1
|
Lenz CG, Urbanschitz L, Shepherd DW. Dynamic syndesmotic stabilisation and reinforcement of the antero-inferior tibiofibular ligament with internal brace. Foot (Edinb) 2023; 56:102026. [PMID: 37001344 DOI: 10.1016/j.foot.2023.102026] [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: 10/31/2021] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Syndesmotic injuries are associated with long recovery times and high morbidity. Systematic reviews show a trend toward better outcomes of suture buttons compared to screw fixation. The anteroinferior tibiofibular ligament (AITFL) confers the most significant component of translational and rotatory stability. Techniques have developed which reinforce the AITFL. This study aimed to assess results of syndesmotic stabilisation with dynamic stabilisation and reinforcement of the AITFL, with an early mobilisation program. MATERIALS AND METHODS Retrospective case series of 30 patients (mean age 31 years). Syndesmotic instability was confirmed with clinical examination, MRI and weightbearing-CT. Dynamic syndesmotic stabilisation with a single suture button was performed followed by the placement of an Internal Brace over the AITFL. A standardised postoperative rehabilitation protocol was established. Foot and Ankle Ability Measure (FAAM) scores were collected postoperatively. RESULTS The average follow-up was 13 months. The total FAAM score for ADL was 95 ± 4.9 % (range, 83 - 100 %) and for sport activities 87 ± 13.6 % (range, 50 - 100 %). The rating of mean postoperative function for ADL was 94 ± 5.5 % (range, 80 - 100 %) and 90 ± 13 % (range, 35 - 100 %) for sportv. The difference between acute and chronic injuries was statistically higher (p < 0.05) for daily activities and sport, but the rating of current level of sport activites as well as for daily activites did not show a significant difference (p = 0.9296 and p = 0.1615, respectively). Twenty-seven patients (90 %) rated their overall current level of function as normal or nearly normal. CONCLUSION This technique aims to directly stabilise the AITFL and the interosseous components of the syndesmosis, and allow early mobilisation and return to sport at 10 weeks. Early results show the procedure is safe, with comparable results to the literature. Acute injuries showed better results of the FAAM score than chronic injuries.
Collapse
Affiliation(s)
| | - Lukas Urbanschitz
- Department of Orthopaedic Surgery, Schulthess Klinik, Zurich, CH, Switzerland.
| | - David W Shepherd
- Western Health Victoria, Melbourne Orthopaedic Group, Victoria, Australia.
| |
Collapse
|
2
|
Lin X, Tu C, Lin W, Xie W, Guo X, Liu Q. Comparison the treatment of anterior inferior tibiofibular ligament anatomical repair and syndesmosis screw fixation for syndesmotic injuries in ankle fracture. BMC Surg 2023; 23:80. [PMID: 37038119 PMCID: PMC10084683 DOI: 10.1186/s12893-023-01982-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND The fixation method of syndesmotic injuries in ankle fractures remains controversial. The goal of the study was to compare radiographic and clinical outcomes between anterior inferior tibiofibular ligament (AITFL) anatomical repair with syndesmosis screw fixation in syndesmotic injuries. METHODS We analyzed 62 patients who were treated with AITFL anatomical repair or syndesmosis screw fixation for syndesmotic injuries in an advanced teaching hospital between March 2016 and March 2019. Fixation was performed with AITFL anatomical repair in 30 patients (AAR group) and syndesmosis screw in 32 patients (SS group). Radiographic evaluations were the differences in mean anterior and posterior (A difference and P difference) tibiofibular distance between injured and uninjured ankle computed tomography (CT) scan at 6 months postoperatively. Clinical evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, the Olerud-Molander Ankle (OMA) score and visual analogue scale (VAS) score at 1, 3, 6 months and 1, 2 years postoperatively. RESULTS The A difference and P difference on CT was no differences (1.6 ± 0.8 mm, 1.3 ± 0.7 mm vs. 1.5 ± 0.7 mm, 1.2 ± 0.7 mm) between the two groups (All of P > 0.05). The AAR group had higher mean AOFAS score (65.6 ± 5.9, 82.3 ± 4.2, 87.6 ± 5.6 vs. 61.8 ± 5.2, 79.1 ± 4.0, 83.8 ± 4.9; P = 0.008, 0.003, 0.007) and higher mean OMA score (45.7 ± 8.7, 79.2 ± 6.5, 84.1 ± 5.3 vs. 40.4 ± 7.3, 74.8 ± 6.3, 80.3 ± 5.8; P = 0.012, 0.009, 0.010)) at 1, 3 and 6 months postoperatively. The AAR group had lower mean VAS scores (2.6 ± 1.2, 1.7 ± 0.7 vs. 3.4 ± 1.2, 2.2 ± 1.1; P = 0.018, 0.038) at 1 and 3 months postoperatively. CONCLUSIONS The results of this study suggest that the AITFL anatomical repair technique could effectively improve ankle function during daily activity. Therefore, AITFL anatomical repair technique is expected to become a better fixation method for syndesmotic injuries.
Collapse
Affiliation(s)
- Xuping Lin
- Department of Orthopedic Surgery, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, 363000, Fujian Province, China
- School of Medicine, Xiamen University, Xiamen, 361005, China
| | - Chengquan Tu
- Department of Orthopedic Surgery, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, 363000, Fujian Province, China
- School of Medicine, Xiamen University, Xiamen, 361005, China
| | - Weihuang Lin
- Department of Orthopedic Surgery, Xiamen Haicang Hospital, Xiamen, 361100, China
| | - Weina Xie
- Department of Anesthesiology, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, 363000, China
| | - Xiaowei Guo
- Department of Orthopedic Surgery, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, 363000, Fujian Province, China
| | - Qingjun Liu
- Department of Orthopedic Surgery, The Affiliated Dongnan Hospital of Xiamen University, Zhangzhou, 363000, Fujian Province, China.
