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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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Zaid HHG, Hua X, Huang Y, Chen B, Jichuan Z, Yang G. Perioperative duloxetine improves postoperative outcomes after anterior talofibular ligament repair for chronic lateral ankle instability for patients with depression: A prospective randomized clinical trial. Orthop Traumatol Surg Res 2024:103837. [PMID: 38355009 DOI: 10.1016/j.otsr.2024.103837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Recent studies have indicated that depression is associated with persistent postoperative pain and decreased satisfaction following foot and ankle surgery. This study aimed to evaluate the effect of perioperative duloxetine on postoperative outcomes of anterior talofibular ligament (ATFL) surgical repair for chronic ankle instability (CAI) in patients with depression. We further sought to evaluate patients' satisfaction and side effects related to duloxetine. MATERIAL AND METHODS Patients undergoing ATFL repair were screened for depression preoperatively with the Patient Health Questionnaire (PHQ-9). Among 249 patients who underwent arthroscopic or open surgical Brostrom repair of the ATFL, 120 patients were identified as being "possibly depressed" and were included in the study. Sixty patients were randomly assigned to the duloxetine group (one day preoperatively and for 6 weeks postoperatively), and the other sixty were randomized to the placebo group. Painkillers and opioid consumption, pain scores, and patient satisfaction were recorded at 12, 24, 48, and 72hours postoperatively and at follow-up visits 1, 3, and 6 months after surgery. Patient-reported outcome measures (PROMs) were assessed preoperatively and at 3, 6, 12 and 24 months postoperatively. Duloxetine-related side effects such as nausea/vomiting and fatigue were also recorded. RESULTS The patients in the duloxetine group reported a significantly longer time to rescue analgesic and reduced opioid requirements (including celecoxib, pregabalin, acetaminophen, and tramadol). The patients experienced decreased pain intensity and greater satisfaction with their pain management at 24, 48, 72h and 1 and 3 months after surgery (p<0.05). The duloxetine group also had significantly better clinical and functional outcomes at 3 and 6 months of follow-up compared to the placebo group (p<0.05). The occurrence and rate of symptoms of duloxetine side effects were not significant. DISCUSSION Depression is an important factor to consider and address because its presence before surgery can predict poor postoperative outcomes, including more severe postoperative pain, persistent postoperative pain, and increased consumption of painkillers and opioids. CONCLUSION Perioperative administration of duloxetine following ATFL repair for CAI in patients with depression increased the time to first postoperative rescue analgesic request and reduced both opioid consumption and postoperative pain. This approach also led to a high level of patient satisfaction. In addition, duloxetine improved the quality of recovery without leading to significant side effects. LEVEL OF EVIDENCE I; prospective randomized controlled trial.
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Affiliation(s)
- Hamood H G Zaid
- Department of Sports Medicine, the First Affiliated Hospital of Xiamen University, No. 55, Zhenhai Street, Siming District, Fujian Province, 361026 Xiamen City, China
| | - Xu Hua
- Department of Orthopedics, Xinglin Branch of the First Affiliated Hospital of Xiamen University, No. 11, Xinglin Hongdai Road, Jimei District, Fujian Province, 361026 Xiamen City, China
| | - Yafu Huang
- Department of Orthopedics, Xinglin Branch of the First Affiliated Hospital of Xiamen University, No. 11, Xinglin Hongdai Road, Jimei District, Fujian Province, 361026 Xiamen City, China
| | - Bingyi Chen
- Department of Orthopedics, Xinglin Branch of the First Affiliated Hospital of Xiamen University, No. 11, Xinglin Hongdai Road, Jimei District, Fujian Province, 361026 Xiamen City, China
| | - Zhuang Jichuan
- Department of Orthopedics, Xinglin Branch of the First Affiliated Hospital of Xiamen University, No. 11, Xinglin Hongdai Road, Jimei District, Fujian Province, 361026 Xiamen City, China
| | - Guo Yang
- Department of Sports Medicine, the First Affiliated Hospital of Xiamen University, No. 55, Zhenhai Street, Siming District, Fujian Province, 361026 Xiamen City, China.
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Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Vialle R, Langlais T, Hardy A. Biomechanical evaluation of the anterior talo-fibular and calcaneo-fibular ligaments using shear wave elastography in young healthy adults. Orthop Traumatol Surg Res 2024; 110:103647. [PMID: 37356798 DOI: 10.1016/j.otsr.2023.103647] [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: 10/06/2021] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the stiffness of the anterior talo-fibular ligament (ATFL) and calcaneo-fibular ligament (CFL) using shear wave elastography (SWE) with the ankle in the neutral position and in varus, in young healthy adult volunteers. We also evaluated the reliability and reproducibility of the SWE measurements. HYPOTHESIS The stiffness of both ligaments increases with increasing ankle varus. SWE may be a reliable tool for evaluating the lateral collateral ligament complex of the ankle. MATERIAL AND METHODS We used SWE to evaluate both ankles of each of 20 healthy volunteers (10 females and 10 males). For each test, the foot was placed on a hinged plate and tested in the neutral position and in 15° and 30° of varus. Stiffness was evaluated based on shear wave velocity (SWV). RESULTS Stiffness of both the ATFL and CFL was minimal in the neutral position (2.06m/s and 3.43m/s, respectively). Stiffness increased significantly for both ligaments in 15° of varus (2.48m/s and 4.11m/s, respectively; p<0.0001) and was greatest in 30° of varus (3.15m/s and 4.57m/s, respectively; p<0.0001). ATFL stiffness was greater in males than in females in 15° (p=0.04) and 30° (p=0.02) of varus. For the CFL, in contrast, stiffness was not different between males and females. Stiffness of the ATFL and CFL was not associated with age, dominant side, height, or foot morphology. No correlations were found between stiffness of the two ligaments in any of the positions. Repeating each measurement three times produced excellent concordance for both ligaments in all three positions. CONCLUSION The ATFL and CFL are the main lateral stabilisers of the ankle, and each exerts a specific function. Their stiffness increases with the degree of varus. This study describes a protocol for evaluating ATFL and CFL density by SWE, which is a reliable and reproducible technique that provides a normal range. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Grégoire Rougereau
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique adulte, hôpital de la Pitié-Salpêtrière, université de la Sorbonne, AP-HP, 75571 Paris, France.
