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Xiang D, Jin W, Li H, Zhao G, Li B, Du S, Liu X. Biomechanical improvement of anterior talofibular ligament by augmentation repair of ligament advance reinforcement system: a cadaver study. BMC Surg 2023; 23:307. [PMID: 37817132 PMCID: PMC10566038 DOI: 10.1186/s12893-023-02136-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/02/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Ankle sprain are one of the most frequent sports injuries. Some individuals will develop chronic lateral ankle instability (CLAI) after ankle sprain and suffer from recurrent ankle sprain. Current surgical treatment of CAI with anterior talofibular ligament (ATFL) rupture fails to restore the stability of the native ATFL. Ligament Advance Reinforcement System (LARS) augmentation repair of ATFL was developed to improve its primary stability after repaired. METHODS This study was performed to evaluate whether LARS augmentation repair of ATFL had similar stability as the modified Broström repair and the intact ATFL to maintain ankle construct stability. Standardized surgical techniques were performed on eighteen fresh frozen cadaver ankle specimens. The intact ATFL group has just undergone an ATFL exploratory surgery. The modified Broström procedure is based on anatomical repair of the ATFL with a 2.9 mm suture anchor, and the LARS procedure is an augmentation procedure of the ATFL using LARS ligaments based on the modified Broström procedure. A dynamic tensile test machine was used to assess load-to-failure testing in the three groups. The ultimate failure load and stiffness were calculated and reported from the load-displacement curve. A one-way analysis of variance was used to detect significant differences (p < 0.05) between the LARS augmentation repair, the modified Broström repair and the intact ATFL, followed by least significant difference (LSD) post-hoc tests. RESULTS The LARS augmentation repair group showed an increased in ultimate failure to load and stiffness compared to the other two groups. There were no significant differences in ultimate failure to load and stiffness between the modified Broström and the intact ATFL, the LARS ligament for ATFL augmentation allows for improved primary stability after repair and reduced stress on the repaired ATFL, which facilitates healing of the remnant ligament. CONCLUSIONS The LARS augmentation repair of ATFL represents a stable technique that may allow for the ankle stability to be restored in patients with CAI after surgery.
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Affiliation(s)
- Dulei Xiang
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Wenming Jin
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Han Li
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Gen Zhao
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Bao Li
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Shuyuan Du
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China
| | - Xinwei Liu
- Department of orthopedics, General Hospital of North Theater Command, 83 Wenhua Road, Shenyang, Liaoning, China.
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Ghasemi SA, Tallapaneni J, Murray BC, Yin C, Raphael J, Vaupel Z, Grant A, Fortin P. Successful Return to Sport and Daily Activities After Suture Augmentation of Both the Anterior Talofibular Ligament and Calcaneofibular Ligament. Arthrosc Sports Med Rehabil 2023; 5:100762. [PMID: 37636256 PMCID: PMC10450845 DOI: 10.1016/j.asmr.2023.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/02/2023] [Indexed: 08/29/2023] Open
Abstract
Purpose To evaluate the return to sport and daily activities in addition to clinical outcomes after modification of the Brostöm repair, specifically using suture augmentation for concomitant fixation of both the anterior talofibular ligament and calcaneofibular ligament. Methods Patients who had grade III ankle sprains and lateral ankle instability, all of whom failed supervised conservative management, were included. Patients underwent a modified Broström procedure consisting of suture augmentation for both the anterior talofibular ligament and calcaneofibular ligament. For clinical outcome evaluation, Foot and Ankle Ability Measure (FAAM) and Karlsson-Peterson Scoring System for Ankle Function questionnaires coupled with questions regarding time of return to sport and level of sports activity were used. Results Thirty-one patients were included. The differences in preoperative and postoperative FAAM scores for both the Activities of Daily Living subscale and Sports subscale were significant (P < .001). The FAAM Activities of Daily Living score improved from an average of 46.06 preoperatively to 77.49 postoperatively (P < .001, 99% confidence interval, 26.4-36.4). The FAAM Sports score improved from an average of 4 preoperatively to 19.31 postoperatively (P < .001, 99% confidence interval, 11.6-19.0). For the Karlsson-Peterson Scoring System for Ankle Function, the surveyed population reported a mean of 82.74 points out of 100 post-op (standard deviation 20.14). The mean time to return to sport activity was 5.72 months. Mean follow-up time was 24.12 months. Conclusions This variant Broström procedure with suture anchors and augmentation of both the anterior talofibular ligament and calcaneofibular ligament was effective in helping patients return to their preinjury functionality level in both daily life and sports activity. Level of Clinical Evidence Level IV, therapeutic case series.
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Affiliation(s)
- S. Ali Ghasemi
- Department of Orthopaedic Surgery, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, U.S.A
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, Michigan, U.S.A
| | | | | | - Clark Yin
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, Michigan, U.S.A
| | - James Raphael
- Department of Orthopaedic Surgery, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, U.S.A
| | - Zachary Vaupel
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, Michigan, U.S.A
| | - Allan Grant
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, Michigan, U.S.A
| | - Paul Fortin
- Royal Oak Beaumont Department of Orthopaedic Surgery, Royal Oak, Michigan, U.S.A
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Sethi M, Limaye R, Rai A, Limaye N. Anterior Talo-Fibular Ligament Reconstruction With InternalBrace™ for Chronic Lateral Ankle Instability in Pediatric Patients. Cureus 2023; 15:e44979. [PMID: 37822443 PMCID: PMC10563824 DOI: 10.7759/cureus.44979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Ankle injuries and instability in a pediatric age group are common problems and often underreported. The injuries can range from a relatively benign ankle sprain to pain-limiting ankle instability that can inhibit the child from participating in sporting activities. However, conservative management and physiotherapy are the mainstay of treatment; a small group of patients present with persistent instability and benefit from surgical intervention in lateral ligament reconstruction. Our study looked at pediatric patients who had instability following failed conservative management. METHODS Retrospective analysis of 14 patients with Chronic lateral Ankle instability (CLAI) who underwent Modified Brostrom-Gould repair( MBG) with or without Internal brace augmentation between January 2015 and October 2020. Patients were evaluated for the visual analogue scale (VAS), Manchester-oxford foot questionnaire (MOxFQ), subjective satisfaction, and return to preinjury activity level. RESULTS Pain score improved from 8 (average 5-9) to 1 (average 0-3) following surgery. Functional assessment was made by assessing the Manchester Oxford questionnaire pre-and postoperatively. MOxFQ scores improved from 64 (8 SD) to 7 (15 SD). Thirteen of fourteen patients returned to normal sporting activities at the final follow-up. CONCLUSION Modified Brostrom-Gould with InternalBrace™ augmentation is an excellent procedure for chronic lateral ligament injuries in the Paediatric population. It can be safely performed if we respect the anatomy and the physeal growth plate. It allows faster rehabilitation and return to preinjury activity level.