- School of Medicine, Xiamen University, Xiamen, 361005, China.
| |
Collapse
|
3
|
Stake IK, Bryniarski AR, Brady AW, Miles JW, Dornan GJ, Madsen JE, Haytmanek CT, Husebye EE, Clanton TO. Effect of Posterior Malleolar Fixation on Syndesmotic Stability. Am J Sports Med 2023; 51:997-1006. [PMID: 36779585 DOI: 10.1177/03635465231151448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Transsyndesmotic fixation with suture buttons (SBs), posterior malleolar fixation with screws, and anterior inferior tibiofibular ligament (AITFL) augmentation using suture tape (ST) have all been suggested as potential treatments in the setting of a posterior malleolar fracture (PMF). However, there is no consensus on the optimal treatment for PMFs. PURPOSE To determine which combination of (1) transsyndesmotic SBs, (2) posterior malleolar screws, and (3) AITFL augmentation using ST best restored native tibiofibular and ankle joint kinematics after 25% and 50% PMF. STUDY DESIGN Controlled laboratory study. METHODS Twenty cadaveric lower-leg specimens were divided into 2 groups (25% or 50% PMF) and underwent biomechanical testing using a 6 degrees of freedom robotic arm in 7 states: intact, syndesmosis injury with PMF, transsyndesmotic SBs, transsyndesmotic SBs + AITFL augmentation, transsyndesmotic SBs + AITFL augmentation + posterior malleolar screws, posterior malleolar screws + AITFL augmentation, and posterior malleolar screws. Four biomechanical tests were performed at neutral and 30° of plantarflexion: external rotation, internal rotation, posterior drawer, and lateral drawer. The position of the tibia, fibula, and talus were recorded using a 5-camera motion capture system. RESULTS With external rotation, posterior malleolar screws with AITFL augmentation resulted in best stability of the fibula and ankle joint. With internal rotation, all repairs that included posterior malleolar screws stabilized the fibula and ankle joint. Posterior and lateral drawer resulted in only small differences between the intact and injured states. No differences were found in the efficacy of treatments between 25% and 50% PMFs. CONCLUSION Posterior malleolar screws resulted in higher syndesmotic stability when compared with transsyndesmotic SBs. AITFL augmentation provided additional external rotational stability when combined with posterior malleolar screws. Transsyndesmotic SBs did not provide any additional stability and tended to translate the fibula medially. CLINICAL RELEVANCE Posterior malleolar fixation with AITFL augmentation using ST may be the preferred surgical method when treating patients with acute ankle injury involving an unstable syndesmosis and a PMF ≥25%.
Collapse
Affiliation(s)
- Ingrid Kvello Stake
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Alex W Brady
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jon W Miles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jan Erik Madsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - C Thomas Haytmanek
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| | | | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
| |
Collapse
|
4
|
Jin-Tao Q, Mei W, Chao-Jun L, Zi-Tian W, Guang P, Hao Y, Yu-Quan J, Yu T. Clinical outcomes of an olive wire and external fixator versus a metallic screw in the treatment of inferior tibiofibular syndesmosis injuries in ankle fractures. Foot Ankle Surg 2023; 29:233-238. [PMID: 36754689 DOI: 10.1016/j.fas.2023.01.011] [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: 10/26/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 01/29/2023]
Abstract
BACKGROUND Metal screws are the most widely used in treating syndesmotic injuries, but failure and the rigidity of the screws can threaten the success of the treatment and increase the cost of care. We have provided an alternative with an olive wire and external fixator(OWEF) used for syndesmotic fixation. METHODS A retrospective longitudinal follow-up study was conducted. From February 2011 to January 2018, 58 of 72 patients with ankle fractures and associated syndesmotic disruption were treated with either screw or OWEF fixation. The costs, complications, and clinical outcomes using Olerud-Molander score and Visual Analog score in screw and OWEF fixation group were compared. RESULTS We found the severity of the injury, BMI of the patients and the different fixation methods were determinants of the complications and clinical outcomes. But if no malreduction of the syndesmosis was present, no difference in clinical result was detected. CONCLUSION The OWEF method appeared to be at least equally functional and effective to screw fixation while maintaining possible lower complication rate. LEVELS OF CLINICAL EVIDENCE Level 3.
