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Migliorini F, Maffulli N, Cocconi F, Schäfer L, Bell A, Katusic D, Vaishya R. Better outcomes using suture button compared to screw fixation in talofibular syndesmotic injuries of the ankle: a level I evidence-based meta-analysis. Arch Orthop Trauma Surg 2024; 144:2641-2653. [PMID: 38740648 DOI: 10.1007/s00402-024-05354-x] [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: 08/30/2023] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION The present meta-analysis evaluated current level I clinical trials which compared the use of a suture button (SB) versus syndesmotic screw (SS) fixation techniques for syndesmosis injuries of the ankle. The outcomes of interest were to compare patient-reported outcome measures (PROMs) and complications. It was hypothesised that SB might achieve better PROMs along with a lower rate of complications. METHODS This study was conducted according to the 2020 PRISMA statement. In August 2023, PubMed, Web of Science, Google Scholar, and Embase were accessed. All the randomised controlled trials (RCTs) which compared SB versus SS fixation for syndesmosis injuries of the ankle were accessed. Data concerning the American Orthopaedic Foot & Ankle Society (AOFAS), and Olerud-Molander score (OMS) were collected at baseline and at last follow-up. Data on implant failure, implant removal, and joint malreduction were also retrieved. RESULTS Data from seven RCTs (490 patients) were collected. 33% (161 of 490) were women. The mean length of the follow-up was 30.8 ± 27.4 months. The mean age of the patients was 41.1 ± 4.1 years. Between the two groups (SB and SS), comparability was found in the mean age, and men:women ratio. The SS group evidenced lower OMS (P = 0.0006) and lower AOFAS (P = 0.03). The SS group evidenced a greater rate of implant failure (P = 0.0003), implant removal (P = 0.0005), and malreduction (P = 0.04). CONCLUSION Suture button fixation might perform better than the syndesmotic screw fixation in syndesmotic injuries of the ankle.
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Affiliation(s)
- Filippo Migliorini
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke On Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Federico Cocconi
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Luise Schäfer
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Andreas Bell
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, Simmerath, Germany
| | - Dragana Katusic
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), 39100, Bolzano, Italy
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, India
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Lewis TL, Ayathamattam J, Vignaraja V, Dalmau-Pastor M, Ferreira GF, Nunes GA, Ray R. Improvement in clinical outcomes following arthroscopic all-inside medial lateral ligament reconstruction for rotational ankle instability. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38770701 DOI: 10.1002/ksa.12244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/07/2024] [Accepted: 04/23/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Rotational ankle instability can be diagnosed in up to 18% of cases of chronic lateral ankle instability. It is characterised by an abnormal increase of talar rotation within the tibiofibular mortise, due to an injury in the most anterior component of the deltoid ligament secondary to a chronic deficiency of the lateral collateral ligament. The aim of this prospective observational study was to investigate the clinical outcomes following arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability. METHODS A prospective observational study of consecutive patients undergoing arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability with minimum 6-month follow-up. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire. Secondary outcomes included the EQ-5D, European Foot and Ankle Society score and complications. RESULTS Between 2020 and 2023, 12 patients underwent primary arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability with pre- and post-operative PROMs available for all 12 patients. The mean ± standard deviation age was 33.9 ± 7.2 years and the mean follow-up was 1.9 ± 1.2 (range: 0.5-3.8, interquartile range: 0.9-3.0) years. There was a significant improvement in all Manchester-Oxford Foot Questionnaire domain scores (p < 0.05): Index 53.1 ± 19.1 to 26.4 ± 27.6, Pain 46.7 ± 20.3 to 26.2 ± 26.8, Walking/Standing 58.7 ± 26.0 to 27.0 ± 30.0 and Social Interaction 51.2 ± 19.5 to 25.6 ± 30.1. There were improvements in EQ-5D-5L Index, VAS and VAS Pain; however, these were not statistically significant. There was one complication-a superficial peroneal nerve injury which resolved with a corticosteroid injection. CONCLUSION The arthroscopic all-inside medial and lateral ligament reconstruction technique is a reliable and safe method for treating rotational ankle instability, demonstrating significant improvement in PROMs at a mean 1.9-year follow-up. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- T L Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - J Ayathamattam
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - V Vignaraja
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - M Dalmau-Pastor
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - G F Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | - G A Nunes
- COTE Brasília Clinic, Foot and Ankle Unit, Brasília, Distrito Federal, Brazil
| | - R Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London, UK
