fractures combined with chronic lateral ankle instability appeared safe and effective.
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Affiliation(s)
- Yu Zhang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xin Wang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xiaomeng Wang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Jianming Cao
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Huijuan Wang
- Department of Histology and Embryology, Hebei Medical University, Shijiazhuang, 050017, Hebei, China
| | - Fengqi Zhang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Dallman J, Wolf MR, Campbell T, Herda T, White J, Tarakemeh A, Vopat BG. Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review. Am J Sports Med 2023:3635465231153165. [PMID: 36917833 DOI: 10.1177/03635465231153165] [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: 03/16/2023]
Abstract
BACKGROUND "Failure" is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability has not been established by clinicians and researchers. PURPOSE To identify the definitions of ankle instability treatment failure that are currently in the literature and to work toward the standardization of the definition. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search of MEDLINE, SPORTDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for LAI and included information about surgical failure. Studies with level of evidence 1 to 4 were included in this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinions were excluded. The included studies were then reviewed for definitions of failure of any surgical procedure that was performed to correct LAI. RESULTS Of the 1200 studies found, 3.5% (42/1200) published between 1984 and 2021 met the inclusion criteria and were analyzed. After reviewing the data, we found numerous definitions were reported in the literature for LAI surgical failure. The most common was recurrent instability (40% [17/42]), followed by rerupture (19% [8/42]). For the original surgical procedure, the anatomic Broström-Gould technique was used most frequently (57% [24/42]). The failure rate of the Broström-Gould technique ranged from 1.1% to 45.2% depending on the definition of failure. CONCLUSION There were multiple definitions of failure for the surgical treatment of LAI, which is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. This definition should include specific, objective physical examination findings that eliminate the ambiguity surrounding failure.
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Affiliation(s)
| | - Megan R Wolf
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Tanner Campbell
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Trent Herda
- Neuromechanics Laboratory, Department of Health, Sport & Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
| | - Jacob White
- Dykes Library, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan G Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Schlickewei C, Krähenbühl N, Rolvien T, Stürznickel J, Yarar-Schlickewei S, DeKeyser G, Frosch KH, Barg A. Surgical outcome of avulsion fractures of the distal fibula: a systematic literature review. Arch Orthop Trauma Surg 2023; 143:1275-1291. [PMID: 34820695 DOI: 10.1007/s00402-021-04256-6] [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: 09/15/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To provide a systematic overview of clinical and radiographic outcomes in patients who underwent surgical treatment of a painful avulsion fragment of the distal fibula also known as posttraumatic os subfibulare. METHODS A systematic literature search across two major sources (PubMed and Scopus) was performed. Twenty-seven studies were included and analyzed using the modified Coleman score to assess the methodologic quality. RESULTS The surgical treatment of symptomatic os subfibulare, with or without concomitant ankle instability, generally results in substantial improvement in clinical and radiographic outcomes with relative low complication rates. Clinical outcome measures may not be affected by the presence of ankle instability or by the fragment size. The methodological quality of analyzed studies was satisfactory. CONCLUSION Posttraumatic os subfibulare may result in chronic pain and ankle instability. If surgery is indicated, ankle instability should be concomitantly addressed when present. Based on available literature, satisfactory postoperative outcomes can be reliably expected following surgical treatment. LEVEL OF EVIDENCE Systematic Review of Level III and Level IV Studies, Level IV.
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Affiliation(s)
- Carsten Schlickewei
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Nicola Krähenbühl
- Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Julian Stürznickel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Sinef Yarar-Schlickewei
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Graham DeKeyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Alexej Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
- Department of Trauma and Orthopaedic Surgery, BG Hospital Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Germany.