Collapse
Affiliation(s)
- Qu Jin-Tao
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Wang Mei
- Department of Anaesthesia, The 925th Hospital, 67# Huanghe RD, China
| | - Li Chao-Jun
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Wang Zi-Tian
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Peng Guang
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Yang Hao
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China
| | - Jiang Yu-Quan
- Department of Orthopedics, The 925th Hospital, 67# Huanghe RD, Guiyang 550009, Guizhou, China.
| | - Tang Yu
- Department of Orthopedics, Xinqiao Hospital, 400037 Chongqing, China.
| |
Collapse
|
5
|
Iannucci LE, Koscso JM, Castile RM, Lake SP, Smith MV. Biomechanical Effect of Differential Tensioning on Suture-Augmented Ulnar Collateral Ligament Reconstruction of the Elbow. Am J Sports Med 2023; 51:205-213. [PMID: 36412519 DOI: 10.1177/03635465221131905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Medial ulnar collateral ligament (mUCL) reconstructions are becoming increasingly prevalent among the overhand throwing population. Suture tape augmentation has the potential to provide biomechanical advantages over standard docking reconstruction. However, the optimal tensioning of the suture augmentation technique has not yet been evaluated. PURPOSE To compare the subfailure biomechanical performance and graft strain of a standard docking mUCL reconstruction to an mUCL reconstruction using suture tape augmentation tensioned with 1 mm or 3 mm of laxity. STUDY DESIGN Controlled laboratory study. METHODS A total of 18 cadaveric elbows were dissected to the mUCL anterior band and biomechanically assessed via a valgus torque protocol to failure. Elbows were randomly assigned to be reconstructed via (1) a standard docking technique, (2) a suture-augmented reconstruction with 1-mm laxity, or (3) a suture-augmented reconstruction with 3-mm laxity. Reconstructed elbows were then subjected to the same loading protocol. Subfailure mechanical properties, failure mode, and mUCL/palmaris strain were assessed. RESULTS All reconstruction groups had decreased rotational stiffness, torque at 5° of angular rotation, and resilience compared with matched native controls. There were no differences in transition torque between groups. The failure mode of suture-augmented specimens was most often due to bone tunnel failure or reaching the maximum allowable angular displacement. In native controls or docking reconstructions, the primary failure mechanism was in the ligament or graft midsubstance. There were no significant differences in strain on the reconstructed or suture-augmented groups at any laxity compared with native controls. CONCLUSION Suture augmentation results in similar subfailure joint biomechanical properties as the standard docking reconstruction procedure at both laxity levels in a cadaveric model. There are improvements in the failure mode of suture-augmented specimens compared with standard docking. Graft strain may be modestly reduced in the 1-mm laxity group compared with other reconstruction groups. CLINICAL RELEVANCE Suture augmentation at both 1-mm and 3-mm laxity appears to offer similar advantages in subfailure biomechanics to standard docking reconstruction of the mUCL, with some improvements associated with failure mode. Strain data suggest a potential avoidance of graft stress shielding when tensioning the suture augmentation to 3-mm laxity, which is not as apparent with 1-mm laxity.
Collapse
Affiliation(s)
- Leanne E Iannucci
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jonathan M Koscso
- Department of Orthopaedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ryan M Castile
- Department of Mechanical Engineering and Materials Science, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Spencer P Lake
- Department of Biomedical Engineering, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Orthopaedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA.,Department of Mechanical Engineering and Materials Science, McKelvey School of Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Matthew V Smith
- Department of Orthopaedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
6
|
Meekaew P, Paholpak P, Wisanuyotin T, Sirichativapee W, Sirichativapee W, Kosuwon W, Kasai Y. Biomechanics comparison between endobutton fixation and syndesmotic screw fixation for syndesmotic injury ankle fracture; a finite element analysis and cadaveric validation study. J Orthop 2022; 34:207-214. [PMID: 36104991 PMCID: PMC9465022 DOI: 10.1016/j.jor.2022.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Various syndesmotic fixation methods in ankle injury are recommended; however, a lack of biomechanical information persists regarding the stiffness of the fixation methods. The current study thus aimed to assess biomechanical cadaveric validation and perform a finite element analysis of syndesmotic fixation comparing endobutton vs. screw after syndesmotic injury with an ankle fracture. Method Five pairs of ankles of fresh cadavers were used for the validity test for Anterior Inferior Tibiofibular Ligament (AITFL), Posterior Inferior Tibiofibular Ligament (PITFL), and Interosseous ligament biomechanics properties. Four finite element models (FEM) were created: an intact model, a fracture model with/without syndesmotic injury, an endobutton fixation model, and a syndesmotic screw fixation model. Each FEM was tested vis-à-vis external rotation force, anteroposterior translation force, and compression force until model failure. The primary outcomes were stiffness and force until failure. Result The respective anteroposterior translation force for the stiffness of the intact model, the screw fixation model, and the endobutton fixation was 8.14, 9.15, and 8.17 N/mm. The respective external rotation force for the stiffness of intact, screw fixation, and endobutton model was 0.927,0.949, and 0.940 Nm/degree. The respective stress under compression force in the intact, screw fixation, and endobutton model was 39.94,25.59, and 37.30 MPa. Conclusion Both screw and endobutton fixation models provided more translation, compression, and rotation stability than normal syndesmosis, but the screw model provided greater translation and compression force stability than the endobutton model. There was no difference in rotational stability between the two models. We thus recommend the same rehabilitation protocol for both fixation methods; however, vigorous translation and compression should be avoided when using endobutton fixation.
Collapse
Affiliation(s)
- Papangkorn Meekaew
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Permsak Paholpak
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Taweechok Wisanuyotin
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Winai Sirichativapee
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Weerachai Kosuwon
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yuichi Kasai
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| |
Collapse
|
7
|
Takahashi K, Teramoto A, Murahashi Y, Nabeki S, Shiwaku K, Kamiya T, Watanabe K, Yamashita T. Comparison of Treatment Methods for Syndesmotic Injuries With Posterior Tibiofibular Ligament Ruptures: A Cadaveric Biomechanical Study. Orthop J Sports Med 2022; 10:23259671221122811. [PMID: 36119124 PMCID: PMC9478698 DOI: 10.1177/23259671221122811] [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: 06/18/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Studies on ankle syndesmosis have focused on anterior inferior tibiofibular
ligament (AITFL) and interosseous membrane injuries; however, the
characteristics of posterior inferior tibiofibular ligament (PITFL) ruptures
remain unclear. Purpose/Hypothesis: This study evaluated the biomechanical characteristics of syndesmotic
instability caused by PITFL injury and compared various treatment methods.
