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Cordier G, Boudahmane S, Ovigue J, Michels F, Araujo Nunes G, Dallaudiere B. MRI Assessment of Tendon Graft After Lateral Ankle Ligament Reconstruction: Does Ligamentization Exist? Am J Sports Med 2024; 52:721-729. [PMID: 38343192 DOI: 10.1177/03635465231225487] [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: 03/02/2024]
Abstract
BACKGROUND No description exists in the literature about the normal evolution of tendon graft after a lateral ankle ligament (LAL) reconstruction. PURPOSE To assess the magnetic resonance imaging (MRI) characteristics and the evolution of the tendon graft during different moments in the follow-up after an endoscopic reconstruction of the LAL. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This prospective study included 37 consecutive patients who underwent an endoscopic reconstruction of the LAL with an autograft using the gracilis tendon to treat chronic ankle instability (CAI) resistant to nonoperative treatment (CAI group) and 16 patients without ankle instability (control group). All patients in the CAI group underwent a postoperative assessment at 6, 12, and 24 months using the Karlsson score and MRI examination. Only patients with good and excellent results were included in the study. Graft assessment consisted of qualitative measurements and quantitative evaluations of the reconstructed anterior talofibular ligament (RATFL) and reconstructed calcaneofibular ligament (RCFL), including signal-to-noise quotient (SNQ) and contrast-to-noise quotient (CNQ) measurements in proton density-fat suppressed (PD-FS) and T1-weighted sequences. The analysis of variance test was used to compare the SNQ and the CNQ at different time points for each sequence. RESULTS The MRI signal at 6 months was increased compared with that of the control group. Next, a significant signal decrease from 6 to 24 months was noted on PD-FS and T1-weighted images. SNQ measurements on PD-FS weighted images for both the RATFL and the RCFL demonstrated a significantly higher signal (P < .01 and P = .01, respectively) at 6 months compared with that of the control group. Subsequently, the signal decreased from 6 to 24 months. Similarly, CNQ measurements on PD-FS weighted images for both the RATFL and the RCFL demonstrated a significantly higher signal (P < .01 and P < .01, respectively) at 6 months compared with that of the control group. Subsequently, the signal decreased from 6 to 24 months. CONCLUSION The present study demonstrated an evolution of the MRI characteristics, suggesting a process of graft maturation toward ligamentization. This is important for clinical practice, as it suggests an evolution in graft properties and supports the possibility of creating a viable ligament.
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Affiliation(s)
- Guillaume Cordier
- Clinique du Sport, Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Sofiane Boudahmane
- Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Merignac, Merignac, France
| | - Jordan Ovigue
- Clinique du Sport de Bordeaux-Merignac, Merignac, France
| | - Frederick Michels
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Orthopaedic Department, AZ Groeninge, Kortrijk, Belgium
- EFAS, ESSKA-AFAS Ankle Instability Group
| | - Gustavo Araujo Nunes
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Cote Brasília Clinic, DF, Brasilia, Brazil
| | - Benjamin Dallaudiere
- Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Merignac, Merignac, France
- Centre de Résonance Magnétique des Systèmes Biologiques, Université de Bordeaux, Bordeaux, France
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Hu D, Wang N, Wang H, Fan D, Teng Q, Zheng X, Hou H. Clinical outcomes of arthroscopic all-inside anterior talofibular ligament suture augmentation repair versus modified suture augmentation repair for chronic ankle instability patients. BMC Musculoskelet Disord 2024; 25:48. [PMID: 38200504 PMCID: PMC10777501 DOI: 10.1186/s12891-023-07085-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/30/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND To compare the clinical efficacies of arthroscopic anterior talofibular ligament suture augmentation repair and modified suture augmentation repair in patients with chronic ankle instability (CAI). METHODS From October 2019 to August 2020, 100 patients with CAI were enrolled after propensity score matching analysis and observed for two years. Among them, 50 underwent modified suture augmentation repair and the other 50 underwent suture augmentation repair. The clinical efficacies of CAI treatments were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) clinical rating scale, visual analog scale (VAS), and anterior drawer test scores. RESULTS The postoperative AOFAS score of the modified suture augmentation repair group (83.8 ± 11.3) was significantly higher than that of the suture augmentation repair group (76.3 ± 11.3; P = 0.001). The VAS (P = 0.863) and anterior drawer test (P = 0.617) scores were not significantly different between the two treatment groups. CONCLUSION Both the modified suture augmentation repair and suture augmentation repair demonstrated good clinical efficacies. The AOFAS score of the modified suture augmentation repair group was superior to that of the conventional suture augmentation repair group. Thus, modified suture augmentation repair is a feasible and practical surgical technique for CAI treatment.
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Affiliation(s)
- Dahai Hu
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
- International School, Jinan University, Guangzhou, 510632, Guangdong, China
| | - Nan Wang
- Department of Clinical Medicine, School of Medicine, Jinan University, Guangzhou, 510632, China
| | - Huajun Wang
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Dongyi Fan
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Qiang Teng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China
| | - Xiaofei Zheng
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
| | - Huige Hou
- Department of Bone and Joint Surgery and Sports Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, China.