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Nishikawa DRC, Saito GH, Mendes AAM, Marangon A, Tardini CH, de Oliveira Junior AS, Duarte FA, Prado MP. Functional outcomes and rates of return to sport activities in a non-athlete population after the open Brostrom-Gould repair: a seven-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1957-1962. [PMID: 38472435 DOI: 10.1007/s00590-024-03882-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION After an ankle sprain, up to 20% of patients may develop chronic lateral ankle instability (CLAI) requiring surgical treatment. The objective of this study was to investigate the functional outcomes and rates of return to sport activities in a cohort of non-athlete patients with chronic lateral ankle instability (CLAI) who underwent the opened Brostrom-Gould technique (BGT). MATERIALS AND METHODS Seventy-nine patients (seventy-nine feet) from three different centers undergoing BGT were reviewed. For clinical and functional analysis, the AOFAS ankle-hindfoot scale was applied and rates of return to sport activities were assessed. Correlation of Δ-AOFAS and rates of return to sport activities with all variables analyzed was performed. RESULTS Mean AOFAS score improved from 64.6 to 97.2 (p < 0.001). Sixty-one (77.2%) returned to preinjury activities and 18 (22.8%) changed to a lower-level modality. Symptoms of instability were related to Δ-AOFAS (p = 0.020). Change in the sport activity was related to pain and symptoms of instability (p = 0.41 and p < 0.001). CONCLUSION Recreational athlete patients who underwent the BGT demonstrated excellent functional outcomes after a mean follow-up of 7 years. Residual pain and symptoms of instability after surgery were the main complaints associated with limitations in physical activities.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil.
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP:01308-050, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Alberto Marangon
- Department of Orthopaedic Surgery, Clinica San Francesco, 21/B, Monte Ortigara Street, 37127, Verona, VR, Italy
| | - Carlos Henrique Tardini
- Department of Orthopaedic Surgery, Instituto Prata de Ortopedia, 161, Paineiras Street, Jardim, Santo André, SP, CEP 09090-521, Brazil
| | - Adilson Sanches de Oliveira Junior
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
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Basciani S, Zampogna B, Gregori P, Shanmugasundaram S, Guelfi M, Marinozzi A. Current concepts in ankle microinstability and ankle functional instability. J Clin Orthop Trauma 2024; 51:102380. [PMID: 38577562 PMCID: PMC10988036 DOI: 10.1016/j.jcot.2024.102380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/25/2024] [Accepted: 02/21/2024] [Indexed: 04/06/2024] Open
Affiliation(s)
- Susanna Basciani
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Biagio Zampogna
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
- BIOMORF Department Biomedical, Dental and Morphological and Functional Images, University of Messina. A.O.U Policlinico "G. Martino" Via Consolare Valeria, 1, 98124, Messina, Italy
| | - Pietro Gregori
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | | | - Matteo Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy
| | - Andrea Marinozzi
- Operative Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo 21, 00128, Rome, Italy
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Shi J, Chang Q, Ma M, Wang P, Li J. Diagnostic value of measuring the talofibular space using stress sonography in chronic lateral ankle instability. Eur J Radiol 2024; 170:111273. [PMID: 38113672 DOI: 10.1016/j.ejrad.2023.111273] [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: 05/18/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To investigate the diagnostic value of measuring the talofibular space using stress sonography for chronic lateral ankle instability (CLAI). MATERIALS & METHODS We recruited patients who were clinically diagnosed with CLAI between October 2018 and December 2019 (CLAI group). A control group of healthy volunteers was also included for this study. Both groups underwent a preliminary stress sonographic examination. First, the ultrasonic characteristics of the anterior talofibular ligament (ATFL), including length, thickness, relaxation, calcification, and rupture, were observed using conventional sonography. Second, the talofibular space at the passive neutral position (D1) and maximum varus position (D2) was measured (by stress sonographic images), and the difference (ΔD = D1-D2) between them was determined. Third, the parameters of the two groups were statistically compared. Finally, receiver operating characteristic (ROC) curves and area under the curve (AUC) analyses were performed for parameters with significant differences. RESULTS The CLAI group comprised 60 patients, yielding data on 60 ankles, whereas the control group comprised 35 participants, yielding data for 70 ankles. Differences in D1, D2, and ΔD of the talofibular space between the two groups were significant, with ΔD proving to be the best diagnostic indicator (P < 0.001). Its AUC, optimal cutoff value, sensitivity, and specificity were 0.922, 0.11 cm, 73 %, and 94 %, respectively, followed by D2 (0.850, 0.47 cm, 67 %, and 94 %, respectively; P < 0.001) and D1 (0.635, 0.47 cm, 67 %, and 94 %, respectively; P = 0.006). CONCLUSION Measurement of talofibular space in stress sonography is a valuable diagnostic indicator for CLAI, especially the ΔD between the neutral and stress position.