We hypothesized that PITFL injury would lead to syndesmotic internal
rotational instability and that the stability would be restored with suture
tape (ST) PITFL augmentation. Study Design: Controlled laboratory study. Methods: Ten uninjured fresh-frozen cadaveric leg specimens were tested via forces
applied to the external and internal rotation of the ankle joint. The
fibular rotational angle (FRA) related to the tibia, anterior tibiofibular
diastasis (aTFD), and posterior tibiofibular diastasis (pTFD) were measured
using a magnetic tracking system. Six models were created: (1) intact, (2)
AITFL injury; (3) AITFL + PITFL injury; (4) suture button (SB) fixation; (5)
SB + anterior ST (aST) fixation; and (6) SB + aST + posterior ST fixation.
The FRA, aTFD, and pTFD were statistically compared between the intact ankle
and each injury or fixation model. Results: In the intact state, the changes in FRA and aTFD were 1.09° and 0.33 mm when
external rotation force was applied and were 0.57° and 0.41 mm when internal
rotation force was applied. In the AITFL injury model, the changes in FRA
and aTFD were 2.38° and 1.51 mm when external rotation force was applied,
which were significantly greater versus intact (P = .032
and .008, respectively). In the AITFL + PITFL injury model, the changes in
FRA and pTFD were 2.12° and 1.02 mm when internal rotation force was
applied, which were significantly greater versus intact (P
= .007 and .003, respectively). In the SB fixation model, the change in FRA
was 2.98° when external rotation force was applied, which was significantly
higher compared with intact (P < .001). There were no
significant differences between the SB + aST fixation model and the intact
state on any measurement. Conclusion: PITFL injury significantly increased syndesmotic instability when internal
rotation force was applied. SB + aST fixation was effective in restoring
syndesmotic stability. Clinical Relevance: These results suggest that SB + aST fixation is sufficient for treating
severe syndesmotic injury with PITFL rupture.
Collapse
Affiliation(s)
- Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
- Atsushi Teramoto, MD, PhD, Department of Orthopaedic Surgery,
Sapporo Medical University School of Medicine, South-1 West-16, Chuo-ku,
Sapporo, Hokkaido 060-8543, Japan (
)
| | - Yasutaka Murahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Shogo Nabeki
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of
Health Sciences, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Hokkaido, Japan
| |
Collapse
|
8
|
Jamieson MD, Stake IK, Brady AW, Brown J, Tanghe KK, Douglass BW, Clanton TO. Anterior Inferior Tibiofibular Ligament Suture Tape Augmentation for Isolated Syndesmotic Injuries. Foot Ankle Int 2022; 43:994-1003. [PMID: 35403468 DOI: 10.1177/10711007221082933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The best operative construct and technique for treatment of isolated syndesmotic injuries is highly debated. The purpose of this study was to determine whether the addition of anterior inferior tibiofibular ligament (AITFL) suture repair or suture tape (ST) augmentation provides any biomechanical advantage to the operative repair of an isolated syndesmotic injury. METHODS Twelve lower leg specimens underwent biomechanical testing in 6 states: (1) intact, (2) AITFL suture repair, (3) AITFL suture repair + transsyndesmotic suture button (SB), (4) AITFL suture repair + ST augmentation + SB, (5) AITFL suture repair + ST augmentation, and (6) complete syndesmotic injury. The ankle joint was subjected to 6 cycles of 5 Nm internal and external rotation torque under a constant axial load. The spatial relationship between the tibia, fibula, and talus was continuously recorded with a 5-camera motion capture system. RESULTS AITFL suture repair and AITFL suture repair + ST augmentation showed no statistically significant change in fibula kinematics compared to the intact state. Compared to native, AITFL suture repair + SB showed increased fibular external rotation (+2.32 degrees, P < .001), and decreased tibiofibular gap (overtightening) (-0.72 mm, P = .007). AITFL suture repair + ST augmentation + SB also showed increased fibular external rotation (+1.46 degrees, P = .013). Sagittal plane motion of the fibula was not significantly different between any states. None of the repairs restored intact state talus rotation; however, the repairs that used ST augmentation reduced the talus external rotation laxity compared to the complete syndesmotic injury. CONCLUSION AITFL suture repair and AITFL ST augmentation best restored the rotational kinematics and stability of the fibula and ankle joint in an isolated syndesmotic injury model. CLINICAL RELEVANCE AITFL suture repair with or without ST augmentation may be a good operative addition or alternative to SB fixation for isolated syndesmotic disruptions.