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Affiliation(s)
- Mohit Sethi
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton, GBR
| | - Rajiv Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton, GBR
| | - Avinash Rai
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton, GBR
| | - Neil Limaye
- Orthopaedics and Trauma, North Tees and Hartlepool NHS Foundation Trust, Stockton, GBR
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Comfort SM, Marchetti DC, Duncan PP, Dornan GJ, Haytmanek CT, Clanton TO. Broström Repair With and Without Augmentation: Comparison of Outcomes at Median Follow-up of 5 Years. Foot Ankle Int 2023; 44:691-701. [PMID: 37282349 DOI: 10.1177/10711007231176806] [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: 06/08/2023]
Abstract
BACKGROUND An augmented Broström repair with nonabsorbable suture tape has demonstrated strength and stiffness more similar to the native anterior talofibular ligament (ATFL) compared to Broström repair alone at the time of repair in cadaveric models for the treatment of lateral ankle instability. The study purpose was to compare minimum 2-year patient-reported outcomes (PROs) following treatment of ATFL injuries with Broström repair with vs without suture tape augmentation. METHODS Between 2009 and 2018, patients >18 years old who underwent primary surgical treatment for an ATFL injury with either a Broström repair alone (BR Cohort) or Broström repair with suture tape augmentation (BR-ST Cohort) were identified. Demographic data and PROs, including Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sport subscales, 12-Item Short Form Health Survey (SF-12), Tegner Activity Scale, and patient satisfaction with surgical outcome, were compared between groups, and proportional odds ordinal logistic regression was used. RESULTS Ninety-one of 102 eligible patients were available for follow-up at median 5 years. The BR cohort had 50 of 53 patients (94%) completed follow-up at a median of 7 years. The BR-ST cohort had 41 of 49 (84%) complete follow-up at a median of 5 years. There was no significant difference in median postoperative FAAM ADL (98% vs 98%, P = .67), FAAM sport (88% vs 91%, P = .43), SF-12 PCS (55 vs 54, P = .93), Tegner score (5 vs 5, P = .64), or patient satisfaction (9 vs 9, P = .82). There was significantly higher SF-12 MCS (55.7 vs 57.6, P = .02) in the BR-ST group. Eight patients underwent subsequent ipsilateral ankle surgery, of which one patient (BR-ST group) was revised for recurrent lateral ankle instability. CONCLUSION At median 5 years, patients treated for ATFL injury of the lateral ankle with Broström repair with suture tape augmentation demonstrated similar patient-reported outcomes to those treated with Broström repair alone. LEVEL OF EVIDENCE Level II, retrospective cohort study.
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Affiliation(s)
| | | | - Parker P Duncan
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | | | - C Thomas Haytmanek
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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Xu Y, Cao YX, Li XC, Xu XY. Revision lateral ankle ligament reconstruction for patients with a failed modified Brostrom procedure. J Orthop Surg (Hong Kong) 2022; 30:10225536221125948. [PMID: 36113017 DOI: 10.1177/10225536221125948] [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: 11/17/2022] Open
Abstract
PURPOSE The Brostrom-Gould procedure has been considered as a gold standard operative technique for chronic lateral ankle instability. Despite the popularity and excellent outcomes of the modified Brostrom procedure, some patients still experience recurrence of ankle instability. Few studies reported outcomes of revision reconstruction for patients with a failed modified Brostrom procedure. This study aimed to evaluate the outcomes of a percutaneous anatomic revision lateral ankle ligament reconstruction for patients with a failed modified Brostrom procedure. METHODS From March 2017 to April 2020, 21 patients with persistent ankle instability after a modified Brostrom procedure underwent revision lateral ankle ligament reconstruction. The operation was performed through minimally invasive incisions. Functional assessment was performed using the Karlsson-Peterson ankle scoring system (KP) and the Visual Analogue Scale (VAS). The questionnaires of KP and VAS were completed before surgery and at the last follow-up. Patients' subjective satisfaction level was graded as excellent, good, fair, and poor. Preoperative and postoperative anterior talar displacement and varus talus tilt angle in stress radiographs were recorded. RESULTS The average age at the revision surgery time was 39.6years. The mean follow-up was 39.2months. The VAS score improved from 4.1 ± 1.5 preoperatively to 1.3 ± 1.3 at the final follow-up (p < .05). The KP score improved from 59.0 ± 20.2 preoperatively to 88.2 ± 9.6 at the last follow-up (p < .05). The mean varus talar tilt angle was 14.1 ± 3.9 mm preoperatively versus 4.9 ± 4.7 mm at the final follow-up (p < .05). The mean anterior talar displacement was 12.8 ± 2.2 mm versus 5.6 ± 3.7 mm at the last follow-up (p < .05). CONCLUSIONS The revision anatomic reconstruction of the lateral ligaments of the ankle is effective for patients with recurrent instability after a failed modified Broström procedure.
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Affiliation(s)
- Yang Xu
- Department of Orthopedics, 66281Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yong-Xing Cao
- Department of Orthopedics, 66281Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xing-Chen Li
- Department of Orthopedics, 66281Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiang-Yang Xu
- Department of Orthopedics, 66281Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Young KL, Morris B, Herda TJ. The Role of Strength and Conditioning in the Prevention and Treatment of Chronic Lateral Ankle Instability. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jain NP, Ayyaswamy B, Griffiths A, Alderton E, Kostusiak M, Limaye RV. Is Internal brace augmentation a gold standard treatment compared to isolated Modified Brostrom Gould repair for chronic lateral ligament ankle instability? Effect on functional outcome and Return to preinjury activity: A retrospective analysis. Foot (Edinb) 2022; 50:101865. [PMID: 35248918 DOI: 10.1016/j.foot.2021.101865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/09/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Modified Brostrom Gould (MBG) repair is widely accepted procedure for chronic lateral ankle instability (CLAI), but there are limitations with regards to strength of repair and risk of reinjury and complications. Internal brace has been recently used as augmentation of standard MBG repair. It provides stronger construct, facilitates early mobilisation and protects repaired ligament with minimal surgical morbidity. The aim of present study is to compare the outcome of MBG repair without and with Internal brace augmentation (IB) in CLAI. METHODS Retrospective analysis of 172 patients with CLAI who underwent MBG repair with or without IBA between November 2017 and October 2019. Patients were evaluated for Visual analogue scale (VAS), Manchester-oxford foot questionnaire (MOxFQ), Patients subjective satisfaction and return to preinjury activity level. RESULTS 148 patients were included in the study with 87 in MBG group and 61 in IB group. The mean age, average injury-surgery interval and mean follow up duration was 40.6 ± 11.2 vs 37.5 ± 14.7 years, 13.1 ± 10.3 vs 14.1 ± 8 months and mean follow up duration of 24.2 ± 5.1 vs 20.7 ± 6.0 months respectively (p > 0.05). The mean time to return to preinjury activity level was significantly better in IB group compared to MBG group of 12.1 ± 2.3 vs 20.3 ± 3.9 weeks, p < 0.001. 55 (90.2%) patients in IB and 73 (83.7%) in MBG group return to preinjury activity level. Mean postoperative VAS score (1.9 ± 1.5 vs. 1.7 ± 1.4, p = 0.428), Mean MOxFQ score (19.7 ± 22.2 vs. 18.2 ± 15.4, p = 0.674) showed no significant difference between MBG and IB group respectively, at final follow up. CONCLUSION The use of IB augmentation with MBG repair showed significantly better outcome in terms of early rehabilitation and return to preinjury activity level compared to isolated MBG repair. The functional outcome and VAS score were better in IB group compared to MBG group with no significant difference. LEVEL OF EVIDENCE Level IV retrospective study.