| | - Thibault Marty-Diloy
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Marie Vigan
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Unité de recherche clinique, hôpitaux universitaires Paris Île-de-France Ouest, AP-HP, 92100 Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France
| | - Raphaël Vialle
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département hospitalo-universitaire MAMUTH pour les thérapies innovantes dans les maladies musculosquelettiques, université de la Sorbonne, Paris, France
| | - Tristan Langlais
- Département de chirurgie orthopédique pédiatrique, hôpital Armand-Trousseau, université de la Sorbonne, AP-HP, 75571 Paris, France; Département de chirurgie orthopédique pédiatrique, hôpital des enfants, université de Toulouse, Purpan, Toulouse, France
| | - Alexandre Hardy
- Département de chirurgie orthopédique, clinique du sport, 75005 Paris, France
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Lee TY, Chen PY, Yang KC, Tzeng IS, Ming Chang C, Wang CC. Comparison of Knot-Tying Techniques During the Arthroscopic Broström-Gould Procedure: Semiconstrained Freehand Versus Knot Pusher Techniques. Orthop J Sports Med 2024; 12:23259671231218649. [PMID: 38274016 PMCID: PMC10809873 DOI: 10.1177/23259671231218649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/29/2023] [Indexed: 01/27/2024] Open
Abstract
Background The arthroscopic Broström technique with or without Gould modification has been used to treat patients with anterior talofibular ligament injury who failed nonoperative management and progressed to chronic lateral ankle instability. However, some patients develop limited range of motion over the ankle joint postoperatively. Purpose/Hypothesis To compare the clinical outcomes and midterm functional performance of knot-tying techniques between using a knot pusher and a semiconstrained freehand tie during arthroscopic Broström-Gould procedure with inferior extensor retinaculum (IER) augmentation. It was hypothesized that the semiconstrained freehand tie would provide better plantarflexion of the ankle joint compared with the knot pusher. Study Design Cohort study; Level of evidence, 3. Methods Included were 135 consecutive patients with mild-to-moderate lateral ankle instability (mean age, 42.7 years; range, 16-78 years) who underwent an arthroscopic Broström-Gould procedure from March 1, 2016, to April 30, 2022. The patients were divided into 2 groups according to the tying technique used in the Gould modification: surgical tie using a knot pusher (KP group; n = 30) or a semiconstrained freehand tie (FT group; n = 105). Radiographic parameters and ultrasound dynamic testing were examined during the preoperative assessment. Preoperative and 2-year postoperative assessments comprised American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale for pain, and 12-Item Short Form Survey (SF-12) scores. Results The 2 groups had no differences in age, sex, or severity distribution in the preoperative assessment. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale, visual analog scale pain, and SF-12 scores were significantly better at the postoperative evaluation (all P < .05) in both groups. No significant difference was noted between groups in outcome scores. In the KP group, however, 7 out of 30 patients (23.3%) developed ankle stiffness with tightness when performing plantarflexion movement. No patients in the FT group reported similar symptoms. Conclusion For mild-to-moderate chronic lateral ankle instability, we propose an arthroscopic Broström procedure with the addition of IER augmentation using a semiconstrained freehand tie to avoid overtightening the IER. This ensures favorable patient satisfaction and clinical outcomes without limitation of plantarflexion of the ankle joint and avoids the possible complication of stiffness with plantarflexion.
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Affiliation(s)
- Tung-Ying Lee
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Pei-Yu Chen
- Department of Orthopedic Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kai-Chiang Yang
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Chia Ming Chang
- Department of Orthopedic Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, Tzu Chi University, Hualien, Taiwan
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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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Han J, Qian S, Lian J, Wu H, Zheng B, Wu X, Xu F, Wei S. Modified classifications and surgical decision-making process for chronic anterior talofibular ligament injuries based on the correlation of imaging studies and arthroscopic findings. INTERNATIONAL ORTHOPAEDICS 2023; 47:2683-2692. [PMID: 37477681 DOI: 10.1007/s00264-023-05896-6] [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: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Surgical treatment of chronic ankle instability (CAI) typically includes ligament repair or reconstruction. Using preoperative ultrasonography or magnetic resonance imaging (MRI) to choose an appropriate arthroscopic procedure is still difficult. The aim of this study was to evaluate the correlation of imaging studies with arthroscopic findings and support the arthroscopic surgical decision-making process. METHODS One hundred twelve patients with chronic anterior talofibular ligament (ATFL) injuries were treated using the arthroscopic surgical decision-making process from November 2018 to August 2020. Preoperative imaging assessments using dynamic ultrasonography, MRI, and combined methods were applied to categorize the ATFL remnants into three quality grades ("good," "fair," and "poor"). Arthroscopic findings were classified into 6 major types (7 subtypes) and used to select an appropriate surgical procedure. Correlations between imaging studies, arthroscopic findings, and surgical methods were evaluated. Diagnostic parameters, clinical outcomes, and complications were also assessed. RESULTS There was a significant interobserver agreement in the evaluation of dynamic ultrasonography (0.954, P < 0.001), MRI (0.958, P < 0.001), and arthroscopy diagnosis (0.978, P < 0.001). There was a significant correlation between the modified imaging classifications, arthroscopic diagnostic types, and surgical procedures. The mean follow-up period was 33.58 ± 8.85 months. Significant improvements were documented in postoperative ankle functions when assessed with Karlson-Peterson scores and Cumberland Ankle Instability Tool scores. The risk of complications is also very low. CONCLUSION The modified classifications and surgical decision-making process based on dynamic ultrasonography, MRI, and arthroscopic findings, as proposed in this study, might help in selecting an appropriate arthroscopic surgical procedure for chronic ATFL injuries.
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Affiliation(s)
- Jing Han
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Shenglong Qian
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Junhong Lian
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
| | - Helin Wu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
- The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Boyu Zheng
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
- Wuhan University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Xinchen Wu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
- Hubei University of Medicine, Shiyan, Hubei Province, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China
- The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, previously), NO. 627, Wuluo Road, Wuhan, 430030, Hubei Province, People's Republic of China.
- The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.
- Wuhan University of Science and Technology, Wuhan, Hubei Province, People's Republic of China.
- Hubei University of Medicine, Shiyan, Hubei Province, People's Republic of China.
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Huang Q, Ji XX, Zhu WH, Cai YH, Cao LH, Wang YC. A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair. Chin J Traumatol 2023; 26:317-322. [PMID: 37926628 PMCID: PMC10755778 DOI: 10.1016/j.cjtee.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/30/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
PURPOSE To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese, and/or with demand for highly intensive sports, and/or with poor-quality ligament remnants. METHODS A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament (ATFL) reconstruction with tensional remnant repair technique from January 2019 to August 2021. General data, including demographics, surgical time, and postoperative adverse events, were recorded. The American Orthopaedic Foot and Ankle Society score (AOFAS), foot and ankle ability measure (FAAM), visual analog scale (VAS), and anterior talar translation were measured preoperatively and at 6 weeks, 3 months, and 2 years postoperatively. Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL. Data were analyzed using SPSS 19.0. F test was used to analyze the pre- and postoperative VAS, FAAM, and AOFAS scores. The significance was set at p < 0.05. RESULTS There were 20 males and 10 females among the patients with a mean age of (30.71 ± 5.81) years. The average surgical time was (40.21 ± 8.59) min. No adverse events were observed after surgery. At 2 years postoperatively, the anterior talar translation test showed grade 0 laxity in all patients. VAS score significantly decreased from preoperatively to 6 weeks, 3 months, and 2 years postoperatively (p < 0.001). Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks, 3 months, and 2 years postoperatively was statistically significant (p < 0.001). At 3 months postoperatively, most patients (23/30) could return to their pre-injured activities of daily living status. At 2 years postoperatively, all patients were able to return to their pre-injured activities of daily living status, and almost every patient (18/19) who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal. The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL. CONCLUSION The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation, and allowed early return to pre-injured activities, which could be a reliable option for patients with chronic lateral ankle instability.