Collapse
Affiliation(s)
- Marissa D Jamieson
- Department of Orthopedic Surgery, University of Colorado, Denver, CO, Steadman Phillipon Research Institute, Vail, CO, USA
| | - Ingrid Kvello Stake
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Gralum, Norway, Steadman Philippon Research Institute, Vail, CO, USA
| | - Alex W Brady
- Steadman Phillipon Research Institute, Vail, CO, USA
| | - Justin Brown
- Steadman Phillipon Research Institute, Vail, CO, USA
| | - Kira K Tanghe
- Steadman Phillipon Research Institute, Vail, CO, USA
| | - Brenton W Douglass
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, Steadman Phillipon Research Institute, Vail, CO, USA
| | | |
Collapse
|
9
|
Comparison of Several Combinations of Suture Tape Reinforcement and Suture Button Constructs for Fixation of Unstable Syndesmosis. J Am Acad Orthop Surg 2022; 30:e769-e778. [PMID: 35171859 DOI: 10.5435/jaaos-d-21-00508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/08/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to arthroscopically evaluate syndesmotic stability after fixation with several combinations of suture buttons (SBs) and suture tape reinforcement in a completely unstable cadaver model. METHODS Fifteen cadaver above-knee specimens underwent sequential ligament transection and fixation to create six experimental models: (1) intact model, (2) after complete disruption of the syndesmotic ligaments, and after repair with either suture tape reinforcement (3), suture tape reinforcement with a single SB (4), suture tape reinforcement with two diverging SBs (5), or two diverging SBs alone (6). Instability measurements included anterior and posterior tibiofibular spaces measured arthroscopically under 100 N coronal stress, tibiofibular anteroposterior and posteroanterior translation in sagittal plane measured arthroscopically under sagittal stress of 100 N, and anterior tibiofibular space measured directly with a caliper under external rotation torque of 7.5 N·m. Instability measurements taken after each fixation method were compared with the uninjured model and with the complete unstable model using the Wilcoxon signed-rank test. RESULTS Fixation using a combination of one SB and singular suture tape reinforcement augmentation provided stability similar to the intact stage (coronal anterior space 1.24 versus 1.15, P = 0.887; coronal posterior space 1.63 versus 1.64, P = 0.8421; anteroposterior translation 0.91 versus 0.46, P = 0.003; posteroanterior translation 0.51 versus 0.57, P = 0.051; external rotation anterior tibiofibular space 1.08 versus 0.55, P = 0.069). Moreover, adding a second SB led to further gains in fixation stability. DISCUSSION This study suggests that although a destabilizing syndesmotic injury that includes the anterior inferior tibiofibular ligament, interosseous ligament, and posterior inferior tibiofibular ligament is not adequately stabilized by either one or two SBs, the addition of a suture tape reinforcement to even one SB restores syndesmotic stability to the preinjury level.
Collapse
|
10
|
Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries. J Clin Med 2022; 11:jcm11020331. [PMID: 35054025 PMCID: PMC8780481 DOI: 10.3390/jcm11020331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.
Collapse
|
11
|
Harris NJ, Nicholson G, Pountos I. Anatomical reconstruction of the anterior inferior tibiofibular ligament in elite athletes using InternalBrace suture tape. Bone Joint J 2022; 104-B:68-75. [PMID: 34969286 DOI: 10.1302/0301-620x.104b1.bjj-2021-0542.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIMS The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. METHODS Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)). RESULTS All patients returned to their pre-injury level of sports activities. One patient developed a delayed union of the medial malleolus. The mean return to play was 62 days (49 to 84) for isolated injuries, while the patients with concomitant injuries returned to play in a mean of 104 days (56 to 196). The AOFAS score returned to 100 postoperatively in all patients. Knee-to-wall measurements were the same as the contralateral side in 18 patients, while one patient lacked 2 cm compared to the contralateral side. CONCLUSION This study suggests the use of the InternalBrace in the management of unstable syndesmotic injuries offers an alternative method of stabilization, with good short-term results, including early return to sports in elite athletes. Cite this article: Bone Joint J 2022;104-B(1):68-75.
Collapse
Affiliation(s)
- Nick J Harris
- Spire Leeds Hospital, Leeds, UK.,Carnegie School of Sport, Leeds Becket University, Leeds, UK
| | | | - Ippokratis Pountos
- Academic Department of Trauma and Orthopaedics, University of Leeds, Leeds, UK.,Chapel Allerton Hospital, Leeds Teaching Hospitals, Leeds, UK
| |
Collapse
|
12
|
Diagnosis and Treatment of Syndesmotic Unstable Injuries: Where We Are Now and Where We Are Headed. J Am Acad Orthop Surg 2021; 29:985-997. [PMID: 34478409 DOI: 10.5435/jaaos-d-20-01350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 07/24/2021] [Indexed: 02/01/2023] Open
Abstract
Up to 10% of ankle sprains are considered "high ankle" sprains with associated syndesmotic injury. Initial diagnosis of syndesmotic injury is based on physical examination, but further evaluation of the distal tibiofibular joint in the sagittal, coronal, and rotational planes is necessary to determine instability. Imaging modalities including weight-bearing CT and ultrasonography allow a physiologic and dynamic assessment of the syndesmosis. These modalities in turn provide the clinician useful information in two and three dimensions to identify and consequently treat syndesmotic instability, especially when subtle. Because there is notable variability in the shape of the incisura between individuals, contralateral comparison with the uninjured ankle as an optimal internal control is advised. Once syndesmotic instability is identified, surgical treatment is recommended. Several fixation methods have been described, but the foremost aspect is to achieve an anatomic reduction. Identifying any associated injuries and characteristics of the syndesmotic instability will lead to the appropriate treatment that restores the anatomy and stability of the distal tibiofibular joint.