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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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Yaka H, Özer M, Türkmen F, Demirel A, Kanatli U. The Relationship Between Fibular Notch Anatomy and ATFL Rupture. J Foot Ankle Surg 2023:S1067-2516(23)00034-0. [PMID: 36941139 DOI: 10.1053/j.jfas.2023.02.004] [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] [Received: 07/23/2022] [Revised: 11/27/2022] [Accepted: 02/02/2023] [Indexed: 03/23/2023]
Abstract
The anterior talofibular ligament (ATFL) is the first to be damaged during a lateral ankle sprain. Dynamic and static structures have been investigated to better understand ATFL rupture, but the predisposing factors have not been fully elucidated. This study aims to define the fibular notch version that can evaluate the position of the fibular notch relative to the tibia and investigate the relationship between the fibular notch version (FNV) and ATFL rupture. This study included 71 patients with isolated ATFL rupture diagnosed clinically and radiologically and 71 control patients without any foot or ankle pathologies. Anterior facet length (AFL), posterior facet length (PFL), anterior-posterior facet angle (APFA), fibular notch depth (ND), and FNV measurements were performed on axial magnetic resonance images (MRI). We defined FNV as a parameter that evaluates the fibular notch's relative position to the distal tibia. The mean FNV was 16.6° ± 4.9° in patients with ATFL rupture and 12.4° ± 5.6° in the control group; when both groups were compared, FNV measurements were significantly higher in patients with ATFL rupture (p = .002). The mean APFA was 123.9° ± 10° in the group with ATFL rupture and 129.7° ± 7.8° in the control group. When both groups were compared, APFA was significantly lower in patients with ATFL rupture (p = .014). There was no significant difference between the groups regarding AFL, PFL, and ND. A more posterior (retroverted) fibular notch and a lower fibular notch angle seem to be associated with higher rates of ATFL rupture.
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Affiliation(s)
- Haluk Yaka
- Department of Orthopaedics & Traumatology, Konya City Hospital, Konya, Turkey.
| | - Mustafa Özer
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Faik Türkmen
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Ahmet Demirel
- Department of Orthopaedics & Traumatology, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics & Traumatology, Gazi University School of Medicine, Ankara, Turkey
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Joo Y, Moon J, Huh B, Lee GK, Cho HR, Kang KN, Lee S, Kim YU. Diagnostic value of the posterior talofibular ligament area for chronic lateral ankle instability. Medicine (Baltimore) 2023; 102:e32827. [PMID: 36749279 PMCID: PMC9901951 DOI: 10.1097/md.0000000000032827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
An injured posterior talofibular ligament (PTFL) is one of the reasons for chronic lateral ankle instability (CLAI). Previous researches have demonstrated that the PTFL thickness (PTFLT) is associated with chronic ligament injuries. However, ligament hypertrophy is different from ligament thickness. Thus, we created the PTFL cross-sectional area (PTFLCSA) as a diagnostic image parameter to assess the hypertrophy of the whole PTFL. We assumed that the PTFLCSA is a key morphological diagnostic parameter in CLAI. PTFL data were obtained from 15 subjects with CLAI and from 16 normal individuals. The T1-weighted axial ankle-MR (A-MR) images were acquired at the level of PTFL. We measured the PTFLT and PTFLCSA at the posterior aspect of the ankle using our imaging analysis program. The PTFLT was measured as the thickness between point of anterior and posterior fiber of PTFL. The PTFLCSA was calculated as the whole cross-sectional PTFL area. The average PTFLT was 3.43 ± 0.52 mm in the healthy group and 4.89 ± 0.80 mm in the CLAI group. The mean PTFLCSA was 41.06 ± 12.18 mm 2 in the healthy group and 80.41 ± 19.14 mm 2 in the CLAI group. CLAI patients had significantly greater PTFLT ( P < .001) and PTFLCSA ( P < .001) than the healthy group. A receiver operating characteristic curve analysis demonstrated that the optimal cutoff score of the PTFLT was 4.19 mm, with 93.3% sensitivity, 93.7% specificity, and an area under the curve of 0.97. The most suitable cutoff value of the PTFLCSA was 61.15 mm 2 , with 93.3% sensitivity, 100% specificity, and area under the curve of 0.99. Even though the PTFLT and PTFLCSA were both significantly associated with CLAI, the PTFLCSA was a more exact morphological measurement parameter.