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Affiliation(s)
- Qiu Huang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China; Department of Joint Surgery, People's Hospital of Leshan, Leshan, Sichuan province, 614000, China
| | - Xiao-Xi Ji
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Wen-Hui Zhu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Ye-Hua Cai
- Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Lie-Hu Cao
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Shanghai, 200000, China
| | - Yong-Cai Wang
- Department of Joint Surgery, People's Hospital of Leshan, Leshan, Sichuan province, 614000, China
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Colò G, Bignotti B, Costa G, Signori A, Tagliafico AS. Ultrasound or MRI in the Evaluation of Anterior Talofibular Ligament (ATFL) Injuries: Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:2324. [PMID: 37510068 PMCID: PMC10378286 DOI: 10.3390/diagnostics13142324] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Ankle sprains represent the second most common cause of emergency department access for musculoskeletal injury and lateral ankle ligament complex tears account for 850,000 cases annually in the United States with a relapse rate of 70%. Clinical examination is limited due to its subjectivity and the difficulty of identifying a specific involvement of the ligament; therefore, US and MRI are frequently requested. Therefore, the goal of this study is to analyze the available literature on the use of ultrasound (US) and magnetic resonance imaging (MRI) to diagnose injuries to the anterior talofibular ligament (ATFL) with a meta-analytic approach. METHODS According to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, all studies regarding the diagnostic accuracy of ultrasound and magnetic resonance imaging ATFL injuries were searched and assessed. The data were obtained from two independent reviewers with 12 and 3 years of experience in meta-analysis. A QUADAS-2 (Quality Assessment of Studies of Diagnostic Accuracy Studies) checklist was carried out to assess the risk of biases. From the selected studies, the sensitivity, specificity, and accuracy data were extracted. RESULTS Nine studies were included. The results of the meta-analysis demonstrate a greater sensitivity for ultrasound [96.88 (95% CI: 94-99) (fixed effects); 97 (95% CI: 94-99) (random effects)] compared to MRI [88.50 (95% CI: 85-91) (fixed effects); 86.98 (95% CI: 77-94) (random effects)], p < 0.05. The result of this meta-analysis shows that the less expensive diagnostic technique is also the most sensitive for the diagnosis of ATFL tears. Ultrasound articles resulted to have non-heterogeneity [(p = 0.2816; I° = 21.4607%)]. CONCLUSION This meta-analysis demonstrates that US appears to be a highly sensitive diagnostic technique for diagnosing tears of the ATFL. Compared to MRI, the sensitivity of US result was higher.
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Affiliation(s)
- Gabriele Colò
- Orthopedic Section, National Hospital of SS. Antonio and Biagio and C. Arrigo, 15121 Alessandria, Italy
| | - Bianca Bignotti
- Department of Radiology, IRCCS-Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Giacomo Costa
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, 16126 Genova, Italy
| | - Alessio Signori
- Biostatistics Section, Department of Health Sciences (DISSAL), University of Genova, 16126 Genova, Italy
| | - Alberto Stefano Tagliafico
- Department of Radiology, IRCCS-Ospedale Policlinico San Martino, 16132 Genova, Italy
- Radiology Section, Department of Health Sciences (DISSAL), University of Genova, 16126 Genova, Italy
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Vega J, Dalmau-Pastor M. Ankle Joint Microinstability: You Might Have Never Seen It but It Has Definitely Seen You. Foot Ankle Clin 2023; 28:333-344. [PMID: 37137627 DOI: 10.1016/j.fcl.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Ankle microinstability results from the superior fascicle of anterior talofibular ligament (ATFL) injury and is a potential cause of chronic pain and disability after an ankle sprain. Ankle microinstability is usually asymptomatic. When symptoms appear, patients describe a subjective ankle instability feeling, recurrent symptomatic ankle sprains, anterolateral pain, or a combination of them. A subtle anterior drawer test can usually be observed, with no talar tilt. Ankle microinstability should be initially treated conservatively. If this fails, and because superior fascicle of ATFL is an intra-articular ligament, an arthroscopic procedure is recommended to address.
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Affiliation(s)
- Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Feixa Llarga s/n. 08907 Hospitalet del Llobregat, Spain; Foot and Ankle Unit, iMove Traumatology-Clinica Tres Torres, Barcelona, Spain; MIFAS by GRECMIP, Merignac, France; Foot and Ankle Consultant, Clinique Montchoisi, Lausanne, Switzerland.
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Feixa Llarga s/n. 08907 Hospitalet del Llobregat, Spain; MIFAS by GRECMIP, Merignac, France
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10
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de Rousiers A, Rougereau G, Rousselin B, Langlais T, Rollet ME, Bauer T, Bachy M, Hardy A. Adaptation of the Signal Noise Quotient MRI classification for graft ligamentization analysis following ATFL and CFL anatomical reconstruction: Validation of the SNQA. Foot Ankle Surg 2023; 29:243-248. [PMID: 36774199 DOI: 10.1016/j.fas.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/19/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic ankle instability is the most frequent clinical sign of an antero tibiofibular (ATFL) and/or calcaneo fibular ligament (CFL) tear. One common surgical technique is to use the distal tendon of the gracilis muscle to reconstruct both the ATFL and CFL. In the knee, the hamstring tendons used in anterior cruciate ligament (ACL) reconstruction may go through structural modifications called "ligamentization ". A noninvasive MRI technique has been developed using the Signal/Noise Quotient to compare the signal of the graft following reconstruction to that of the posterior cruciate ligament. To our knowledge no studies have ever evaluated radiographic changes in the graft over time. The main goal of this study was to develop a specific MRI protocol to evaluate graft remodeling following ATFL and CFL reconstruction over time. METHODS A prospective study of the changes in the MRI signal of the ATFL-CFL graft 3-months postoperatively was performed in 20 patients. The main outcome was a comparison of the graft signal to that of the peroneal fibular tendon and the surrounding noise to determine the Ankle SNQ (SNQA). MRI images were evaluated by two senior radiologists to assess inter-rater reliability and then 2 weeks later for the intra-rater reproducibility. RESULTS The intraclass correlation (ICC) showed excellent inter- and intra rater reliability for the ATFL SNQA (0.96 and 0.91, respectively); and for the CFL SNQA, the ICC was 0.97 and 0.99, respectively. Bland-Altman analysis showed very limited bias in the interpretation of SNQA. CONCLUSION This preliminary study confirmed the inter- and intra- rater reliability of a new tool using the SNQA.