Collapse
|
13
|
Kim JS, Shin HS. Suture Anchor Augmentation for Acute Unstable Isolated Ankle Syndesmosis Disruption in Athletes. Foot Ankle Int 2021; 42:1130-1137. [PMID: 34088225 DOI: 10.1177/10711007211015188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Isolated ankle syndesmosis disruption (without fibula fracture) causes acute pain and may cause chronic instability and pain. The aim of the present study was to evaluate the outcomes after anterior inferior tibiofibular ligament (AITFL) anatomical fixation using anchor sutures for unstable isolated syndesmosis disruption without fibular fractures. METHODS This study assessed 22 athletes who were diagnosed with unstable isolated syndesmosis disruption with a positive external rotation test, had more than 2-mm diastasis on ultrasound, and had complete AITFL rupture on magnetic resonance imaging between 2004 and 2020. Eighteen patients (82%) were elite-level athletes, and the remaining 4 were recreational athletes. Twelve patients (55%) were injured by an external rotation force. The athletes underwent open anatomical suture anchor fixation between the AITFL attachment sites, the fibula and tibia. The mechanism of injury, return-to-play time, and Foot and Ankle Outcome Score (FAOS) were evaluated. RESULTS All athletes returned to previous play except 1 retired elite athlete. Twenty-two athletes returned to jogging, team training, and official game play at an average of 62, 89, and 102 days, respectively. The final average follow-up FAOS symptom, pain, daily activity, sports activity, and quality of life scores were 98, 97, 100, 99, and 97, respectively. Two athletes were reinjured, and 1 required reoperation in the follow-up period. CONCLUSION Athletes with isolated syndesmosis disruption had a high likelihood to return to their previous activity level after suture anchor augmentation. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Jin Su Kim
- Department of Orthopedic Surgery, Sejong Sports Medicine and Performance Center, Seoul, Korea
| | - Hyuck Soo Shin
- Department of Orthopedic Surgery, Seoul CM Hospital, Seoul, Korea
| |
Collapse
|
14
|
Kamiya T, Otsubo H, Suzuki T, Shiwaku K, Kitamura C, Teramoto A, Yamashita T. Hamstring Graft Prepared With Suture Tape Is Effective in Anterior Cruciate Ligament Reconstruction: A Biomechanical Analysis. Arthrosc Sports Med Rehabil 2021; 3:e1003-e1009. [PMID: 34430879 PMCID: PMC8365212 DOI: 10.1016/j.asmr.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/18/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the graft diameters and mechanical properties of hamstring tendons sutured using different materials and techniques. Methods This study used 30 fresh, frozen human cadaveric semitendinosus tendons; the free ends of 10 specimens each were sutured by 2 No. 3 braided polyester sutures with the Krackow technique (BP group), SutureTape with the Krackow technique (ST group), or SutureTape Loop with the locking SpeedWhip technique (SL group). First, the changes in graft diameter from before suturing to after suturing were investigated. Each graft was pre-tensioned to 100 N for 3 cycles and then cyclically loaded to 200 N for 200 cycles. Elongation after cyclic loading and displacement in the 200th cycle were calculated. Finally, each specimen was loaded to failure. The ultimate failure load and stiffness were analyzed. These mechanical properties were statistically analyzed using 1-way analysis of variance. The level of statistical significance was set at P < .05. Results In the BP group, the changes in graft diameter were significantly larger than those in the ST and SL groups (P = .001). The elongation values after 200 cycles in the BP and ST groups were 3.1 ± 2.0 mm and 5.9 ± 3.4 mm, respectively. In the SL group, elongation (7.7 ± 3.6 mm) was significantly larger compared with that in the BP group (P = .037). In contrast, displacement in the 200th cycle was significantly smaller in the ST and SL groups compared with the BP group (P = .017). No statistically significant difference was evident for the ultimate failure loads among the 3 groups (P = .543). Conclusions The results of this study suggest that SutureTape may be an appropriate option for preparing the hamstring graft in anatomic anterior cruciate ligament (ACL) reconstruction. Clinical Relevance This biomechanical study shows the effectiveness of SutureTape in ACL graft preparation. Clinically, SutureTape may be of benefit in single- or double-bundle ACL reconstruction.
Collapse
Affiliation(s)
- Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hidenori Otsubo
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Chihiro Kitamura
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
15
|
Fisher A, Bond A, Philpott MDG, Jayatilaka MLT, Lambert LA, Fisher L, Weigelt L, Myatt D, Molloy A, Mason L. The anatomy of the anterior inferior tibiofibular ligament and its relationship with the Wagstaffe fracture. Foot Ankle Surg 2021; 27:291-295. [PMID: 33446454 DOI: 10.1016/j.fas.2021.01.003] [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: 11/14/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Our aim in this study was to identify the fibular footprint of the Anterior Inferior Tibiofibular Ligament (AITFL) and its relation to Wagstaffe fracture fragment size. METHODS We examined 25 cadaveric lower limbs which were carefully dissected to identify the lateral ankle ligaments. The AITFL anatomy was compared to 40 Wagstaffe fractures identified from our ankle fracture database. RESULTS The AITFL origin was from the anterior fibular tubercle with an average length of 21.61 mm (95% CI 20.22, 22.99). The average distance of the distal aspect of the AITFL footprint to the distal fibula margin was 11.60 mm (95% CI 10.49, 12.71). In the ankle fractures analyzed, the average length of the Wagstaffe fragment was 17.88 mm (95% CI 16.21, 19.54). The average distance from the distal tip of the fibula to the Wagstaffe fracture fragment was 21.40 mm (95% CI 19.78, 23.01). In total there were 22 syndesmosis injuries. There was no statistical difference in Wagstaffe fragment size between stable and unstable groups. CONCLUSION The AITFL fibular origin was both larger and more distal than the Wagstaffe fracture fragments seen in our institution. Therefore, this suggests that a ligamentous failure will also have to occur to result in syndesmotic instability. The size of fracture fragment also did not confer to syndesmotic instability on testing. Level of Evidence - 3.