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Affiliation(s)
- Young Joo
- Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University, Goyang, Republic of Korea
| | - JeeYoun Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Republic of Korea
| | - Billy Huh
- Department of Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Geung Kyu Lee
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Hyung Rae Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Keum Nae Kang
- Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea
| | - Sooho Lee
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
- * Correspondence: Young Uk Kim, Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Simgokro, 100 Gil 25, Seo-Gu, Incheon City 22711, Republic of Korea (e-mail: )
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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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13
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Preoperative Lymphocyte-to-Monocyte Ratio Can Indicate the Outcomes in Repair of I-III Degree Injury of Lateral Ankle Ligament. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6234561. [PMID: 35496050 PMCID: PMC9042596 DOI: 10.1155/2022/6234561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
Background. This study is aimed at exploring the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR), an index of systemic inflammation before operation, in ankle lateral ligament repair (ALLR). Methods. A total of 213 I-III degrees injuries of lateral ankle ligament patients received ALLR and were followed up for more than 2 years. Univariate and multivariable linear regression analysis was used to determine the relationship between preoperative LMR and postoperative recovery. The evaluations of postoperative recovery include American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson-Peter ankle score (KPAS), Cumberland Ankle Instability Tool (CAIT) score, Visual Analog Scale (VAS) score, and range of motion (ROM). The prognostic value of preoperative LMR was measured by receiver operating characteristic (ROC) curve. Results. 178 patients (178 ankles) were followed up successfully, with a follow-up of
years. Overall, the mean AOFAS, KPAS, CAIT and VAS scores, and ankle varus angle were significantly improved at the final follow-up. Univariate and multiple linear regression analysis showed that preoperative LMR was the only independent factor associated with postoperative function, ROM, and pain. The preoperative LMR of patients with poor recovery was significantly lower than that of patients with good recovery. Based on the ROC analysis, the cutoff value of preoperative LMR was 3.824. The clinical outcomes of patients with
were significantly lower than that of patients with
. The corresponding specificity and sensitivity were 84.6% and 71.4%. Conclusion. The clinical outcomes of open or arthroscopic repair for ATFL injury are satisfactory. As a marker of systemic inflammation, preoperative LMR can be used as a prognostic indicator for ALLR.
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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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15
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Wei S, Fan D, Han F, Tang M, Kong C, Xu F, Cai X. Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment. BMC Musculoskelet Disord 2021; 22:289. [PMID: 33736616 PMCID: PMC7977304 DOI: 10.1186/s12891-021-04165-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Minimally invasive reconstruction techniques are used for anatomical ligament construction of the lateral collateral ligament complex of the ankle, but the two key elements, the bone tunnel and the appropriate graft tension, for the identification of the anatomic location during the surgery are not clearly stated. Methods The patients with chronic ankle instability who received arthroscopic anatomic lateral ligament complex reconstruction were retrospectively analyzed. The anatomical location of the bone tunnel was performed under arthroscopy combined with fluoroscopy for accurate location of the bone tunnel entrance. The graft tension and routing were controlled under arthroscopic visualization. The clinical outcomes were assessed using the Karlsson-Peterson score, Sefton articular stability scale, and Visual Analogue Scale (VAS). The complications were recorded during the follow-up. Results A total of 18 patients were enrolled in this study. The mean follow-up was 33.33 ± 3.69 (range from 24 to 36) months. No patient had recurrence of ankle instability after the operation. According to the Sefton articular stability scale, 94.5% of the patients had excellent/good function. The mean value of the anterior drawer tests and the talar tilt angle examination were decreased. The mean of the Karlsson-Peterson score and the Visual Analogue Scale(VAS) score were both improved significantly. Conclusions The anatomic reconstruction of the ankle lateral ligament complex to treat chronic ankle instability using the arthroscopy combined with the fluoroscopic technique could improve the clinical functions, satisfaction, and reduced pain of patients.