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Affiliation(s)
- Arnaud de Rousiers
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France.
| | - Grégoire Rougereau
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Benoit Rousselin
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Trousseau Hospital, Sorbonne University, APHP, 26 avenue du Dr. Arnold Netter, 75012 Paris, France
| | - Marie-Eva Rollet
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Thomas Bauer
- Departement of Orthopedic Surgery, Ambroise Paré Hospital, APHP, 9 avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - Manon Bachy
- Department of Pediatric Orthopedic Surgery, Trousseau Hospital, Sorbonne University, APHP, 26 avenue du Dr. Arnold Netter, 75012 Paris, France; Université de Paris, B3OA, UMR CNRS 7052, INSERM U1271, 10 avenue de Verdun, 75010 Paris, France
| | - Alexandre Hardy
- Clinique du Sport, 28 boulevard Saint Marcel, 75005 Paris, France; GRC33 Sorbonne Université Service de Chirurgie Orthopédique et Réparatrice de l'Enfant, Hôpital Armand Trousseau, 26 avenue du Dr Arnold Netter 75012 Paris
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11
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Su T, Zhu YC, Du MZ, Jiang YF, Guo QW, Hu YL, Jiao C, Jiang D. Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:4181-4188. [PMID: 35674772 DOI: 10.1007/s00167-022-07011-5] [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: 01/03/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the return-to-activity and long-term clinical outcomes between anatomic lateral ligament reconstruction using the autologous gracilis tendon and modified Broström-Gould (MBG) procedure in chronic lateral ankle instability (CLAI). It was hypothesised that there was no difference between the two techniques. METHODS From 2013 to 2018, 30 CLAI patients with grade III joint instability confirmed by anterior drawer test underwent anatomic reconstruction of lateral ankle ligament with the autologous gracilis tendon (reconstruction group) in our institute. Another 30 patients undergoing MBG procedure (MBG group) were matched in a 1:1 ratio based on demographic parameters. The post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner activity score, Karlsson-Peterson score, surgical complications, return-to-activities and work were retrospectively evaluated and compared between the two groups. RESULTS All subjective scores significantly improved after the operation (all with p < 0.001) without difference between the two groups (all n.s.). The MBG group showed a significantly higher proportion of postoperative sprain recurrence than the reconstruction group (26.7% vs. 0, p = 0.002). The reconstruction group showed a significantly longer period to start walking with full weight-bearing (10.5 ± 6.9 vs. 7.0 ± 3.1 weeks, p = 0.015), jogging (17.1 ± 8.9 vs. 12.7 ± 6.9 weeks, p = 0.043) and return-to-work (13.5 ± 12.6 vs. 8.0 ± 4.7 weeks, p = 0.039) than the MBG group. CONCLUSIONS Both anatomic reconstruction using the autologous gracilis tendon and MBG procedure could equally achieved reliable long-term clinical outcomes and the tendon reconstruction showed a relatively lower incidence of postoperative sprain recurrence but delayed recovery to walking, jogging and return-to-work. The MBG procedure was still the first choice with rapid recovery but the tendon reconstruction was recommended for patients with higher strength demand. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yi-Chuan Zhu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Ming-Ze Du
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China.
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China.
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12
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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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13
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Katakura M, Odagiri H, Charpail C, Calder J, Guillo S. Arthroscopic treatment for anterolateral impingement of the ankle: Systematic review and exploration of evidence about role of ankle instability. Orthop Traumatol Surg Res 2022; 108:103159. [PMID: 34856406 DOI: 10.1016/j.otsr.2021.103159] [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: 02/12/2021] [Revised: 07/21/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Arthroscopic debridement is a common surgical treatment for patients with anterolateral impingement (ALI) of the ankle. Although they often have a history of ankle sprain, information regarding the role of ankle instability in ALI is limited. The aims of this review were to: 1) assess the clinical outcomes of arthroscopic surgical treatment for ALI of the ankle; and 2) review the data regarding anterior talofibular ligament (ATFL) injury and lateral ankle instability in patients who underwent arthroscopic surgery for ALI. METHOD A literature search of Pubmed and EMBASE was performed. Studies that met the following inclusion criteria were reviewed: (1) human clinical studies investigating patients who underwent arthroscopic surgery for ALI; (2) results with at least one scoring system with minimum follow-up of six months. The quality of each study was evaluated using the Oxford CEBM tool to assess the level of evidence and the grade of recommendation. The data of patient characteristics, intraoperative findings and clinical outcomes were extracted. RESULTS Eight articles were included in this systematic review, all of which were graded level 4 with grade C recommendation. In total, 203 patients with a mean age of 32 years (ranging from 11 to 74) were analysed. AOFAS score was used in 6 studies and scored 90.1 on average at follow-up. Two other studies used original scores. One study reported arthroscopic findings of the ATFL and another study reported on residual instability after surgery. New ankle sprains during follow-up period were reported in 8.3 to 20.0% of patients in 4 studies. DISCUSSION This review showed good clinical results of arthroscopic debridement with a grade C recommendation. Reports regarding arthroscopic observation of the ATFL and residual instability after surgery were lacking. Further investigation of what we are still calling "ALI" should be made with higher level of evidence focusing more on ATFL injury and its effect on clinical outcomes.
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Affiliation(s)
- Mai Katakura
- Fortius Clinic London, London, UK; Imperial College, London, UK
| | | | | | - James Calder
- Fortius Clinic London, London, UK; Imperial College, London, UK
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14
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Yang KC, Chen PY, Loh C, Tzeng IS, Chang SM, Wang CC. Chronic Lateral Ankle Instability Treated With Tendon Allografting: A Preliminary Comparison of Arthroscopic and Open Anatomic Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221126693. [PMID: 36250031 PMCID: PMC9561677 DOI: 10.1177/23259671221126693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Roughly 30% of patients with chronic lateral ankle instability (CLAI) have
long-lasting painful instability requiring surgical intervention. Ligament
reconstruction with the traditional open method and using tendon allografts
can provide sufficient mechanical stability for severe CLAI. Arthroscopic
ligament reconstruction with tendon allograft has recently been introduced
to treat CLAI. Purpose: In this study, we describe an arthroscopic ligament reconstruction procedure
involving the use of the tendon allograft for patients with CLAI, and we
compare the efficacy of this procedure with open ligament reconstruction
with tendon allograft. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled 10 patients (4 men and 6 women) with CLAI (mean age, 37.3 years;
range, 16-57 years) who underwent arthroscopic ligament reconstruction with
tendon allografting between November 2017 and June 2019. The control group
consisted of 10 patients who received open tendon allograft reconstruction.
Preoperative and 2-year postoperative functional outcomes were evaluated
using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale
(AOFAS), Karlsson Ankle Functional Score (KAFS), pain visual analog scale
(VAS), 12-Item Short Form Health Survey (SF-12), and Tegner activity score
(TAS). Results: The mean operative time was 118 and 110 minutes in the arthroscopic and open
groups, respectively. At 2-year follow-up, scores on the AOFAS improved
significantly compared with preoperatively, from 71.3 to 96.4
(P = .006) in the arthroscopic group, and from 68.6 to
96.7 (P = .005) in the open group. The postoperative AOFAS,
VAS, KAFS, and SF-12 scores did not differ significantly between the 2
groups; however, the TAS score was significantly higher in the arthroscopic
reconstruction group compared with in the open group (7 vs 6.1,
respectively; P = .01). Conclusion: Arthroscopic ligament reconstruction with tendon allografting resulted in
sufficient ankle stability and no donor-site morbidity. This procedure can
yield similar functional outcomes to open reconstruction technique and may
be an option for the management of CLAI.