Collapse
Affiliation(s)
| | | | | | | | | | - Lauren Fisher
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Darren Myatt
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Andrew Molloy
- University of Liverpool, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lyndon Mason
- University of Liverpool, Liverpool, UK; Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| |
Collapse
|
16
|
Huang H, Yang Y. [Research progress in diagnosis and treatment of distal tibiofibular syndesmosis injury]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:1346-1351. [PMID: 33063503 DOI: 10.7507/1002-1892.201911090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress in the diagnosis and treatment of distal tibiofibular syndesmosis injury. Methods The recent literature about distal tibiofibular syndesmosis injury was reviewed and analyzed. Results Distal tibiofibular syndesmosis injury is commonly seen in ankle joint injury, the anatomical complexities make diagnosis and treatment difficult. Preoperative physical examination, radiologic evaluation, and intraoperative stress-testing are important for the diagnosis. Aggressive treatment is also recommended for these injuries to prevent long-term chronic instability. Internal fixation is the main treatment, including metal screw, degradable screw, elastic fixation, and hybrid techniques. Metal screw fixation is still the current mainstream, but elastic fixation represented by Suture-button is more in line with the physiological characteristics of ankle joint, and the rate of secondary operation is low while the clinical outcome is satisfactory. The application prospect of elastic fixation is worthy of expectation. Conclusion It's crucial for patient with ankle fracture to repair the distal tibiofibular syndesmosis injury. How to diagnose the injury more accurately and simply, how to increase the success rate of reduction, and how to reduce the complications of surgery are still worthy for further exploration.
Collapse
Affiliation(s)
- Hui Huang
- Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| | - Yunfeng Yang
- Department of Orthopaedics, Tongji Hospital, Tongji University, Shanghai, 200065, P.R.China
| |
Collapse
|
17
|
Kwon JY, Stenquist D, Ye M, Williams C, Giza E, Kadakia AR, Kreulen C. Anterior Syndesmotic Augmentation Technique Using Nonabsorbable Suture-Tape for Acute and Chronic Syndesmotic Instability. Foot Ankle Int 2020; 41:1307-1315. [PMID: 32916075 DOI: 10.1177/1071100720951172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Syndesmotic instability is a source of significant pain and disability. Both subtle instability and gross diastasis, whether acute or chronic, require stabilization and may benefit from reconstruction with ligamentous augmentation. The use of nonabsorbable suture-tape has emerged as a promising operative strategy, allowing surgeons to anatomically reconstruct the syndesmosis, in particular the anterior inferior tibiofibular ligament. The current work provides a detailed description of the technique and preliminary results of a patient cohort treated using nonabsorbable suture-tape for syndesmotic augmentation.Level of Evidence: Level V, expert opinion.
Collapse
Affiliation(s)
- John Y Kwon
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Derek Stenquist
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Ye
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Caroline Williams
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Eric Giza
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Anish R Kadakia
- Department of Orthopedics, University of California, Davis, Sacramento, CA, USA
| | - Christopher Kreulen
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Chicago, IL, USA
| |
Collapse
|
18
|
Li H, Zhao Y, Chen W, Li H, Hua Y. No Differences in Clinical Outcomes of Suture Tape Augmented Repair Versus Broström Repair Surgery for Chronic Lateral Ankle Instability. Orthop J Sports Med 2020; 8:2325967120948491. [PMID: 32974410 PMCID: PMC7495671 DOI: 10.1177/2325967120948491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background Suture tape (ST) augmented repair, an alternative to traditional Broström repair (BR), may protect the repaired anterior talofibular ligament during ligament healing. No systematic review of cohort studies has been conducted to compare traditional BR with ST-augmented repair for chronic lateral ankle instability. Purpose To review the current evidence in the literature to ascertain whether ST-augmented repair is superior to traditional BR in managing chronic lateral ankle instability. Study Design Systematic review; Level of evidence, 3. Methods A literature search was performed to identify relevant articles published in PubMed, Embase, and Cochrane Library databases in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search included cohort studies comparing the efficacy of BR and ST-augmented repair procedures in terms of incidence of instability recurrence, functional scores, talar tilt angle (TTA), anterior talar translation (ATT), and complication rate. Methodological quality was assessed using the Jadad scale for randomized studies and the Newcastle-Ottawa Scale for nonrandomized studies. Results A total of 4 clinical trials with 254 patients were included. No significant differences were detected between BR and ST-augmented repair procedures in terms of incidence of recurrent instability, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, Foot and Ankle Ability Measure, TTA, ATT, or complication rate. The ST group appeared to have a shorter operation time compared with the BR group. Conclusion No significant differences were found between ST-augmented repair and BR surgery regarding incidence of recurrent instability, functional outcome scores, or complication rates. Although technically challenging, the ST-augmented repair procedure appears to be a safe and fast option.