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Affiliation(s)
- Nimesh P Jain
- Department of Trauma and Orthopaedics, North Tees & Hartlepool University Hospital and NHS Foundation Trust, Stockton on Tees, United Kingdom.
| | - Brijesh Ayyaswamy
- Department of Trauma and Orthopaedics, North Tees & Hartlepool University Hospital and NHS Foundation Trust, Stockton on Tees, United Kingdom
| | - Alexandra Griffiths
- Department of Trauma and Orthopaedics, North Tees & Hartlepool University Hospital and NHS Foundation Trust, Stockton on Tees, United Kingdom
| | - Elizabeth Alderton
- Department of Trauma and Orthopaedics, North Tees & Hartlepool University Hospital and NHS Foundation Trust, Stockton on Tees, United Kingdom
| | - Milosz Kostusiak
- Department of Trauma and Orthopaedics, North Tees & Hartlepool University Hospital and NHS Foundation Trust, Stockton on Tees, United Kingdom
| | - Rajiv V Limaye
- Department of Trauma and Orthopaedics, North Tees & Hartlepool University Hospital and NHS Foundation Trust, Stockton on Tees, United Kingdom
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Clinical outcomes of anterior tibiofibular ligament's distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients. Arch Orthop Trauma Surg 2022; 142:2829-2837. [PMID: 34846587 PMCID: PMC9474461 DOI: 10.1007/s00402-021-04214-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Treatment of chronic ankle instability (CAI) for ankle sprain patients remains a challenge. If initial treatments fail, surgical stabilization techniques including ligament reconstruction should be performed. Anterior tibiofibular ligament (ATiFL) distal fascicle transfer for CAI was recently introduced. The goal of the study is to assess the 1-year clinical effectiveness of ATiFL's distal fascicle transfer versus ligament reconstruction with InternalBrace™ (Fa. Arthrex, Naples). METHODS Between October 2019 and February 2021, 25 patients (14 males and 11 females) scheduled for ligament reconstruction treatment of CAI were enrolled after propensity score matching. Twelve underwent ligament reconstruction with InternalBrace™ (InternalBrace™ group) and thirteen underwent ATiFL's distal fascicle transfer (ATiFL's distal fascicle transfer group). We recorded the American Orthopedic Foot & Ankle Society (AOFAS) score, Visual Analogue Scale (VAS), anterior drawer test grade, patient satisfaction and complications. All results of this study were retrospectively analyzed. RESULTS Statistically significant (p = 0.0251, independent-samples t test) differences in the AOFAS can be found between the ATiFL's distal fascicle transfer group and the InternalBrace™ group. No substantial changes in the VAS (p = 0.1778, independent-samples t test), patient satisfaction (p = 0.1800, independent-samples t test) and anterior drawer test grade (p = 0.9600, independent-samples t test) were found between the two groups. There was one patient with superficial wound infection and one patient with sural nerve injury in the InternalBrace™ group and ATiFL's distal fascicle transfer group, respectively. CONCLUSION This is the first study that assessed a cohort of CAI patients and suggests that the ATiFL's distal fascicle transfer operation has the potential to attain good-to-excellent clinical outcomes after 1-year recovery. The AOFAS scores were significantly higher for patients with ATiFL's distal fascicle transfer, indicating that this technique may be considered a viable option for both patients and their surgeon, while long-term outcomes should be investigated in the future.
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Yang H, Su M, Chen Z, Qu R, Yuan Z, Yuan J, He S, Li Z, Liu C, Xiao Z, Liang H, Ouyang J, Dai J. Anatomic Measurement and Variability Analysis of the Anterior Talofibular Ligament and Calcaneofibular Ligament of the Ankle. Orthop J Sports Med 2021; 9:23259671211047269. [PMID: 34820459 PMCID: PMC8607490 DOI: 10.1177/23259671211047269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL)
contribute greatly to the overall stability of the ankle joint; however,
ATFL and combined ATFL-CFL sprains are common. Anatomic reconstruction of
the lateral collateral ligament with grafts has been proposed for patients
with poor tissue quality or inadequate local tissue. Anatomic reconstruction
of the lateral ankle ligaments requires a good understanding of their
anatomic location. Purpose: To describe the anatomy of the ATFL and CFL ligaments quantitatively and
qualitatively and explore the relationship of some morphological
parameters. Study Design: Descriptive laboratory study. Methods: A total of 66 adult ankle specimens were analyzed for ATFL band type, origin,
length, width, thickness, and angle between the ATFL and CFL, and 73 adult
ankle specimens were used for measuring the origin of the CFL. The
coefficient of variation was used to describe and compare the respective
variability of angle, length, width, and thickness. The origin of the ATFL
was labeled as point A, and the leading edge of the CFL
intersection with the articular surface of the calcaneus was considered
point B. Results: The ATFL had a variable number of bands. A high degree of variability
(coefficient of variation >0.2) was seen for most morphological
measurements of the ATFL. In addition, the length of distance
AB also varied. The CFL originated at the tip of the
fibula in only 9% of specimens. It was found more commonly at the anterior
border of the lateral malleolus (4.94 ± 1.70 mm from the tip). The angle
between the ATFL and CFL was consistent at 100° to 105º. Conclusion: A fair amount of variability of ATFL length, width, and thickness were found
in our study, with less variability in the ATFL-CFL angle. Most CFLs
attached anterior to the tip of the fibula. Clinical Relevance: Providing relevant anatomic data of ATFL and CFL is important in ensuring
proper surgical treatment of ankle joint injuries.
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Affiliation(s)
- Han Yang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Minghao Su
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Zhimin Chen
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Rongmei Qu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhirong Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Jiajie Yuan
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Shanli He
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zeyu Li
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Zhaoming Xiao
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Haibin Liang
- Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
| | - Jingxing Dai
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Medical Biomechanics, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China.,Investigation performed at the Guangdong Provincial Medical Biomechanical Key Laboratory, Department of Anatomy, School of Basic Medical Science, Southern Medical University, Guangzhou, China
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10
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Eble SK, Hansen OB, Patel KA, Drakos MC. Lateral Ligament Reconstruction With Hamstring Graft for Ankle Instability: Outcomes for Primary and Revision Cases. Am J Sports Med 2021; 49:2697-2706. [PMID: 34283932 DOI: 10.1177/03635465211026969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Optimal treatment for patients with severe ankle instability or failed previous ankle stabilization is not well defined, and newer techniques have limited presence in the literature. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate clinical and radiographic outcomes after modified anatomic lateral ligament reconstruction using hamstring auto- or allograft in primary cases versus revision cases. We hypothesized that patients undergoing a revision procedure would demonstrate inferior patient-reported and radiographic outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent modified anatomic lateral ligament reconstruction by a single surgeon between 2010 and 2017 were identified. Indications included failure of previous ankle stabilization or severe ankle laxity. Patients completed preoperative and minimum 1-year postoperative Foot and Ankle Outcome Score (FAOS) surveys. They also underwent pre- and postoperative stress radiographs using the Telos Stress Device. RESULTS A total of 41 patients (42 ankles) were identified. The mean age was 32.1 years, and 36 patients (88%) were women. There were 25 primary procedures and 17 revision procedures. Hamstring autograft was utilized in 35 ankles and hamstring allograft in 7 ankles. A total of 34 patients (83%) provided postoperative patient-reported outcome scores at a mean of 26 months (range, 12-65 months). When comparing primary versus revision procedures, revision patients had significantly lower FAOS Pain (77.14 vs 90.66; P = .009), Sports (63.46 vs 82.16; P = .008), and Quality of Life (53.53 vs 76.70; P = .002) scores. In total, 34 patients (83%) had stress radiographs at a mean of 14 months (range, 3-62 months) postoperatively. Revision patients also had lower, though statistically insignificant, postoperative talar tilt measurements on average (5.73° vs 7.10°; P = .252), and pre- to postoperative change in talar tilt was not significantly different between groups (-4.94° vs -7.03°; P = .415). CONCLUSION Revision procedures had significantly lower postoperative patient-reported outcome scores and lower talar tilt compared with patients undergoing a primary procedure, although the pre- to postoperative change in the talar tilt was not significantly different between groups.