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Affiliation(s)
- Kai-Chiang Yang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist
Tzu Chi Medical Foundation, New Taipei City, Taiwan.,School of Dental Technology, College of Oral Medicine, Taipei
Medical University, Taipei, Taiwan
| | - Pei-Yu Chen
- Department of Orthopedic Surgery, National Taiwan University
Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh Loh
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist
Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi
Medical Foundation, New Taipei City, Taiwan
| | - Shun-Min Chang
- Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital,
Kaohsiung Medical University, Kaohsiung City, Hualien, Taiwan
| | - Chen-Chie Wang
- Department of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist
Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Orthopedics, School of Medicine, Tzu Chi University,
Hualien, Taiwan.,Chen-Chie Wang, MD, PhD, Department of Orthopedic Surgery,
Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City
23142, Taiwan ()
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15
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Yang Y, Han J, Wu H, Zhi X, Lian J, Xu F, Cai X, Wei S. Arthro-Broström with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques. BMC Musculoskelet Disord 2022; 23:795. [PMID: 35987668 PMCID: PMC9392268 DOI: 10.1186/s12891-022-05709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background There is still some controversy about the augmentation of the inferior extensor retinaculum after arthroscopic anterior talofibular ligament repair. The aim of this study was to evaluate the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques for chronic lateral ankle instability. Methods Thirty-four cases with grade-2 or grade-3 chronic anterior talofibular ligament lesions who underwent the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques were assessed retrospectively. A total of 30 cases (30 ankles) were followed up for a mean of 26.67 ± 4.19 months (range, 24—36 months). four cases were excluded due to insufficient medical records or loss of follow-up reports. The Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were evaluated before surgery and at the final follow-up time. Also, the results of stress fluoroscopic tests and complications were recorded. Results At the final follow-up, the average of the Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were 86.63 ± 6.69 (range, 77—100), 90.17 ± 4.64 (range, 85—100) and 0.53 ± 0.63 (range, 0—2), respectively. Moreover, the results of stress fluoroscopic tests were improved significantly after surgery. Mild keloid formation and/or knot irritation were observed in four cases. No wound infections, nerve injuries and recurrent instability were recorded. Also, no stiffness or arthritis of the subtalar joint was encountered. Conclusions The arthro-Broström procedure combined with endoscopic retinaculum augmentation using all-inside lasso-loop techniques is reliable and safe due to the advantage of direct endoscopic visualization.
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16
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Lee SH, Yang JH, Kim I. Nonanatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair With a High-Position Anchor versus Anatomic Repair: An Analysis Based on 3D CT. Am J Sports Med 2022; 50:2134-2144. [PMID: 35612848 DOI: 10.1177/03635465221097119] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND In patients with chronic ankle instability, it is important to repair the anterior talofibular ligament (ATFL) at the anatomic origin site. However, there are limited reports on the clinical outcomes according to anatomic ATFL repair. PURPOSE To compare the clinical outcomes after arthroscopic ATFL repair according to whether the anchor is fixed at an anatomic position. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair for chronic ankle instability and were available for a minimum 2-year follow-up. The patients were divided into 3 groups according to the anchor position at the distal fibula on 3-dimensional computed tomography: anatomic arthroscopic ATFL repair (anatomic group), subanatomic arthroscopic ATFL repair (subanatomic group), and nonanatomic arthroscopic ATFL repair (nonanatomic group). The visual analog scale for pain, Foot and Ankle Outcome Score (FAOS), and Karlsson ankle functional score were measured as subjective outcomes. Posturographic analysis and radiologic evaluation using stress radiographs and axial view magnetic resonance imaging were performed as objective outcomes. RESULTS Of 96 patients, 16 were excluded per the exclusion criteria, and 80 were evaluated (anatomic group, n = 24; subanatomic group, n = 42; nonanatomic group, n = 14). The mean age of the patients was 34.5 years, and the mean follow-up period was 27.4 months. A between-group comparison revealed significant differences in FAOS, Karlsson score, and fall risk evaluated by posturography at the final follow-up. Post hoc analysis revealed that the anatomic group had better clinical scores on the FAOS than did the nonanatomic group in all 5 domains (all P < .017). Patients in the anatomic and subanatomic groups had better Karlsson scores and fall risk than those in the nonanatomic group (P = .004 and P = .013, respectively). In terms of objective outcomes, patients in the anatomic and subanatomic groups had better outcomes in fall risk than did those in the nonanatomic group (both P = .001). There were no differences in clinical scores and objective outcomes between the anatomic and subanatomic groups. CONCLUSION Nonanatomic ATFL repair showed inferior outcomes when compared with anatomic ATFL repair. When arthroscopic ATFL repair is performed, the anchor should be fixed in the anatomic position to improve prognosis.
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Affiliation(s)
- Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, South Korea
| | - Je Heon Yang
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, South Korea
| | - Isac Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, South Korea
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17
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Ajaka N, Bouché PA, Dagher M, Lopes R, Bauer T, Hardy A. The French Ankle Ligament Reconstruction - Return to Sport after Injury (ALR-RSI-Fr) is a valid scale for the French population. J Exp Orthop 2022; 9:27. [PMID: 35314901 PMCID: PMC8938531 DOI: 10.1186/s40634-022-00463-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/02/2022] [Indexed: 01/02/2023] Open
Abstract
PURPOSE The aim of this study was to translate, adapt and validate in French the Ankle Ligament Reconstruction - Return to Sport after Injury (ALR-RSI), a 12-item English language scale assessing the psychological impact of returning to sports after ACL reconstruction. Our hypothesis was that the French version of the ALR-RSI scale would be valid and adaptable to the French population. METHODS The procedure followed the guidelines for the intercultural adaptation of the self-administered questionnaires. A version of the ALR-RSI-Fr questionnaire was validated according to the international guidelines of COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments). A prospective study was conducted between March 2020 and June 2021. The study included two population groups, the first one being that of adult athletes of all levels who underwent arthroscopic ankle ligament reconstruction and the second being that of adult athletes who did not suffer from any ankle problems. After consent, patients completed three questionnaires, the ALR-RSI-Fr, the AOFAS and the Karlsson score. RESULTS The study included 30 patients and 30 controls who were all athletes. The mean age of the patients was 34.6 with 60% male and 40% female. The average time for patients to return to sport was 5.6 months. Twenty-nine patients (96.6%) underwent arthroscopic ankle reconstruction while only one was eligible for ligament reinsertion. The control group with demographic data matched to the patient group was included in this study. Correlations between ALRSI, the total Karlsson score and its different sub items and the AOFAS were estimated using Spearman coefficients. Discriminant validity was tested between the "patient" and "control" groups and sub-groups using the Wilcoxon tests. Reliability was evaluated on the ρ intraclass correlation coefficient (ICCC). A strong correlation was noted between the ALR-RSI-Fr , Karlsson and AOFAS with a Spearman score of 0.90 [0.76-0.96].A highly significant difference was found between the "patient" and "control" groups. The internal consistency of the questionnaire was excellent with a Cronbach's alfa of 0.94. Reproducibility was "excellent" with an interclass correlation coefficient of q = 0.97 [0.94-0.99]. CONCLUSION This study showed that the cross-cultural adaptation of the English version of the ALR-RSI was successful and validated for the French-speaking population. The discriminant capacity of the scale between patients who underwent reconstruction and healthy subjects was also confirmed. This questionnaire will allow surgeons to better evaluate the psychological impact of returning to sports after ankle ligament reconstruction in French speaking patients LEVEL OF EVIDENCE: LEVEL II: Prospective cohort study (patients enrolled at different points in their disease) Control arm of randomized trial.