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Affiliation(s)
- Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China. .,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.
| | - Dongsheng Fan
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Province, People's Republic of China
| | - Fang Han
- Department of Nutrition, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), Wuhan, Hubei Province, People's Republic of China
| | - Ming Tang
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Changwang Kong
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xianhua Cai
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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16
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Potocnik P, Toepfer A. [43/m-occasional ankle sprain and symptoms of muscle fatigue : Preparation for the medical specialist examination: part 67]. DER ORTHOPADE 2021; 50:188-193. [PMID: 33709177 DOI: 10.1007/s00132-021-04084-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- P Potocnik
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Schweiz.
| | - A Toepfer
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Schweiz
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17
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Feng SM, Sun QQ, Wang AG, Zhang ZY, Hao L. Long-term functional outcomes of all-inside arthroscopic repair of anterior talofibular ligament avulsion fracture. Foot Ankle Surg 2021; 27:156-161. [PMID: 32414701 DOI: 10.1016/j.fas.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The main purpose of this study was to describe the all-inside arthroscopic technique for repairing anterior talofibular ligament (ATFL) avulsion fractures at the attachment points of the fibula and talus, and to evaluate the functional outcomes during long-term follow-up. METHODS The data of 78 patients with ATFL avulsion fracture treated in our hospital from August 2013 to November 2016 were analyzed retrospectively. All patients underwent surgery. Patients were divided into two groups according to whether they had undergone all-inside arthroscopic treatment or open treatment. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Foot and Ankle Outcome Score (FAOS) and a 36-item Short Form Health Survey questionnaire (SF-36) were used to evaluate functional outcomes. RESULTS The postoperative follow-up period was 24-48 months. All patients reported subjective improvements to ankle stability without any nerve, blood vessel or tendon complications. At the final follow-up, there was no significant difference in the AOFAS, SF-36 or sport participation rate between the arthroscopic group and the open group; however, the KAFS and FAOS were significantly higher in the arthroscopic group than in the open group. CONCLUSIONS For ATFL avulsion fractures, the all-inside ankle arthroscopic procedure produced better outcomes than did the open procedure. The all-inside ankle arthroscopic procedure provides a minimally invasive technique with acceptable long-term functional outcomes.
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Affiliation(s)
- Shi-Ming Feng
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China.
| | - Qing-Qing Sun
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Ai-Guo Wang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Zai-Yi Zhang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Lin Hao
- Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Surgical Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China.
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18
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Pintore E, Cipollaro L, Pintore R, Oliva F, Maffulli N. Extensor Retinaculum Flap and Fibular Periosteum Ligamentoplasty After Failed Surgery for Chronic Lateral Ankle Instability. Foot Ankle Int 2020; 41:1546-1552. [PMID: 32755269 DOI: 10.1177/1071100720945703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The anterior talofibular ligament and the calcaneofibular ligament are 2 of the most frequently injured structures in sports, being damaged in 30% to 45% of all sports injuries. Most reconstructive procedures are successful but can deteriorate with time and can lead to low-grade radiographic degeneration. METHODS We operated on 26 consecutive patients from 2001 to 2008 who had failed previous surgical procedures for the lateral ligamentous complex of the ankle, with an average of 104 (range, 75-140) months. RESULTS The overall functional rating was excellent in 14 ankles, good in 10, fair in 1, and poor in 1. Twenty-four patients (92.3%) were satisfied with the procedure and 15 (57.7%) were able to return to their preinjury level of activity. Local complications were detected in 2 patients who presented with skin necrosis; 1 patient developed severe reflex sympathetic dystrophy. CONCLUSION Revision surgery for the management of failure after surgical treatment of chronic lateral ankle instability is under debate, and the literature is devoid of clinical studies with long-term follow-up. The technique described offers a high rate of long-term excellent and good results, with a low rate of complications and a good rate of return to preinjury level. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Ernesto Pintore