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Veiga Sanhudo JA, Ferkel E, Alencar Mendes de Carvalho K. Chronic Lateral Ankle Instability: Can We Get Even Better with Surgical Treatment? Foot Ankle Clin 2023; 28:321-332. [PMID: 37137626 DOI: 10.1016/j.fcl.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ligament attenuation may occur after repetitive ankle sprains, creating instability. Management of chronic ankle instability requires a comprehensive approach to mechanical and functional instability. Surgical treatment, however, is indicated when conservative treatment is not effective. Ankle ligament reconstruction is the most common surgical procedure to resolve mechanical instability. Anatomic open Broström-Gould reconstruction is the gold standard for repairing affected lateral ligaments and returning athletes to sports. Arthroscopy may also be beneficial for identifying associated injuries. In severe and long-standing instability, reconstruction with tendon augmentation could be necessary.
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Affiliation(s)
- Jose Antonio Veiga Sanhudo
- Foot & Ankle Department, Hospital Moinhos de Vento, Avenida Juca Batista 8000, 18 Porto Alegre RS, Brazil CEP 91781-200.
| | - Eric Ferkel
- Southern California Orthopedic Institute, 6815 Noble Avenue, Suite 200, Van Nuys, CA, USA
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Elaraby AER, Shahien M, Jahan AM, Etoom M, Bekhet AH. The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-analysis. ADVANCES IN REHABILITATION SCIENCE AND PRACTICE 2023; 12:11795727231151636. [PMID: 36891135 PMCID: PMC9933927 DOI: 10.1177/11795727231151636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/02/2023] [Indexed: 02/11/2023]
Abstract
Introduction Orthopedic ankle injuries are considered among the most common musculoskeletal injuries. A wide variety of modalities and techniques have been used for the management of these injuries, and virtual reality (VR) is one modality that has been examined in ankle injuries rehabilitation. Purpose This study aims to systemically review previous studies evaluating the effect of virtual reality in rehabilitating orthopedic ankle injuries. Methods We searched six online databases: PubMed, Web of Science (WOS), Scopus, the Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL), and Cochrane Central Register of Controlled Trials (CENTRAL). Results Ten randomized clinical trials met the inclusion criteria. Our results showed that VR had a significant effect on overall balance compared to conventional physiotherapy (SMD = 0.359, 0.009-0.710 P = 0.04), [I 2= 17%, P = 0.30]. Compared with conventional physiotherapy, VR programs significantly improved gait parameters such as speed and cadence, muscle power, and perceived ankle instability; however, no significant difference was detected in the foot and ankle ability measure (FAAM). Additionally, significant improvements in static balance and perceived ankle instability were reported after the use of VR balance and strengthening programs. Finally, only two articles were deemed to have good quality, and the other studies' quality ranged from poor to fair. Conclusion VR rehabilitation programs can be used to rehabilitate ankle injuries, as they are regarded as safe interventions and have promising effects. However, there is a need for studies with high quality since most included studies' quality varied from poor to fair.
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Affiliation(s)
- Abd El Rahman Elaraby
- Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Impact Research Group, Cairo, Egypt
| | - Mostafa Shahien
- Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Impact Research Group, Cairo, Egypt
| | - Alhadi M Jahan
- Impact Research Group, Cairo, Egypt.,School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada.,Department of Physiotherapy, College of Medical Technology, Misrata, Libya
| | - Mohammad Etoom
- Division of physical therapy, allied medical sciences department, Aqaba University of Technology, Aqaba, Jordan
| | - Amira Hassan Bekhet
- Faculty of Physical Therapy, Cairo University, Giza, Egypt.,Impact Research Group, Cairo, Egypt.,Medical Research Group of Egypt (MRGE), Cairo, Egypt
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Yoshimoto K, Noguchi M, Maruki H, Tominaga A, Ishibashi M, Okazaki K. Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair. Knee Surg Sports Traumatol Arthrosc 2022; 31:2183-2191. [PMID: 36396801 DOI: 10.1007/s00167-022-07211-z] [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: 06/08/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The relationship between ligament remnant quality and postoperative outcomes after arthroscopic lateral ankle ligament repair for chronic lateral ankle instability is controversial. This study aimed to determine whether the signal intensity of the anterior talofibular ligament on preoperative magnetic resonance imaging and ligament remnant quality identified on arthroscopy are associated with recurrent ankle instability after arthroscopic lateral ankle ligament repair. METHODS A total of 68 ankles from 67 patients with chronic lateral ankle instability who underwent arthroscopic lateral ankle ligament repair were retrospectively studied. The signal intensity of the anterior talofibular ligament was evaluated using T2-weighted magnetic resonance imaging. Arthroscopy was used to evaluate the thickness and mechanical resistance of the anterior talofibular ligament by hook palpation and to classify ankles into two groups: the present anterior talofibular ligament group with adequate mechanical resistance and the absent anterior talofibular ligament group with no mechanical resistance. The