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Affiliation(s)
- Nahi Ajaka
- Service de chirurgie orthopédique et traumatologique, Hôpital Ambroise Pare, Paris, France.
| | - Pierre-Alban Bouché
- Service de chirurgie orthopédique et traumatologique, Hôpital Lariboisière, Paris, France
| | - Michel Dagher
- Service de chirurgie orthopédique et traumatologique, Hôpital Henri-Mondor, Paris, France
| | - Ronny Lopes
- Service de chirurgie orthopédique et traumatologique, Polyclinique de l'Atlantique, Nantes, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, Hôpital Ambroise Pare, Paris, France
| | - Alexandre Hardy
- Clinique du Sport, 36 boulevard Saint-Marcel, 75005, Paris, France
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18
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Qin J, Fu Q, Zhou Q, Wu H, Zhi X, Xu F, Cai X, Wei S. Fully Intra-articular Lasso-Loop Stitch Technique for Arthroscopic Anterior Talofibular Ligament Repair. Foot Ankle Int 2022; 43:439-447. [PMID: 34514905 DOI: 10.1177/10711007211044442] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic techniques have gradually become popular for anterior talofibular ligament (ATFL) repair. However, the reliability of the repair and the risk of nerve injuries are of concern. The aim of this study was to evaluate the fully intra-articular lasso-loop stitch technique for arthroscopic ATFL repair. METHODS From October 2018 to December 2019, 43 cases with chronic lateral ankle instability were treated with this fully intra-articular lasso-loop stitch technique using the Arthro-Pierce instrument. The Karlsson-Peterson score, Cumberland Ankle Instability Tool (CAIT) score, visual analog scale (VAS) score, anterior drawer and talar tilt stress fluoroscopy were evaluated at the preoperative and final follow-up appointments, respectively. All surgical complications were also recorded. RESULTS A total of 39 cases were followed up for a mean of 28.23 ± 3.64 months (range, 23-34 months). At the final follow-up, the averages of the Karlsson-Peterson, CAIT and VAS scores were 90.26 ± 6.58, 88.56 ± 7.21 and 0.79 ± 1.06, respectively. During surgery, 2 cases were modified with augmentation of the inferior extensor retinaculum. No nerve injuries were encountered. Only 1 female complained about mild knot irritation. A 25-year-old solider required revision surgery due to an accidental injury. CONCLUSION We found the fully intra-articular lasso-loop stitch technique for ATFL repair using the Arthro-Pierce instrument to be reliable and safe with a sufficient and good-quality ligament remnant. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jiajun Qin
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China
| | - Qiang Fu
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China
| | - Qing Zhou
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China
| | - Helin Wu
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiaosong Zhi
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xianhua Cai
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (previously Wuhan General Hospital of Guangzhou Command), Wuhan, Hubei Province, People's Republic of China.,The First Clinical Medical School of Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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19
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Nunes GA, Ferreira GF, Caetano RM, Mann TS, Guelfi M. All-inside arthroscopic repair of the anterior talofibular ligament: a case series. INTERNATIONAL ORTHOPAEDICS 2022; 46:273-279. [PMID: 35022814 DOI: 10.1007/s00264-021-05283-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 12/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The all-inside arthroscopic repair of the anterior talofibular ligament (ATFL) is a technically challenging and still-recent procedure to treat chronic ankle instability (CAI). Favourable clinical outcomes have been shown from originator centers, but this is one of the first series from a non-originator centre. The purpose of the present study is to present the clinical and functional results of patients with CAI underwent arthroscopic all-inside ATFL repair. METHODS This is a series of cases of 18 consecutive patients who underwent the all-inside arthroscopic ATFL repair, for CAI, after the failure of conservative treatment performed for six months. The evaluation was made using the American Orthopaedic Foot and Ankle Score (AOFAS), visual analog pain scale (VAS), anterior drawer, and talar tilt tests. RESULTS All 18 patients were evaluated for a mean follow-up period of 12 months. There was an improvement in the AOFAS (p < 0.001), with the mean improving from 69.6 points to 98.1, standard deviation (SD) = 11.09, and in the mean VAS score (p < 0.001), from 5.0 to 0.5 points (SD = 0.78). All ankles were stable, as assessed by the anterior drawer test and talar tilt test. The only complication found was neurapraxia of the superficial fibular nerve in one patient (5%). All of the patients classified the treatment as good or excellent and returned to sports activities without limitations. CONCLUSION Treatment of CAI by the all-inside arthroscopic ATFL repair was able to restore ankle stability and showed good clinical results and high satisfaction rates.
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Affiliation(s)
- Gustavo Araujo Nunes
- Foot and Ankle Unit, Hospital Brasília, Brasília, Distrito Federal, Brazil. .,Grecmip MIFAS (Group of Research and Study in Minimally Invasive Surgery of the Foot - Minimally Invasive Foot and Ankle Society), Barcelona, Spain. .,PHD (C) Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain.
| | - Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | - Rafael Medeiros Caetano
- Orthopaedics and Traumatology Unit, Hospital Universitário Ciências Médicas (FCMMG), Belo Horizonte, MG, Brazil
| | | | - Matteo Guelfi
- Foot and Ankle Unit, Clinica Montallegro, Genoa, Italy
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Guillo S, Takao M, Stone J, Bauer T. From improved knowledge to certain technical revolutions: Many advances in foot and ankle surgery. Orthop Traumatol Surg Res 2021; 107:103014. [PMID: 34273583 DOI: 10.1016/j.otsr.2021.103014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Stéphane Guillo
- SOS Pied Cheville Bordeaux, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, 341-1, Mangoku, Kisarazu, 2920003 Chiba, Japan
| | - James Stone
- Orthopedic Institute of Wisconsin, Assistant Clinical Professor of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Thomas Bauer
- Department of Orthopedic Surgery and Traumatology, Ambroise-Paré University Hospital, University Paris Saclay, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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21
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Yokoe T, Tajima T, Yamaguchi N, Ota T, Nagasawa M, Morita Y, Chosa E. Internal Fixation of a Lateral Inverted Osteochondral Fracture of the Talus (LIFT) Lesion Using an Innovative Surgical Approach: Inverting the Capsulo-Lateral Fibulotalocalcaneal Ligament (LFTCL)-Fibular Periosteum Complex. J Foot Ankle Surg 2021; 60:1054-1059. [PMID: 33840566 DOI: 10.1053/j.jfas.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/09/2020] [Accepted: 03/10/2021] [Indexed: 02/03/2023]
Abstract
Osteotomy of the distal fibula or anterolateral corner of the tibia is usually required to fix a displaced osteochondral fracture of the talus that is located central to posterior area of the lateral talar dome. However, osteotomy is an invasive procedure and is associated with complications, including nonunion, persistent pain, and hardware-related problems. Lateral inverted osteochondral fracture of the talus (LIFT) lesion is an extremely rare type of displaced osteochondral lesion of the talus. We describe a case in which a LIFT lesion was fixed using an innovative surgical approach, inverting capsulo-lateral fibulotalocalcaneal ligament (LFTCL)-fibular periosteum complex, with a favorable short-term clinical outcome.