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Affiliation(s)
| | | | - Karan A Patel
- Hospital for Special Surgery, New York, New York, USA.,Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Mark C Drakos
- Hospital for Special Surgery, New York, New York, USA
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11
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Hellwinkel JE, Confino JE, Vosseller JT. Revision Lateral Ankle Reconstruction 40 Years After Chrisman-Snook Procedure: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00004. [PMID: 34228662 DOI: 10.2106/jbjs.cc.20.00567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
CASE A 70-year-old active woman presented with lateral ankle instability 40 years after a lateral ankle reconstruction procedure. Examination demonstrated gross instability, and advanced imaging revealed attenuation of her previous graft. She underwent anatomic reconstruction through a modified Brostrom-Gould technique and was able to return to hiking without pain. CONCLUSION Recurrent lateral ankle instability after reconstruction represents a unique challenge for orthopaedic surgeons. Utilization of a modified Brostrom-Gould procedure with suture tape augmentation is a promising alternative to allograft or autograft reconstruction for patients with active lifestyle goals in the context of recurrent instability.
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Affiliation(s)
- Justin E Hellwinkel
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, New York
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Lateral augmentation reconstruction system versus modified Brostrom-Gould procedure: A meta-analysis of RCTs. Foot Ankle Surg 2021; 27:263-270. [PMID: 33199156 DOI: 10.1016/j.fas.2020.11.001] [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: 07/19/2020] [Revised: 09/16/2020] [Accepted: 11/02/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study is to compare the clinical efficacy between the ligament augmentation reconstruction system (LARS) and the modified Brostrom-Gould (MBG) operations in the treatment of chronic ankle instability. METHODS We searched the MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane library, and the Clinicaltrial.gov databases for eligible studies. The Review Manager 5.3 software was applied to compare various postoperative functional scoring, ankle stability and complications between the two groups. RESULTS Four randomized controlled trials including a total of 209 patients were conducted. No significant difference was found in terms of postoperative FAOS, FAAM, ankle stability and complications between the LARS and MBG group. CONCLUSIONS The present meta-analysis suggested that there was no clinical superiority for the LARS operation over the MBG operation for patients with chronic ankle instability.
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Finney FT, Irwin TA. Recognition of Failure Modes of Lateral Ankle Ligament Reconstruction: Revision and Salvage Options. Foot Ankle Clin 2021; 26:137-153. [PMID: 33487237 DOI: 10.1016/j.fcl.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Primary lateral ankle ligament reconstruction has a high success rate, but failures may lead to recurrent instability. In patients with recurrent lateral ankle instability, it is important to determine the mode of failure. Underlying cavovarus deformity and joint hypermobility must be identified and addressed at the time of revision surgical stabilization. The modified Brostrom-Gould procedure is typically performed for primary lateral ankle ligament reconstruction, but it may be used in revision stabilization procedures utilizing suture-tape augmentation. Revision lateral ankle stabilization surgery can also be addressed with anatomic allograft reconstruction of the ATFL and CFL, and is the authors'preferred technique.
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Affiliation(s)
- Fred T Finney
- Peachtree Orthopedics, 3200 Downwood Circle NW, Suite 700, Atlanta, GA 30327, USA
| | - Todd A Irwin
- OrthoCarolina Foot and Ankle Institute, Atrium Health Musculoskeletal Institute, 2001 Vail Avenue, Suite 200B, Charlotte, NC 28207, USA.
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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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Anterior Talofibular Ligament Repair With Suture Tape Augmentation. Arthrosc Tech 2020; 9:e1893-e1897. [PMID: 33381397 PMCID: PMC7768115 DOI: 10.1016/j.eats.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/10/2020] [Indexed: 02/03/2023] Open
Abstract
The most common injury sustained to the ankle ligaments is a result of inversion of the foot. This mechanism results in injury to the anterior talofibular ligament alone or in conjunction with the calcaneofibular ligament and posterior talofibular ligament. Patients experiencing recurrent ankle sprains despite nonoperative measures often require surgical management. Recent focus has been on augmentation procedures to improve the stability of a lateral ankle ligament repair by protecting it during the healing phase and supporting early mobilization. This article describes, with video illustration, anterior talofibular ligament repair with suture tape augmentation.
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Hamstring Autograft for Lateral Ligament Stabilization. Curr Rev Musculoskelet Med 2020; 13:289-297. [PMID: 32367429 DOI: 10.1007/s12178-020-09623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to review the current literature and trends regarding use of hamstring autograft for lateral ankle instability. RECENT FINDINGS Reconstruction of the lateral ankle ligaments using hamstring autograft has been found to be an effective method to treat ankle instability in terms of patient-reported outcomes and objective measures. Biomechanically, reconstruction has been shown to be stronger (load to failure) when compared with the Broström procedure. Clinical studies have demonstrated non-inferiority when compared with the Broström procedure, with one synthetic reconstruction technique demonstrating superior outcomes. Reconstruction of the lateral ankle ligaments using hamstring autograft is especially useful in patients who are at high risk of failure (insufficient soft tissue available for repair, ligamentous laxity, previous failed ligament repair, ossicle > 1 cm, or in the heavier, high-demand athletes).
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Boey H, Verfaillie S, Natsakis T, Vander Sloten J, Jonkers I. Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures. Am J Sports Med 2019; 47:1921-1930. [PMID: 31125267 DOI: 10.1177/0363546519848421] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Altered kinematics and persisting ankle instability have been associated with degenerative changes and osteochondral lesions. PURPOSE To study the effect of ligament reconstruction surgery with suture tape augmentation (isolated anterior talofibular ligament [ATFL] vs combined ATFL and calcaneofibular ligament [CFL]) after lateral ligament ruptures (combined ATFL and CFL) on foot-ankle kinematics during simulated gait. STUDY DESIGN Controlled laboratory study. METHODS Five fresh-frozen cadaveric specimens were tested in a custom-built gait simulator in 5 different conditions: intact, ATFL rupture, ATFL-CFL rupture, ATFL-CFL reconstruction, and ATFL reconstruction. For each condition, range of motion (ROM) and the average angle (AA) in the hindfoot and midfoot joints were calculated during the stance phase of normal and inverted gait. RESULTS Ligament ruptures mainly changed ROM in the hindfoot and the AA in the hindfoot and midfoot and influenced the kinematics in all 3 movement directions. Combined ligament reconstruction was able to restore ROM in inversion-eversion in 4 of the 5 joints and ROM in internal-external rotation and dorsiflexion-plantarflexion in 3 of the 5 joints. It was also able to restore the AA in inversion-eversion in 2 of the 5 joints, the AA in internal-external rotation in all joints, and the AA in dorsiflexion-plantarflexion in 1 of the joints. Isolated ATFL reconstruction was able to restore ROM in inversion-eversion and internal-external rotation in 3 of the 5 joints and ROM in dorsiflexion-plantarflexion in 2 of the 5 joints. Isolated reconstruction was also able to restore the AA in inversion-eversion and dorsiflexion-plantarflexion in 2 of the joints and the AA in internal-external rotation in 3 of the joints. Both isolated reconstruction and combined reconstruction were most successful in restoring motion in the tibiocalcaneal and talonavicular joints and least successful in restoring motion in the talocalcaneal joint. However, combined reconstruction was still better at restoring motion in the talocalcaneal joint than isolated reconstruction (1/3 for ROM and 1/3 for the AA with isolated reconstruction compared to 1/3 for ROM and 2/3 for the AA with combined reconstruction). CONCLUSION Combined ATFL-CFL reconstruction showed better restored motion immediately after surgery than isolated ATFL reconstruction after a combined ATFL-CFL rupture. CLINICAL RELEVANCE This study shows that ligament reconstruction with suture tape augmentation is able to partially restore kinematics in the hindfoot and midfoot at the time of surgery. In clinical applications, where the classic Broström-Gould technique is followed by augmentation with suture tape, this procedure may protect the repaired ligament during healing by limiting excessive ROM after a ligament rupture.