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Affiliation(s)
- Jinjun Shi
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Qin Chang
- Department of Orthopedics, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Ming Ma
- Department of Rehabilitation, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Pingping Wang
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
| | - Jia Li
- Department of Ultrasound, Affiliated Zhongda Hospital of Southeast University, No. 87 Dingjiaqiao, Hunan Road, Gulou District, Nanjing, China.
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Guelfi M, Baalbaki R, Malagelada F, Dalmau-Pastor M, Vega J. Arthroscopic all-inside ligament repair has similar or superior clinical outcomes compared to open repair for chronic ankle instability without concomitant intra-articular pathology at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:6052-6058. [PMID: 37843588 DOI: 10.1007/s00167-023-07621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Open ligament repair is widely considered the gold standard treatment for chronic ankle instability. Nevertheless, arthroscopic treatment of ankle instability has gained popularity becoming the preferred technique for many surgeons. This study aimed to compare the clinical outcomes of all-inside arthroscopic versus open lateral ligament repair for chronic ankle instability at 5 years follow-up. METHODS Ninety consecutive patients were surgically treated for chronic ankle instability without concomitant intra-articular pathology observed on MRI: 41 patients [median age 28 (range 15-54) years] underwent an open lateral ligament repair (OLR); 49 patients [median age 30 (range 19-47) years] underwent an all-inside arthroscopic ligament repair (ALR). Functional outcomes using the Foot Functional Index (FFI), the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score, and the Foot and Ankle Ability Measure-Sports Subscale (FAAM-SS) were assessed preoperatively and at the latest follow-up. At the latest follow-up, the satisfaction rate and complications were also recorded. RESULTS The mean follow-up was 58 ± 17.6 (range 47-81) months. In both groups FFI, AOFAS and FAAM-SS score significantly improved compared to preoperative values (p < 0.001). There was no statistically significant difference in postoperative outcomes between groups in the AOFAS (n.s) and FAAM-SS (n.s), but the FFI results were significantly better in the ALR group (p < 0.05). No major complications were reported in either group. CONCLUSION Open and arthroscopic ligament repair to treat chronic ankle instability without concomitant intra-articular pathology produced excellent comparable clinical outcomes at 5 years follow-up. The complications were minimal in both study groups with no significant differences in AOFAS and FAAM-SS scores. However, arthroscopic repair showed significantly better results on the FFI. Therefore, when treating chronic lateral ankle instability, surgeons should consider arthroscopic ligament repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matteo Guelfi
- Foot and Ankle Unit, Casa di Cura Villa Montallegro, Genoa, Italy.