outcomes included recurrent ankle instability (respraining of the operated ankle after surgery) and Self-Administered Foot Evaluation Questionnaire scores. RESULTS Thirteen ankles were diagnosed with recurrent ankle instability. Patients with a high anterior talofibular ligament T2 signal intensity experienced more recurrent ankle instability than those with a low intensity. As determined via arthroscopy, the absent anterior talofibular ligament group had a higher rate of recurrent ankle instability than the present anterior talofibular ligament group. There were no significant differences in Self-Administered Foot Evaluation Questionnaire scores between patients with high and low anterior talofibular ligament T2 signal intensity, as well as between absent and present anterior talofibular ligament groups based on arthroscopy. CONCLUSION Poor quality of the anterior talofibular ligament remnant could result in recurrent ankle instability after arthroscopic lateral ankle ligament repair. Therefore, when treating chronic lateral ankle instability, surgeons should consider ligament quality. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Kensei Yoshimoto
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-0054, Japan.,Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-Ku, Tokyo, 157-8550, Japan
| | - Masahiko Noguchi
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-0054, Japan. .,Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-Ku, Tokyo, 157-8550, Japan. .,Department of Orthopaedic Surgery, Saitama Medical University Hospital, Moroyama, Saitama, Japan.
| | - Hideyuki Maruki
- Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-Ku, Tokyo, 157-8550, Japan.,Department of Orthopaedic Surgery, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Ayako Tominaga
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-0054, Japan.,Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-Ku, Tokyo, 157-8550, Japan
| | - Mina Ishibashi
- Orthopaedic Foot and Ankle Center, Shiseikai Daini Hospital, 5-19-1 Kamisoshigaya, Setagaya-Ku, Tokyo, 157-8550, Japan
| | - Ken Okazaki
- Department of Orthopedic Surgery, Tokyo Women's Medical University, 8-1 Kawadacho, Shinjuku-Ku, Tokyo, 162-0054, Japan
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Su T, Jiang YF, Hou ZC, Zhao YQ, Chen W, Hu YL, Guo QW, Jiang D, Jiao C. The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30:2166-2173. [PMID: 35217882 DOI: 10.1007/s00167-022-06880-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/13/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To compare the mid- to long-term clinical and radiological outcomes of the confluent L-shaped tunnel technique with the Y-graft technique for anatomic lateral ankle ligament reconstruction. METHODS This retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L-shaped tunnel group and 24 patients in the Y-graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow-up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared. RESULTS The mean follow-up times were 72 and 42 months for the L-shaped group and Y-graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L-shaped group vs. 2.53 ± 1.29 in the Y-graft group, p = 0.035). The incidence of flexion-extension ROM restriction (≥ 5°) was significantly higher in the Y-graft group (41.2%) than in the L-shaped group (12.5%) (p = 0.035). CONCLUSIONS Both the confluent L-shaped tunnel technique and the Y-graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid- to long-term follow-up. The confluent L-shaped tunnel technique resulted in lower rates of flexion-extension ROM restriction, while the Y-graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Zong-Chen Hou
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Yu-Qing Zhao
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China.
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China.
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Abstract
Ankle sprains are mainly benign lesions, but if not well addressed can evolve into permanent disability. A non-treated lateral, syndesmotic or medial ankle instability can evolve into ankle osteoarthritis. For this reason, diagnosis and treatment of these entities is of extreme importance.In general, acute instabilities undergo conservative treatment, while chronic instabilities are better addressed with surgical treatment. It is important to identify which acute instabilities are better treated with early surgical treatment.Syndesmosis injuries are frequently overlooked and represent a cause for persistent pain in ankle sprains. Unstable syndesmotic lesions are always managed by surgery.Non-treated deltoid ligament ruptures can evolve into a progressive valgus deformity of the hindfoot, due to its links with the spring ligament complex. This concept would give new importance to the diagnosis and treatment of acute medial ligament lesions.Multi-ligament lesions are usually unstable and are better treated with early surgery. A high suspicion rate is required, especially for combined syndesmotic and medial lesions or lateral and medial lesions.Ankle arthroscopy is a powerful tool for both diagnostic and treatment purposes. It is becoming mandatory in the management of ankle instabilities and multiple arthroscopic lateral/syndesmotic/medial repair techniques are emerging. Cite this article: EFORT Open Rev 2021;6:420-431. DOI: 10.1302/2058-5241.6.210017.
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Affiliation(s)
- Nuno Corte-Real
- Department of Orthopaedics, Hospital de Cascais Dr. José de Almeida, Portugal
| | - João Caetano
- Department of Orthopaedics, Hospital de Cascais Dr. José de Almeida, Portugal
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