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Affiliation(s)
- Hannelore Boey
- Biomechanics Section, KU Leuven, Leuven, Belgium
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | | | - Tassos Natsakis
- Biomechanics Section, KU Leuven, Leuven, Belgium
- Department of Automation, Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | | | - Ilse Jonkers
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
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Abstract
Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.
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Affiliation(s)
| | | | - Yu Deng
- Department of Foot and Ankle Surgery, Wuhan University, Hubei, China
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson
- San Antonio Military Medical Center, TX
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Porter M, Shadbolt B, Ye X, Stuart R. Ankle Lateral Ligament Augmentation Versus the Modified Broström-Gould Procedure: A 5-Year Randomized Controlled Trial. Am J Sports Med 2019; 47:659-666. [PMID: 30699039 DOI: 10.1177/0363546518820529] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND "Ankle sprain" is a common injury, and >20% of patients may develop chronic instability for which surgery is indicated. The modified Broström-Gould (MBG) procedure remains the gold standard; however, there are a number of relative contraindications to this procedure, and the longer-term outcomes after the MBG have been questioned. An alternative procedure is augmentation of a primary repair with a ligament augmentation reconstruction system (LARS). PURPOSE To conduct a randomized controlled trial testing the null-hypothesis that there is no difference in patient scored outcomes and activity levels, between patients undergoing a MBG procedure compared with those undergoing a primary repair with LARS augmentation, for lateral ligament instability of the ankle. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients who satisfied the inclusion criteria were invited to take part in the study. Patients were randomly allocated to undergo the LARS or MBG procedure. Both groups followed similar postoperative rehabilitation. Patients completed the Foot and Ankle Outcome Score (FAOS) before surgery and then at 1, 2, and 5 years after surgery. Tegner activity scores were recorded at 5years. The scores in the 2 groups were compared via statistical analysis ( P < .05). RESULTS Of the 50 patients satisfying the inclusion criteria, 47 agreed to take part in the study. Twenty-two were randomized to the LARS group and 25 to the MBG group. At 5 years, follow-up data were complete for 20 patients in the LARS group and 21 in the MBG. There were 2 failures in the MBG group and 0 in the LARS group. The LARS group had significantly better improvement in total FAOS at 1 year (mean ± SD, 92.4 ± 2.5 vs 78.2 ± 3.4, P = .005), 2 years (94.0 ± 3.0 vs 78.0 ± 5.2, P = .003), and 5 years (93.7 ± 6.0 vs 75.1 ± 5.5, P = .002) after surgery. The 5-year Tegner activity scores were higher in the LARS group (8.25 ± 1.1 vs 7.2 ± 0.9, P = .03). CONCLUSION Among physically active patients with chronic lateral ligament instability, primary repair combined with LARS results in better total FAOS at 5-year follow-up and higher Tegner activity scores as compared with the MBG procedure. REGISTRATION ACTRN12618000906257 (Australia New Zealand Clinical Trial Registry).
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Affiliation(s)
- Mark Porter
- Canberra Orthopaedics and Sports Medicine, Calvary Clinic, Bruce, Australia
| | - Bruce Shadbolt
- Department of Epidemiology, Canberra Hospital, Garran, Australia
| | - Xuan Ye
- Prince of Wales Hospital, Randwick, Australia
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and treatment for lateral ankle instability in pediatric patients. RECENT FINDINGS Chronic ankle instability is a common sequela of lateral ankle sprain in young athletes. Incidence is increasing, possibly due in part to inadequate treatment of first-time ankle sprains, as well as increased youth participation in organized and competitive sports. The anterior talofibular ligament (ATFL) is injured in every case, whereas the calcaneofibular ligament (CFL) and syndesmosis may be involved in severe cases. A clinical history, focused physical exam, and appropriate radiographic studies aid in diagnosis, and predisposing factors must be identified. Early treatment of ankle sprains involves bracing or immobilization, followed by a course of physical therapy. Surgery involves anatomic repair of the torn ligaments, and may be required in cases of severe functional and mechanical instability with recurrent sprains refractory to nonsurgical management. Intraarticular disorders should be identified and may be addressed with ankle arthroscopy. SUMMARY Prompt treatment of lateral ankle instability in young athletes is important to prevent chronic ankle instability. Many patients are successfully treated without surgery, and those requiring operative intervention improve function postoperatively.
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Abstract
PURPOSE OF REVIEW Ankle sprains, which account for 40% of sports injuries in the USA, can lead to chronic ankle instability. Chronic ankle instability can be classified as functional, mechanical, or a combination of both and is diagnosed using a combination of a physical exam, an MRI, and stress radiographs. This review focuses on different approaches to treatment, including non-operative and operative techniques, of chronic ankle instability, including reviewing traditional procedures as well as more novel and newer techniques. RECENT FINDINGS Based on existing literature, non-operative treatment should always precede operative treatment of chronic ankle instability. If rehabilitation fails, Brostrom-Gould type ankle stabilization has been the preferred surgical option. Recent literature suggests that arthroscopic repair might reduce recovery time and improve outcomes in certain populations; however, there are higher rates of complication following these surgeries. In more high-risk populations, some literature reports that ligament repair with peroneus brevis transfer could be a more effective treatment option. Currently, varying surgical techniques exist for the treatment of chronic ankle instability. While the more recently reported techniques show promise, it is important to note that there is little evidence showing they are more successful than traditional techniques. It is imperative that future studies focus on outcomes and complication rates of these newer procedures.
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Affiliation(s)
- Rachel J Shakked
- Rothman Institute, 3300 Tillman Drive, 2nd Floor, Bensalem, Philadelphia, PA, 19020-2071, USA.