- Department of Orthopaedic Surgery "Gruppo Policlinico Di Monza", Clinica Salus, Alessandria, Italy.
| | - Rayan Baalbaki
- Foot and Ankle Department, Clinique Montchoisi, Lausanne, Switzerland
| | - Francesc Malagelada
- Foot and Ankle Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Miki Dalmau-Pastor
- MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | - Jordi Vega
- MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
- Foot and Ankle Unit, Hospital Quirón, Barcelona, Spain
- iMove Traumatology Tres Torres, Barcelona, Spain
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Liu CX, Zhang ZZ, Wang JS, Luo XY, Liu TY, Ma YF, Deng XH, Zhou YF, Xu DZ, Li WP, Wang P, Song B. Optimal fibular tunnel direction for anterior talofibular ligament reconstruction: 45 degrees outperforms 30 and 60 degrees. Knee Surg Sports Traumatol Arthrosc 2023; 31:4546-4550. [PMID: 37308663 DOI: 10.1007/s00167-023-07452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/02/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE There is currently no consensus on the optimal drilling direction of the fibular bone tunnel for anterior talofibular ligament (ATFL) reconstruction, and few studies have investigated the potential injury to the peroneus longus and brevis tendons and the possibility of fibular fractures during the drilling process. The aim of this study was to assess the potential risk of drilling the tunnel from different directions and determine the most appropriate tunnel direction. The hypothesis was that drilling the tunnel in the 45-degree direction would be the safest and most suitable for the fibular tunnel. METHODS Forty-eight fibular tunnels were drilled on fresh ankle specimens using a K-wire guide and a 5.0 mm hollow drill. Three tunnel orientations were created, parallel to the sagittal plane of the long axis of the fibula and angled 30°, 45°, and 60° to the coronal plane. The length of the fibular tunnel and the distances from the outlet of the K-wire to the peroneus longus and brevis tendons were measured. The occurrence of a fibula fracture was also observed. RESULTS The lengths of the bone tunnels in the three groups were 32.9 ± 6.1 mm (30°), 27.2 ± 4.4 mm (45°) and 23.6 ± 4.0 mm (60°). The length of the tunnel drilled at 30° was the longest when compared with that of the tunnels drilled at 45° and 60° (all p values < 0.05). The distances from the outlet of the K-wire to the peroneus longus tendon were 3.0 ± 3.8 mm (30°), 3.8 ± 3.2 mm (45°) and 5.3 ± 1.8 mm (60°), and the distances to the peroneus brevis tendon were 4.2 ± 4.0 mm (30°), 6.1 ± 3.8 mm (45°), 7.9 ± 3.5 mm (60°). In terms of protecting the peroneus longus and brevis tendons, drilling in the 60° direction was better than drilling in the 30° and 45° directions (all p values < 0.05). The risk of injury to the peroneal longus and brevis tendons was 62.5% (30°), 31.3% (45°), and 0% (60°). Although no fibular fractures were observed in any of the three directions, drilling the bone tunnel in the 60° direction disrupted the lateral cortex of the fibula. CONCLUSION This study shows that drilling the tunnel in the 45° direction is less likely to cause injury to the peroneus longus and brevis tendons, while ensuring that the tunnel has a sufficient length and avoiding fracturing the distal fibula. Drilling a fibular bone tunnel in a 45° direction is safer and recommended for ATFL reconstruction.
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Affiliation(s)
- Cheng-Xiao Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Zheng-Zheng Zhang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Jing-Song Wang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Xi-Yuan Luo
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tian-Yu Liu
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yu-Fan Ma
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xing-Hao Deng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Yun-Feng Zhou
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Da-Zheng Xu
- Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wei-Ping Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China
| | - Peng Wang
- Department of Orthopedics, Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China.
| | - Bin Song
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, No. 107 on Yanjiang Road West, Guangzhou, 510120, Guangdong, China.