- Department of Orthopaedic Surgery, Istituto Clinico Mediterraneo, Agropoli (Salerno), Campania, Italy
| | - Lucio Cipollaro
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), Italy
| | - Raffaele Pintore
- Department of Orthopaedic Surgery, Istituto Clinico Mediterraneo, Agropoli (Salerno), Campania, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, Baronissi (SA), Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, England.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England
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19
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Li H, Zhao Y, Chen W, Li H, Hua Y. No Differences in Clinical Outcomes of Suture Tape Augmented Repair Versus Broström Repair Surgery for Chronic Lateral Ankle Instability. Orthop J Sports Med 2020; 8:2325967120948491. [PMID: 32974410 PMCID: PMC7495671 DOI: 10.1177/2325967120948491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background Suture tape (ST) augmented repair, an alternative to traditional Broström repair (BR), may protect the repaired anterior talofibular ligament during ligament healing. No systematic review of cohort studies has been conducted to compare traditional BR with ST-augmented repair for chronic lateral ankle instability. Purpose To review the current evidence in the literature to ascertain whether ST-augmented repair is superior to traditional BR in managing chronic lateral ankle instability. Study Design Systematic review; Level of evidence, 3. Methods A literature search was performed to identify relevant articles published in PubMed, Embase, and Cochrane Library databases in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search included cohort studies comparing the efficacy of BR and ST-augmented repair procedures in terms of incidence of instability recurrence, functional scores, talar tilt angle (TTA), anterior talar translation (ATT), and complication rate. Methodological quality was assessed using the Jadad scale for randomized studies and the Newcastle-Ottawa Scale for nonrandomized studies. Results A total of 4 clinical trials with 254 patients were included. No significant differences were detected between BR and ST-augmented repair procedures in terms of incidence of recurrent instability, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, Foot and Ankle Ability Measure, TTA, ATT, or complication rate. The ST group appeared to have a shorter operation time compared with the BR group. Conclusion No significant differences were found between ST-augmented repair and BR surgery regarding incidence of recurrent instability, functional outcome scores, or complication rates. Although technically challenging, the ST-augmented repair procedure appears to be a safe and fast option.
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Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yujie Zhao
- Department of Nursing, Huashan Hospital, Shanghai, People's Republic of China
| | - Wenbo Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
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20
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The calcaneofibular ligament has distinct anatomic morphological variants: an anatomical cadaveric study. Knee Surg Sports Traumatol Arthrosc 2020; 28:40-47. [PMID: 31776625 DOI: 10.1007/s00167-019-05797-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/07/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate if the calcaneofibular ligament (CFL) presents morphologic variants and measure the morphometrics of the ligament and its footprints METHODS: An anatomical study of 47 fresh-frozen below-the-knee ankle specimens was performed. Lateral ankle structures were dissected to expose the CFL. Overdissection was avoided to not modify the native morphology. The morphology (number and orientation of CFL bundles) and measurements of CFL insertions were recorded with ankle secured in neutral position. RESULTS Four distinct morphological-oriented shapes of the CFL were observed. These included single bundle, Y-shape double bundle, V-shape double bundle, and associated with the lateral talocalcaneal ligament. The most frequent CFL morphology observed was the single bundle and the Y-shape double bundle, present in 21 (44.7%) and 13 (27.7%) ankles. The V-shape double bundle and the CFL double bundle associated with the lateral talocalcaneal ligaments were less common, appearing only in eight (17.0%) and five (10.6%) ankles. The CFL length was higher in single bundle and Y-shaped double bundle CFL variants, about 30 mm each. Footprint morphometrics were heterogenous amongst the different CFL variants. CONCLUSION The CFL presents four distinct morphological-oriented shapes. The double bundle, V-shaped and Y-shaped CFL variants are uncommon and poorly reported in the literature. Their relation to the lateral talocalcaneal ligament and the inferior fascicle of the anterior talofibular ligament requires further research. The CFL morphology provides detailed knowledge of CFL anatomy that can improve diagnostic procedures. Furthermore, this information can fine-tune graft selection and sizing and allow a more precise anatomic placement during surgical reconstruction.