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22
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Park KH, Lee JW, Suh JW, Shin MH, Choi WJ. Generalized Ligamentous Laxity Is an Independent Predictor of Poor Outcomes After the Modified Broström Procedure for Chronic Lateral Ankle Instability. Am J Sports Med 2016; 44:2975-2983. [PMID: 27480980 DOI: 10.1177/0363546516656183] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The modified Broström procedure for chronic lateral ankle instability (CLAI) has presented outstanding clinical results. However, after the procedure, some patients with generalized ligamentous laxity have experienced a recurrence of ankle instability. PURPOSE To understand the effect of generalized ligamentous laxity on prognosis and risk of recurrence in a cohort of patients with CLAI after the modified Broström procedure. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 199 ankles from 188 patients underwent the modified Broström procedure for CLAI with a mean follow-up of 60.1 months (range, 48-108 months). Generalized ligamentous laxity was assessed in all patients. The Karlsson-Peterson ankle score (Karlsson score), talar tilt angle, and anterior displacement of the talus were used to evaluate clinical and radiological outcomes. Risk factors associated with clinical outcomes were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan-Meier analysis. RESULTS Generalized ligamentous laxity was evident in 42 cases (21.1%). The average Karlsson score improved from 54.6 ± 7.1 preoperatively to 87.9 ± 7.2 at last follow-up (P < .001). The presence of generalized ligamentous laxity was significantly associated with poor clinical and radiological outcomes. The rates of clinical failure were 10.8% and 45.2% in the nonlaxity group and the laxity group, respectively (P < .001). According to bivariate analysis, generalized ligamentous laxity, syndesmosis widening, osteochondral lesion of the talus, high preoperative talar tilt angle (>15°), and high preoperative anterior displacement of the talus (>10 mm) were significantly associated with clinical failure. Multivariate logistic regression analysis revealed that generalized ligamentous laxity was the most important independent predictor of clinical failure after the modified Broström procedure. The cumulative success rates for the nonlaxity group were significantly superior to those for the laxity group in Kaplan-Meier curves (P < .001). CONCLUSION Generalized ligamentous laxity is an independent predictor of poor outcomes and a risk factor of recurrent instability following the modified Broström procedure for CLAI.
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Affiliation(s)
- Kwang Hwan Park
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Kyeonggi-do, South Korea
| | - Jin Woo Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Wan Suh
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung Ho Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Woo Jin Choi
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
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23
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Yoo JS, Yang EA. Clinical results of an arthroscopic modified Brostrom operation with and without an internal brace. J Orthop Traumatol 2016; 17:353-360. [PMID: 27108426 PMCID: PMC5071235 DOI: 10.1007/s10195-016-0406-y] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/08/2016] [Indexed: 01/11/2023] Open
Abstract
Background The concept of utilizing nonabsorbable suture tape fixed directly to bone to augment Brostrom repairs of the anterior talofibular ligament (ATFL) has been proposed. However, no clinical data are currently available regarding the arthroscopic modified Brostrom operation with an internal brace. Materials and methods This study involved 85 consecutive patients (22 in the with internal brace group; 63 in the without internal brace group) who could be followed up for >6 months after undergoing an arthroscopic modified Brostrom operation. The American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to assess the functional status. At preoperation and at 24 weeks after surgery, the anterior drawer test was examined clinically. Results Improvement of mean AOFAS score in the internal brace group from before surgery to two weeks after surgery was statistically significant (p < 0.05). At 24-week follow-up, the anterior drawer test showed grade 0 laxity in 19 patients (86.4 %) and grade 1 in three patients (13.6 %). Improvement of AOFAS score in the group without an internal brace from before surgery to 6 weeks after surgery was not statistically significant (p = 0.001). At 24-week follow-up, the anterior drawer test showed grade 0 laxity in 54 patients (85.7 %) and grade 1 in nine patients (14.3 %). Conclusion Patients in the internal brace group were able to quickly return to activity and sports. We believe this technique could be a viable option for surgically treating chronic lateral ankle instability in patients who need an early return to activity and sports. Level of evidence III.
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Affiliation(s)
- Jae-Sung Yoo
- Department of Orthopedic Surgery, Chungpyung Army Hospital, 926, GyungChoon-ro Chungpyung myun, Gapyung, GaPyung gun, 477-815, South Korea.
| | - Eun-Ah Yang
- Department of Anesthesiology, Cha Hospital, Bundang, South Korea
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Willegger M, Benca E, Hirtler L, Hradecky K, Holinka J, Windhager R, Schuh R. Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL. Knee Surg Sports Traumatol Arthrosc 2016; 24:1015-21. [PMID: 26878851 PMCID: PMC4823330 DOI: 10.1007/s00167-016-4048-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 01/21/2016] [Indexed: 10/29/2022]
Abstract
PURPOSE Current methods of anterior talofibular ligament (ATFL) reconstruction fail to restore the stability of the native ATFL. Therefore, augmented anatomic ATFL reconstruction gained popularity in patients with attenuated tissue and additional stress on the lateral ankle ligament complex. The aim of the present study was to evaluate the biomechanical stability of the InternalBrace (Arthrex Inc., Naples, FL, USA), a tape augmentation designed to augment the traditional Broström procedure. METHODS Twelve (12) fresh-frozen human anatomic lower leg specimens were randomized into two groups: a native ATFL (ATFL) and a tape augmentation group (IB). Dual-energy X-ray absorptiometry (DEXA) scans were carried out to determine bone mineral density (BMD) of the specimens. The ligaments were stressed by internally rotating the tibia against the inverted fixated hindfoot. Torque at failure (Nm) and angle at failure (°) were recorded. RESULTS The ATFL group failed at an angle of 33 ± 10°. In the IB group, construct failure occurred at an angle of 46 ± 16°. Failure torque reached 8.3 ± 4.5 Nm in the ATFL group, whereas the IB group achieved 11.2 ± 7.1 Nm. There was no correlation between angle at ATFL or IB construct failure or torque at failure, respectively, and BMD for both groups. CONCLUSION This study reveals that tape augmentation for ATFL reconstruction shows similar biomechanical stability compared to an intact native ATFL in terms of torque at failure and angle at failure. BMD did not influence the construct stability. Tape augmentation proved an enhanced initial stability in ATFL reconstruction which may allow for an accelerated rehabilitation process. LEVEL OF EVIDENCE II.
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Affiliation(s)
- M Willegger
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - E Benca
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - L Hirtler
- Institute of Anatomy, Medical University of Vienna, Vienna, Austria
| | - K Hradecky
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - J Holinka
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - R Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - R Schuh
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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25
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Sha Y, Wang H, Ding J, Tang H, Li C, Luo H, Liu J, Xu Y. A novel patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments. INTERNATIONAL ORTHOPAEDICS 2015; 40:59-64. [PMID: 26130278 DOI: 10.1007/s00264-015-2817-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/08/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We discuss the clinical effects of anatomical reconstruction of the lateral ankle ligaments to treat chronic lateral ankle instability (CAI) by creating fibular channels with a patient-specific navigational template. METHODS From August 2010 to February 2014, 15 patients presenting with CAI were treated by creating fibular channels with a patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments. RESULTS All patients were followed up for nine to 24 months postoperatively (15 months on average); no recurrent CAI was found. Pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores for patients in the calcaneofibular ligament (CFL) plus anterior talofibular ligament (ATFL) repair group were 48.3 ± 5.1 and 88.1 ± 6.7) respectively. The difference (average 39.8) showed high statistical significance (P < 0.001). Pre- and postoperative scores in the ATFL group were 50.4 ± 6.2 and 90.3 ± 7.8, respectively. The difference (average 39.9) showed high statistical significance (P < 0.001). Regarding the Good score, 14 patients were rated as "excellent and one as good (good = 100 %). No severe complications were found in the patients in this group. CONCLUSIONS We studied and successfully built a digital navigation template for creating fibular channels to anatomically reconstruct the lateral ankle ligament. By using the template, fibular channels could be built, and lateral ligaments could be anatomically reconstructed individually, easily and safely, which largely facilitates the treatment of CAI.