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Luthfi APWY, Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Kawabata S, Adachi N. Risk Factors for the Recurrence of Instability After Lateral Ankle Ligament Repair. Foot Ankle Int 2023; 44:617-628. [PMID: 37162133 DOI: 10.1177/10711007231171080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Arthroscopic anterior talofibular ligament (ATFL) repair is widely performed for chronic lateral ankle instability (CLAI). Although many studies have reported excellent outcomes with this procedure, the recurrence of instability remains a common concern. Therefore, this study aimed to analyze the risk factors for the recurrence of instability after arthroscopic repair for CLAI. METHODS Fifty-six ankles of 53 patients with a mean age of 31.8 ± 14.7 years were retrospectively reviewed. All patients underwent arthroscopic ATFL repair. If instability remained immediately after ATFL repair, calcaneofibular ligament (CFL) repair was performed. The Ankle Activity Score (AAS) was assessed preoperatively, and clinical outcomes including the Japanese Society for Surgery of the Foot scale, Karlsson-Peterson scores, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated preoperatively and at the final follow-up. Talar tilt angle (TTA) was assessed preoperatively and 1 year postoperatively. Ankles were divided into 2 groups-nonrecurrence (postoperative TTA, <6 degrees) and recurrence (postoperative TTA, ≥6 degrees)-and clinical outcomes were compared. RESULTS Sixteen ankles showed recurrent instability, whereas 40 did not. AAS, TTA, and social functioning in the SAFE-Q were significantly higher in the recurrence group than those in the nonrecurrence group preoperatively. In addition, the rate of poor ATFL remnant quality and the number of CFLs not repaired despite the preoperative injury diagnosis were significantly higher in the recurrence group than in the nonrecurrence group. CONCLUSION Arthroscopic repair for ATFL and CFL deficiencies with preoperative high activity, poor remnant quality, and neglected CFL injury can result in the recurrence of instability. Appropriate surgical procedures to prevent the recurrence of instability should be selected for these ankles. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Andi Praja Wira Yudha Luthfi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Orthopaedics and Traumatology, Bhayangkara Tk.I R. Said Sukanto Police Hospital, Jakarta, Indonesia
| | - Tomoyuki Nakasa
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Zhang Y, Wang X, Wang X, Cao J, Wang H, Zhang F. Allogeneic tendons in the treatment of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability. BMC Musculoskelet Disord 2023; 24:273. [PMID: 37038121 PMCID: PMC10084655 DOI: 10.1186/s12891-023-06390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The aim of this study is to report our institution's experience regarding the application of allogeneic tendons for the reconstruction of malunited lateral malleolar avulsion fractures with chronic lateral ankle instability. METHODS This retrospective study included 34 (34 ankles) patients surgically treated for malunited lateral malleolar avulsion fractures with chronic lateral ankle instability from January 2016 to December 2019. All patients underwent allogeneic tendon reconstruction. The pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores、Karlsson Ankle Functional Scores (KAFS) and visual analogue scale (VAS) scores were used to evaluate the functional recovery of the ankle joint. The final follow-up, based on radiographic assessment, including talar tilt and anterior talar translation, was performed to evaluate the stability of the postoperative ankle joints. RESULTS Thirty-two patients (32 ankles) returned for final clinical and radiologic follow-up at an average of 29 (range 24-35) months and 2 patients (2 ankles) were lost to follow-up. The preoperative talus inclination angle (13.6 ± 1.9°) and anterior displacement (9.6 ± 2.8 mm) were re-examined under X-ray and found to be reduced to 3.4 ± 1.2° and 3.8 ± 1.1 mm, respectively (p<0.01). The AOFAS scores increased from 58.5 ± 4.0 to 90.9 ± 3.8 and the Karlsson scores improved from 52.2 ± 3.6 to 89.8 ± 4.5, which was obviously better and the difference was statistically significant (P < 0.01). The VAS scores were significantly reduced from a preoperative mean of 6.8 ± 1.0 to 2.8 ± 0.9 postoperatively (p<0.01). CONCLUSION In this population and with this follow-up, the application of allogeneic tendons to treat malunited lateral malleolar avulsion fractures combined with chronic lateral ankle instability appeared safe and effective.
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Affiliation(s)
- Yu Zhang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xin Wang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Xiaomeng Wang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Jianming Cao
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Huijuan Wang
- Department of Histology and Embryology, Hebei Medical University, Shijiazhuang, 050017, Hebei, China
| | - Fengqi Zhang
- Department of Foot and Ankle Orthopaedics Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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Jackson JB. CORR Insights®: Apoptosis Occurs in the Anterior Talofibular Ligament of Patients With Chronic Lateral Ankle Instability: An In Vitro Study. Clin Orthop Relat Res 2022; 480:2430-2431. [PMID: 36214793 PMCID: PMC10538934 DOI: 10.1097/corr.0000000000002404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Affiliation(s)
- J Benjamin Jackson
- Assistant Professor, Orthopaedic Surgery, University of South Carolina, Columbia, SC, USA
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