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21
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Zeng G, Hu X, Liu W, Qiu X, Yang T, Li C, Song W. Open Broström-Gould Repair vs Arthroscopic Anatomical Repair of the Anterior Talofibular Ligament for Chronic Lateral Ankle Instability. Foot Ankle Int 2020; 41:44-49. [PMID: 31535563 DOI: 10.1177/1071100719875964] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND The comparative studies on open vs arthroscopic anterior talofibular ligament (ATFL) repair are limited. This study aimed to compare the early therapeutic efficacy and cost between the traditional open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL for chronic lateral ankle instability. METHODS A total of 27 of patients with chronic lateral ankle instability undergoing repair of the ATFL between January 2013 and June 2015 were retrospectively included with a traditional open surgery (n = 10) group and arthroscopy (n = 17) group. The surgery duration, surgical cost, postoperative complications, and the preoperative/postoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Karlsson-Peterson score were compared between groups. RESULTS Compared to the arthroscopy group, the open surgery group had significantly shorter surgery duration and lower surgical cost. However, there was no significant difference in hospitalization duration between groups. At 3 years after operation, the AOFAS and Karlsson scores were significantly improved in both groups. Nevertheless, there was no significant difference in the AOFAS and Karlsson scores between groups at both preoperative and postoperative assessment. No significant difference was found in the incidence of postoperative complications between the 2 groups. CONCLUSION These results suggest that open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL have comparable therapeutic efficacy for chronic lateral ankle instability. The arthroscopic surgery had a smaller incision, while the open Broström-Gould had a shorter surgery duration and lower cost. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Gang Zeng
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong Province, China
| | - Xumin Hu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong Province, China
| | - Wenzhou Liu
- Department of Orthopaedics, the People's Hospital of Nanhai Disrtrict, Foshan, Guangdong, China
| | - Xuemei Qiu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong Province, China
| | - Tao Yang
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong Province, China
| | - Chunhai Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong Province, China
| | - Weidong Song
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong Province, China
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22
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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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Lopes R, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Thès A, Elkaïm M, Boniface O, Guillo S, Bauer T. Arthroscopic treatment of chronic ankle instability: Prospective study of outcomes in 286 patients. Orthop Traumatol Surg Res 2018; 104:S199-S205. [PMID: 30245066 DOI: 10.1016/j.otsr.2018.09.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/03/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chronic ankle instability (CAI) is the main complication of ankle sprains and requires surgery if non-operative treatment fails. Surgical ankle stabilisation techniques can be roughly classified into two groups, namely, repair involving retensioning and suturing of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) and reconstruction using a tendon graft. Arthroscopic repair and reconstruction techniques for CAI have been introduced recently. The objective of this prospective multicentre study was to assess the feasibility, morbidity, and short-term outcomes of these arthroscopic ankle-stabilisation techniques. MATERIAL AND METHODS Consecutive patients scheduled for arthroscopic treatment of CAI were included prospectively. Of the 286 included patients, 115 underwent ligament repair and 171 ligament reconstruction. Mean follow-up was 9.6 months (range, 6-43 months). We recorded the AOFAS and Karlsson scores, patient satisfaction, complications, and time to return to sports. RESULTS The overall patient satisfaction score was 8.5/10. The AOFAS and Karlsson scores improved significantly between the pre- and postoperative assessments, from 62.1 to 89.2 and from 55 to 87.1, respectively. These scores were not significantly different between the groups treated by repair and by reconstruction. Neurological complications occurred in 10% of patients and consisted chiefly in transient dysesthesia (with neuroma in 3.5% of patients). Cutaneous or infectious complications requiring surgical revision developed in 4.2% of patients. DISCUSSION Arthroscopic treatment is becoming a method of choice for patients with CAI, as it allows a comprehensive assessment of the ligament lesions, the detection and treatment of associated lesions, and repair or reconstruction of the damaged ligaments. These simple, reliable, and reproducible arthroscopic techniques seem as effective as conventional surgical techniques. The rate of cutaneous complications is at least halved compared to open surgery. CONCLUSION Arthroscopic ankle stabilisation repair and reconstruction techniques hold considerable promise but require further evaluation to better determine the indications of repair versus reconstruction and to obtain information on long-term outcomes.
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Affiliation(s)
- Ronny Lopes
- Polyclinique de l'atlantique (PCNA), avenue Claude-Bernard, 44800 Saint-Herblain, France
| | - Michael Andrieu
- Clinique Pont-de-Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France
| | - Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - François Molinier
- Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - André Thès
- Hôpital privé d'Eure-et-Loir, 2, rue Roland-Buthier, 28300 Mainvilliers, France; Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, AP-HP, groupe hospitalier universitaire Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Marc Elkaïm
- Clinique de Tournan, 2, rue Jules-Lefebvre, 77220 Tournan-en-Brie, France
| | - Olivier Boniface
- Clinique Générale-Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France
| | - Stéphane Guillo
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, AP-HP, groupe hospitalier universitaire Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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