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Affiliation(s)
- Yong Sha
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Area Command of Chinese PLA, Kunming, China
| | - Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, China
| | - Jing Ding
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Area Command of Chinese PLA, Kunming, China
| | - Hui Tang
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Area Command of Chinese PLA, Kunming, China
| | - Chunxiao Li
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Area Command of Chinese PLA, Kunming, China
| | - Haotian Luo
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Area Command of Chinese PLA, Kunming, China
| | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, China
| | - Yongqing Xu
- Department of Orthopedics, Kunming General Hospital of Chengdu Military Area Command of Chinese PLA, Kunming, China.
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Haytmanek CT, Williams BT, James EW, Campbell KJ, Wijdicks CA, LaPrade RF, Clanton TO. Radiographic identification of the primary lateral ankle structures. Am J Sports Med 2015; 43:79-87. [PMID: 25325559 DOI: 10.1177/0363546514553778] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lateral ankle ligament injuries rank among the most frequently observed athletic injuries, requiring repair or reconstruction when indicated. However, there is a lack of quantitative data detailing the ligament attachment sites on standard radiographic views. PURPOSE To quantitatively describe the anatomic attachment sites of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) on standard radiographic views with respect to reproducible osseous landmarks to assist with intraoperative and postoperative assessment of lateral ankle ligament repairs and reconstructions. STUDY DESIGN Descriptive laboratory study. METHODS Twelve nonpaired, fresh-frozen cadaveric foot and ankle specimens were dissected to identify the origins and insertions of the 3 primary lateral ankle ligaments. Ligament footprint centers were marked with 2-mm stainless steel spheres shallowly embedded at the level of the cortical bone prior to obtaining standard lateral and mortise radiographs. Measurements were performed twice by 2 blinded raters independently to calculate mean distances and assess reliability via intraclass correlation coefficients (ICCs). RESULTS Radiographic measurements demonstrated excellent reproducibility between raters (all interobserver ICCs>0.97) and across trials (all intraobserver ICCs>0.99). On the lateral view, the ATFL fibular attachment (mean±SD) was 8.4±1.8 mm proximal and anterior to the inferior tip of the lateral malleolus and attached on the talus 13.8±2.0 mm proximal and anterior to the apex of the lateral talar process. The CFL originated 5.0±1.4 mm superior and anterior to the inferior tip of the lateral malleolus and inserted on the calcaneus 18.5±4.6 mm posterior and superior to the posterior point of the peroneal tubercle. On the mortise view, the ATFL origin was 4.9±1.4 mm proximal to the inferior tip of the lateral malleolus and inserted on the talus 9.0±2.1 mm medial and superior of the apex of the lateral talar process and 18.9±3.1 mm inferior and slightly lateral to the superior lateral corner of the talar dome. The fibular CFL origin was 2.9±1.6 mm proximal and slightly medial to the inferior tip of the lateral malleolus and inserted on the calcaneus 18.0±5.1 mm distal to the apex of the lateral talar process. CONCLUSION Radiographic parameters quantitatively describing the anatomic origins and insertions of the lateral ankle ligaments were defined with excellent reproducibility and agreement between reviewers. CLINICAL RELEVANCE Quantitative radiographic anatomy data will assist in preoperative planning, improve intraoperative localization, and provide objective measures for postoperative assessment of anatomic repairs and reconstructions.
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Affiliation(s)
- C Thomas Haytmanek
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | - Evan W James
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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Porter M, Shadbolt B, Stuart R. Primary ankle ligament augmentation versus modified Brostrom-Gould procedure: a 2-year randomized controlled trial. ANZ J Surg 2014; 85:44-8. [PMID: 25171115 DOI: 10.1111/ans.12837] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND More than 20% of patients develop chronic instability following appropriate management of an 'ankle sprain'. There is little research comparing surgical techniques. 'Anatomical' procedures, such as the modified Brostrom-Gould (MBG), are generally preferred. However, not all patients are suitable for this procedure. Augmentation of a primary repair using a synthetic ligament, such as the ligament augmentation reconstruction system (LARS), is another 'anatomic' option. Our objective was to compare the clinical outcome following the MBG with that following the LARS technique using a prospective randomized clinical trial. METHODS Patients who satisfied the study criteria were randomly allocated to undergo the LARS procedure or the MBG procedure. All patients followed a similar rehabilitation programme. Patients completed the foot and ankle outcome score (FAOS) before surgery, and then at 1 year and 2 years following surgery. Statistical analysis was used to compare the groups (P < 0.05). RESULTS Forty-one patients took part in the study, 21 were randomized to the LARS group and 20 to the MBG group. The LARS group had a significantly better improvement in the total FAOS at both 1 year (25.5 standard error (SE) 3.8 versus 16.0 SE 3.3) and 2 years (27.1 SE 4.5 versus 15.8 SE 4.9) post-surgery. CONCLUSION Primary repair combined with LARS results in better patient-scored clinical outcome, at 2 years post-surgery, than the MBG procedure. Although longer follow-up is required, the LARS procedure may be considered as an alternative, especially in those patients for whom the MBG is relatively contra-indicated.
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Affiliation(s)
- Mark Porter
- Porter Sports Orthopaedics, Canberra, Australian Capital Territory, Australia
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Viens NA, Wijdicks CA, Campbell KJ, Laprade RF, Clanton TO. Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Broström repair techniques with the intact anterior talofibular ligament. Am J Sports Med 2014; 42:405-11. [PMID: 24275864 DOI: 10.1177/0363546513510141] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The concept of utilizing nonabsorbable suture tape fixed directly to bone to augment Broström repairs of the anterior talofibular ligament (ATFL) has been proposed. No biomechanical studies of this technique are available. HYPOTHESIS We hypothesized that suture tape augmentation alone and Broström repair with suture tape augmentation would have similar biomechanical properties to the intact ATFL at time zero in a cadaveric model. STUDY DESIGN Controlled laboratory study. METHODS Eighteen fresh-frozen cadaveric ankles were randomized into 3 groups of 6 specimens each: (1) intact ATFL, (2) suture tape augmentation, and (3) Broström repair with suture tape augmentation. The specimens were loaded to failure to determine the strength and stiffness of each construct. RESULTS The mean ultimate load to failure of suture tape augmentation (315.5 ± 66.8 N) was significantly higher than that of the intact ATFL (154.0 ± 63.7 N) (P = .017). The mean ultimate load of the Broström repair with suture tape augmentation (250.8 ± 122.7 N) was not significantly different from that of the intact ATFL. The mean stiffness of augmentation alone (31.4 ± 9.9 N/mm) was significantly higher than that of the intact ATFL (14.5 ± 4.4 N/mm) (P = .008). The mean stiffness of the Broström repair with augmentation (21.1 ± 9.1 N/mm) was not significantly different from that of the intact ATFL. CONCLUSION The ATFL with suture tape augmentation is at least as strong and stiff as the native ATFL at time zero in a fresh-frozen cadaveric model. CLINICAL RELEVANCE The Broström repair for lateral ankle ligament ruptures is often unsuccessful in circumstances of poor tissue quality. Augmentations, such as with suture tape, have been proposed for these situations. Suture tape used alone or in combination with the Broström repair provided increased strength and stiffness compared with the standard Broström repair, which produced an immediate strength of less than 50% of the intact ATFL. Adding strength to the Broström repair may be valuable in patients with generalized ligamentous laxity, in large patients or elite athletes, or when graft reconstruction is not feasible.