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Affiliation(s)
- Takuji Yokoe
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan.
| | - Takuya Tajima
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Nami Yamaguchi
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Tomomi Ota
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Makoto Nagasawa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Yudai Morita
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
| | - Etsuo Chosa
- Division of Orthopaedic Surgery, Department of Medicine of Sensory and Motor Organs, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki 889-1692, Japan
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22
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Lee SH, Cho HG, Yang JH. Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary. Am J Sports Med 2021; 49:1721-1731. [PMID: 33886379 DOI: 10.1177/03635465211008097] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although several arthroscopic surgical techniques for the treatment of chronic ankle instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. PURPOSE To compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI between 2016 and 2018. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into 2 groups according to the surgical technique used for CAI: arthroscopic ATFL repair (group A; n = 37) and arthroscopic ATFL repair with additional IER augmentation (group R; n = 45). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). RESULTS Out of 101 patients, 19 (18.5%) were excluded per the exclusion criteria, and 82 were evaluated. We identified 6 retears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL retear on MRI (8.1% [3/37] in group A and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement >3 mm as compared with the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups (P < .001). However, there were no significant differences in the clinical results and radiologic findings between the groups. CONCLUSION The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.
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Affiliation(s)
- Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Hyung Gyu Cho
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Je Heon Yang
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea
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Li HY, Guo A, Yang F, Zheng JJ, Hua YH, Chen SY. The anterior talofibular ligament-posterior talofibular ligament angle decreased after ankle lateral stabilization surgery. Knee Surg Sports Traumatol Arthrosc 2021; 29:1510-1515. [PMID: 32725448 DOI: 10.1007/s00167-020-06174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The angle between the anterior talofibular ligament (ATFL) and the posterior talofibular ligament (PTFL) is increased in patients with chronic ATFL injury. This study aimed to compare the AFTL-PTFL angle before versus after ankle lateral stabilization surgery, and to evaluate whether the ATFL-PTFL angle correlates with the ligament injury severity. METHODS This retrospective study included 48 patients with mechanical ankle instability treated between 2016 and 2018. After arthroscopic evaluation, all patients underwent ankle lateral stabilization surgery comprising ligament repair (n = 28) or reconstruction (n = 20). The ATFL-PTFL angle was measured in the axial plane on pre- and postoperative MRI. Comparisons were made of the pre- versus postoperative ATFL-PTFL angles, and the ATFL-PTFL angle of the repair versus reconstruction groups. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of the ATFL-PTFL angle in selecting the surgical technique. RESULTS The postoperative ATFL-PTFL angle was significantly decreased compared with preoperatively. The ATFL-PTFL angle was significantly smaller in the repair group than the reconstruction group preoperatively and postoperatively. The area under the ROC curve was 0.741 (P < 0.01). The optimal cutoff point for the selection of ligament reconstruction was an ATFL-PTFL angle of 89.4° (sensitivity 0.85, specificity 0.61). CONCLUSION The ATFL-PTFL angle decreases after ankle lateral stabilization surgery. The ATFL-PTFL angle is related to the severity of the ATFL injury. Ankle lateral ligament reconstruction should be considered when the ATFL-PTFL angle is > 89.4°. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hong-Yun Li
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, No. 12 Urumq Middle Road, Shanghai, 20040, China
| | - Ao Guo
- Department of Sports Medicine, Taizhou Orthopedics Hospital, Taizhou, 317500, Zhejiang, China
| | - Fan Yang
- Department of Foot and Ankle Surgery, Sanmenxia Central Hospital, Sanmenxia, 472000, Henan, China
| | - Jie-Jiao Zheng
- Department of Rehabilitation Medicine, Huadong Hospital Affiliated To Fudan University, Shanghai, 200040, China
| | - Ying-Hui Hua
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, No. 12 Urumq Middle Road, Shanghai, 20040, China.
| | - Shi-Yi Chen
- Sports Medicine Center of Fudan University, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, No. 12 Urumq Middle Road, Shanghai, 20040, China
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24
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Vega J, Malagelada F, Dalmau-Pastor M. Ankle microinstability: arthroscopic findings reveal four types of lesion to the anterior talofibular ligament's superior fascicle. Knee Surg Sports Traumatol Arthrosc 2021; 29:1294-1303. [PMID: 32518964 DOI: 10.1007/s00167-020-06089-z] [Citation(s) in RCA: 21] [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] [Received: 03/21/2020] [Accepted: 06/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE ATFL's superior fascicle injury has been considered to be the underlying cause in cases of ankle microinstability. As its clinical diagnosis can be difficult, arthroscopic examination may be the only objective diagnostic tool. The purpose of this study was to determine what types of injuries to the ATFL's superior fascicle are associated with ankle microinstability, and to provide the reader with an arthroscopic classification of the types of microinstability affecting the ankle. METHODS Ankle arthroscopy video records obtained during a four-year period from 232 patients with the diagnosis of ankle microinstability were reviewed. The characteristics of the ATFL's superior fascicle injury were identified, described and recorded along with any concomitant intra-articular pathology. RESULTS Four different injury patterns were consistently seen affecting the ATFL's superior fascicle. These ranged from ligament attenuation associated with loss of tension (type I), through to partial detachment (type II) or total detachment (type III) from the fibula. Finally, a total or partial resorption of the ATFL's superior fascicle (type IV) was also observed. There was a statistically significant association between the type of injury identified and the rate of intra-articular pathology observed arthroscopically. Equally, the higher the type in the classification, the higher the rate of loose bodies, lateral talar OCD, deltoid "open book" tears, and anterior soft-tissue formation. CONCLUSION Different types of ATFL's superior fascicle injury can be observed in patients with ankle microinstability, ranging from ligament attenuation associated with a loss of tension (8.2%) to different degrees of partial (69.1%) and total (16.8%) ligament detachment from the fibula, or ligament remnant resorption (5.9%). As the type of injury progresses along with the proposed classification, the rate of intra-articular injuries also increases. The clinical relevance of this study is that a morphological ATFL's superior fascicle tear is recognized in patients with the diagnosis of ankle microinstability. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Via Augusta, 281, 08023, Barcelona, Spain.
- Foot and Ankle Unit, iMove Tres Torres, and Hospital Quirón Barcelona, Barcelona, Spain.
- GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France.
| | - Francesc Malagelada
- Department of Trauma and Orthopedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Miki Dalmau-Pastor
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Via Augusta, 281, 08023, Barcelona, Spain
- GRECMIP-MIFAS (Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied-Minimally Invasive Foot and Ankle Society), Merignac, France
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Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6695096. [PMID: 33575340 PMCID: PMC7861910 DOI: 10.1155/2021/6695096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/17/2022]
Abstract
We investigated the therapeutic effect of a postoperative hospital-based systemic rehabilitation protocol on ankle function in chronic ankle instability (CAI) patients. Thirty-five patients who underwent a modified Broström procedure for CAI were recruited in this prospective randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Education-based rehabilitation was conducted at home in the control group. The outcomes were evaluated at baseline (T0), 12 weeks (T1), and 16 weeks (T2). The primary outcome was the foot and ankle outcome score (FAOS). Ankle motor strength and spatiotemporal gait metrics were assessed as secondary outcomes. There were significant time and group interaction effects on the pain, symptoms, activities of daily living, sports activities, and quality of life (QOL) domains of the FAOS (P < 0.05, all). The patients in the intervention group showed larger improvements in all domains of the FAOS than did the control group at both T1 and T2 (P < 0.05, all). The time and group interaction effects on invertor and evertor strength were also significant (P = 0.047 and P = 0.044). Invertor and evertor strength improved significantly more in the intervention group than in the control group at T1 and T2 (P < 0.05, all). The preferred walking velocity, cadence, step length on the affected side, and double stance phase duration tended to improve over time. Postoperative hospital-based rehabilitation helped improve CAI pain, symptoms, independence in activities of daily living, sports activity levels, and QOL more effectively than did conventional rehabilitation at home.
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Predictive role of ankle MRI for tendon graft choice and surgical reconstruction. Radiol Med 2020; 125:763-769. [PMID: 32222954 DOI: 10.1007/s11547-020-01177-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Tendon transfers have become a common surgical procedure around the ankle. In this study, we sought to evaluate the existence of a correlation between specific anthropometric parameters and the size of some ankle tendons measured on MRI, in particular those mostly used as graft in ankle surgery. METHODS We recorded gender, height, weight, and body mass index (BMI) of 113 patients (57 females; mean age: 42 ± 18) who underwent ankle MRI. MRI measurements performed by a radiologist were: axial shortest diameter of Achilles (AT), posterior tibialis (PTT), flexor digitorum longus (FDLT), flexor hallucis longus (FHLT), peroneus longus (PLT), and anterior tibialis (ATT) tendons, intermalleolar distance (ID) and talus width (TW). Mann-Whitney U test and Pearson's correlation coefficient were used. After applying the Bonferroni correction for multiple comparisons, statistical significance was set at p < 0.002. RESULTS The mean patient height, weight and BMI were 169 ± 9.8 cm (range: 140-193), 72.4 ± 16.4 kg (range: 44-142), and 25 ± 5.7 (range: 16-50), respectively. The mean ankle measurements were: AT = 5.3 ± 1.4 mm, PTT = 3.3 ± 0.6 mm, FDLT = 2.6 ± 0.4 mm, FHLT = 2.7 ± 0.4 mm, PLT = 2.9 ± 0.5 mm, ATT = 3±0.6 mm, ID = 62.9 ± 4.5 mm, and TW = 28.8 ± 2.5 mm. A statistical difference between male and female patients was observed regarding ID (z = -6.955, p < .001), TW (z = -6.692, p < .001), AT (z = -3.587, p < .001), PTT (z = -3.783, p < .001), and FDLT (z = -3.744, p < .001). Both PTT and FDLT showed a significant correlation with ID (p < .001) and TW (p < .001). ATT size was significantly correlated with weight, ID and TW (all with p < 0.001). PLT and AT showed a significant correlation only with ID and weight (p ≤ .001), respectively. CONCLUSION Our data might help orthopaedists in preoperative planning to identify the best graft for ankle surgical procedures including tendon transfers.
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Endoscopic anatomic ligament reconstruction is a reliable option to treat chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:86-92. [PMID: 31728603 DOI: 10.1007/s00167-019-05793-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/06/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Anatomic reconstruction of the anterior talofibular ligament and calcaneofibular ligament is a valid treatment of chronic hindfoot instability. The purpose of this study was to investigate the outcomes of this procedure performed by an all-inside endoscopic technique. METHODS This study is a retrospective evaluation of a prospective database. Subjects were all patients who underwent an endoscopic lateral ligament reconstruction between 2013 and 2016. All patients had symptoms of ankle instability with positive manual stress testing and failed nonoperative treatment during at least 6 months. At final follow-up the outcome was assessed using the visual analogue score (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score and Karlsson-Peterson scores. RESULTS After an average follow-up of 31.5 ± 6.9 months, all patients reported significant improvement compared to their preoperative status. The preoperative AOFAS score improved from 76.4 ± 15 to 94.7 ± 11.7 postoperatively (p = 0.0001). The preoperative Karlsson-Peterson score increased from 73.0 ± 16.0 to 93.7 ± 10.6 postoperatively (p = 0.0001). The VAS score improved from 1.9 ± 2.5 to 0.8 ± 1.7 (p < 0.001). Two patients had complaints of recurrent instability. CONCLUSION Endoscopic ligament reconstruction for chronic lateral ankle instability is a safe procedure and produces good clinical results with minimal complications. In addition, the endoscopic approach allows an assessment of the ankle joint and treatment of associated intra-articular lesions. LEVEL OF EVIDENCE II.
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28
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Guillo S, Odagiri H. All-Inside Endoscopic Broström-Gould Technique. Arthrosc Tech 2019; 9:e79-e84. [PMID: 32021778 PMCID: PMC6993130 DOI: 10.1016/j.eats.2019.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/02/2019] [Indexed: 02/03/2023] Open
Abstract
Ankle sprain is the most frequent sports trauma. Surgical treatment is needed in case of chronical instability, after failure of conservative treatment. The technique established today worldwide consists in repairing the ligament (Broström technique) and strengthening the repair by adding extensor retinaculum (Gould technique). An arthroscopic technique recently has been developed; nevertheless, no published technique has proposed a total endoscopic Broström technique associated with a Gould augmentation because of difficulty in visualizing the retinaculum by anterior ankle arthroscopy. Lateral ankle endoscopy can provide a view of this area that is superior to open surgery. In this technique, the procedure is able to be performed safely and reproducible under perfect viewing. The purpose of this study is to describe an all-inside endoscopic Broström-Gould technique.
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Affiliation(s)
- Stephane Guillo
- Center for Orthopaedic Sports Surgery, Bordeaux-Mérignac, France
| | - Haruki Odagiri
- Center for Orthopaedic Sports Surgery, Bordeaux-Mérignac, France,Kumamoto Foot and Ankle center, Hotakubo Orthopaedic Hospital, Kumamoto, Japan,Address correspondence to Haruki Odagiri, M.D., Kumamoto Foot and Ankle Center, Hotakubo Orthopaedic Hospital, Kumamoto, Japan.
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