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Affiliation(s)
- Nicholas A Viens
- Thomas O. Clanton, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
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Clanton TO, Viens NA, Campbell KJ, Laprade RF, Wijdicks CA. Anterior talofibular ligament ruptures, part 2: biomechanical comparison of anterior talofibular ligament reconstruction using semitendinosus allografts with the intact ligament. Am J Sports Med 2014; 42:412-6. [PMID: 24280308 DOI: 10.1177/0363546513509963] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anatomic reconstructions of the lateral ankle ligaments with grafts have been proposed for patients with generalized ligamentous laxity, long-standing instability with attenuated native tissues, varus hindfoot misalignment, or failed prior lateral ligament surgery and for very large patients or elite athletes because of increased demands. HYPOTHESIS Anatomic reconstruction of the anterior talofibular ligament (ATFL) using a semitendinosus allograft fixed with biocomposite interference fit screws would have similar biomechanical properties to the intact ATFL at time zero in a cadaveric model. STUDY DESIGN Controlled laboratory study. METHODS Allograft reconstruction of the ATFL was performed in 6 fresh-frozen cadaveric ankles. The specimens were loaded to failure to determine the strength and stiffness of the reconstruction and compared with data from 6 cadaveric specimens with intact ATFLs. RESULTS The mean ultimate load to failure of the allograft reconstruction (170.7 ± 54.8 N) was not significantly different from that of the intact ATFL (154.0 ± 63.7 N). The mean stiffness of the allograft reconstruction (23.1 ± 9.3 N/mm) was also not significantly different from that of the intact ATFL (14.5 ± 4.4 N/mm). CONCLUSION Anatomic reconstruction of the ATFL with allografts demonstrated similar strength and stiffness to the native ligament at time zero in a fresh-frozen cadaveric model. CLINICAL RELEVANCE This technique of anatomic reconstruction of the ATFL with allografts has biomechanical validation for use in clinical situations where a Broström repair of the lateral ankle ligaments is unlikely to be successful or has previously failed.
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Affiliation(s)
- Thomas O Clanton
- Thomas O. Clanton, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
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Budny AM, Schuberth JM. Autologous split peroneus longus lateral ankle stabilization. J Foot Ankle Surg 2012; 51:588-92. [PMID: 22819615 DOI: 10.1053/j.jfas.2012.05.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Indexed: 02/03/2023]
Abstract
Lateral ankle instability is a common clinical entity, and a variety of surgical procedures are available for stabilization after conservative management fails. Herein the authors reviewed outcomes after performing autologous split peroneus longus lateral ankle stabilization, using a previously described surgical technique to anatomically recreate the anterior talofibular and calcaneofibular ligaments. Twenty-five consecutive patients from 2 surgeons' practices underwent reconstruction between March 2007 and January 2011 with a minimum follow-up of 12 (range 12 to 51) months (mean 29.5 months). Follow-up interviews demonstrated 92.0% good or excellent outcomes with only 8.0% rating the outcome as fair and none as poor; 92.0% had no recurrent sprains or difficulty going up or down hills; 88.0% related no difficulty with uneven ground. The authors conclude that the autologous split peroneus longus lateral ankle stabilization results in a stable ankle with a low rate of complications and high patient satisfaction.
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Affiliation(s)
- Adam M Budny
- Attending Physician, Blair Orthopedics, Altoona, PA 16635, USA.
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Ellis SJ, Williams BR, Pavlov H, Deland J. Results of anatomic lateral ankle ligament reconstruction with tendon allograft. HSS J 2011; 7:134-40. [PMID: 22754413 PMCID: PMC3145865 DOI: 10.1007/s11420-011-9199-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 02/07/2011] [Indexed: 02/07/2023]
Abstract
Chronic ankle instability can be addressed surgically through direct lateral ligament repair, non-anatomic reconstruction, or anatomic reconstruction. The goal of this study was to assess the radiographic, functional, and clinical results of patients undergoing an anatomic lateral ankle ligament reconstruction using an anterior tibial tendon allograft. Eleven patients (12 feet; mean age, 48.9 ± 11.4 years) undergoing lateral ankle ligament reconstruction were followed at a mean of 3.5 ± 1.7 years after surgery (range, 1.2 to 5.0 years). Indications for surgery were previous failed repair (i.e., Broström; one case), hyperlaxity (seven cases), and high-demand patients (four cases). Subjective outcomes including the Foot and Ankle Outcome Score (FAOS), SF-36, and activity level were assessed. Mortise and lateral ankle stress radiographs were performed. The FAOS daily activity and sports activity subscores were 93.4 (range, 77.9 to 100) and 78.6 (range, 30 to 100), respectively. The SF-36v2 physical health and mental health components were 50.4 (range, 30.6 to 65.7) and 45.0 (range, 24.8 to 68.0), respectively. Four patients (five feet) reported no restriction; six patients reported mild restrictions, and one patient reported moderate activity restrictions. Tibiotalar tilt improved significantly from 20.2° to 4.6° after surgery (p < 0.01). The radiographic anterior displacement of the talus from the tibia was 6.5 mm postoperatively. The technique described restores mechanical stability in patients with chronic lateral ankle instability and may be considered in a select group of patients.
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Affiliation(s)
- Scott J. Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Benjamin Roller Williams
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Helene Pavlov
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA
| | - Jonathan Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Saxena A, Luhadiya A, Ewen B, Goumas C. Magnetic resonance imaging and incidental findings of lateral ankle pathologic features with asymptomatic ankles. J Foot Ankle Surg 2011; 50:413-5. [PMID: 21570324 DOI: 10.1053/j.jfas.2011.03.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Indexed: 02/03/2023]
Abstract
We prospectively evaluated 102 magnetic resonance imaging (MRI) examinations in 100 patients with asymptomatic lateral ankles. The patients were undergoing MRI for other ankle pathologic features, including medial ankle, posterior ankle, soft tissue masses, or Achilles tendon pain. No patient had had a recent lateral ankle injury or any surgery. Whether the anterior talofibular ligament, calcaneofibular ligament, and peroneal tendons were intact, torn, or absent was recorded. The average patient age was 46.4 years. Of the 100 patients, 67 (66%) had no history of a lateral ankle sprain, and 35 (34%) had sustained 1 or more sprains in the remote past. Also, 72 had an intact anterior talofibular ligament (71%), 90 had an intact calcaneofibular ligament (89%), 67 had intact peroneus brevis tendons (66%), and 68 (67%) had intact peroneus longus tendons. One accessory peroneal tendon was noted. Approximately 30% of asymptomatic patients undergoing MRI had abnormal anterior talofibular ligaments and peronei. Because the published data show that functional rehabilitation is successful for 90% of symptomatic lateral ankle patients, caution is warranted if choosing surgical treatment on the basis of the MRI findings alone.
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Affiliation(s)
- Amol Saxena
- Palo Alto Division, Palo Alto Foundation Medical Group, Palo Alto, CA 94301, USA.
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Abstract
Chronic ankle and subtalar joint (STJ) instability is a common clinical entity and the physician must be able to determine the exact pathologic condition for proper treatment. There are many diagnostic techniques that can be used to evaluate the ankle joint and STJ. These diagnostic techniques do not take the place of a proper patient history taking. Appropriate and aggressive rehabilitation should be attempted in all cases of chronic ankle and subtalar instability before electing surgical reconstruction.
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