Collapse
Affiliation(s)
- Hong Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yujie Zhao
- Department of Nursing, Huashan Hospital, Shanghai, People's Republic of China
| | - Wenbo Chen
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Shanghai, People's Republic of China
| |
Collapse
|
19
|
Abstract
Acute and chronic syndesmotic injuries significantly impact athletic function and activities of daily living. Patient history, examination, and judicious use of imaging modalities aid diagnosis. Surgical management should be used when frank diastasis, instability, and/or chronic pain and disability ensue. Screw and suture-button fixation remain the mainstay of treatment of acute injuries, but novel syndesmotic reconstruction techniques hold promise for treatment of acute and chronic injuries, especially for athletes. This article focuses on anatomy, mechanisms of injury, diagnosis, and surgical reduction and stabilization of acute and chronic syndesmotic instability. Fixation methods with a focus on considerations for athletes are discussed.
Collapse
|
20
|
Syndesmosis Injury From Diagnosis to Repair: Physical Examination, Diagnosis, and Arthroscopic-assisted Reduction. J Am Acad Orthop Surg 2020; 28:517-527. [PMID: 32109919 DOI: 10.5435/jaaos-d-19-00358] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures. Syndesmotic ligament injury can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The syndesmosis complex is a relatively simple construct of well-documented ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. Thus, we propose a simplified general video guide to do the diagnostic examinations and arthroscopic-assisted reduction based on current evidence-based medicine.
Collapse
|
21
|
Kikuchi S, Tajima G, Sugawara A, Yan J, Maruyama M, Oikawa S, Saigo T, Oikawa R, Doita M. Characteristic features of the insertions of the distal tibiofibular ligaments on three-dimensional computed tomography- cadaveric study. J Exp Orthop 2020; 7:3. [PMID: 31974931 PMCID: PMC6977791 DOI: 10.1186/s40634-020-0220-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/10/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose The purpose of this study was to clarify the insertion sites of the anterior inferior tibiofibular ligament (AITFL) and posterior inferior tibiofibular ligament (PITFL) and related osseous landmarks on three-dimensional computed tomography images. Methods Twenty-nine non-paired, formalin-fixed human cadaveric ankles were evaluated. The tibial and fibular insertion sites of the AITFL and PITFL were identified. The morphology and location of the insertion sites and their positional relationships with osseous structures were analyzed on three-dimensional computed tomography images. Results The AITFL had a trapezoidal shape, with fibers that ran obliquely lateral from a wider insertion at the lateral distal tibia to the medial distal fibula. The PITFL had a similar shape to the AITFL; however, it ran more horizontally, with fibers running in the same direction. In the tibia, the anterior capsular ridge and the Chaput’s and Volkmann’s tubercles were useful osseous landmarks for the insertion sites. In the fibula, the centers of the insertion sites of the AITFL and PITFL were located on the edges of the distal anterior and posterior fibula, which were useful osseous landmarks. The mean distances between the center points of the tibial and fibular insertion sites of the AITFL and PITFL were 10.1 ± 2.4 mm and 11.7 ± 2.6 mm, respectively. Conclusions The relationships between the characteristic features of the distal tibia and fibula and the insertions of the AITFL and PITFL were consistent. The present findings improve the understanding of the anatomy of the insertions of the distal tibiofibular syndesmotic joint.
Collapse
Affiliation(s)
- Sho Kikuchi
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan.
| | - Goro Tajima
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan
| | - Atsushi Sugawara
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan
| | - Jun Yan
- Department of Anatomy, Iwate Medical University, Uchimaru,19-1, Morioka, Japan
| | - Moritaka Maruyama
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan
| | - Shinya Oikawa
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan
| | - Takaaki Saigo
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan
| | - Ryunosuke Oikawa
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan
| | - Minoru Doita
- Department of Orthopedic Surgery, Iwate Medical University, Uchimaru, 19-1, Morioka, Iwate, Japan
| |
Collapse
|
22
|
Shoji H, Teramoto A, Suzuki D, Okada Y, Sakakibara Y, Matsumura T, Suzuki T, Watanabe K, Yamashita T. Suture-button fixation and anterior inferior tibiofibular ligament augmentation with suture-tape for syndesmosis injury: A biomechanical cadaveric study. Clin Biomech (Bristol, Avon) 2018; 60:121-126. [PMID: 30342380 DOI: 10.1016/j.clinbiomech.2018.10.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/29/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Suture-button (SB) fixation has been widely performed for syndesmosis injuries, but it has been reported unstable in some biomechanical studies. The purpose of this study was to evaluate the stability of the syndesmosis using SB fixation with anterior inferior tibiofibular ligament augmentation using suture-tape (ST). METHODS Eight normal fresh-frozen cadaveric legs were used. After initial tests of intact and injured models, SB fixation, SB fixation with ST augmentation, ST augmentation alone, and screw fixation were performed sequentially for each specimen. Loading tests stimulating dorsiflexion, inversion, and external rotation of the ankle joint were performed for each model. The tibiofibular diastasis (TFD) and the fibular rotational angle related to the tibia (FRA) were measured using a magnetic tracking system. FINDINGS In the injured model, both TFD and FRA increased significantly compared with the intact model in all directions (P < .05). In the SB fixation model, TFD and FRA generally showed significant increases (P < .05, except for TFD in external rotation). In the SB fixation with ST augmentation model and ST augmentation alone, TFD and FRA were not significantly different compared with the intact model (P > .05). In the screw fixation model, FRA with inversion force at the ankle was significantly decreased compared with the intact model (P = .027). INTERPRETATION SB fixation alone did not provide stability of the syndesmosis, and screw fixation became too rigid compared with the intact model. Using ST augmentation achieved dynamic stability similar to the intact model for syndesmotic injuries.
Collapse
Affiliation(s)
- Hiroaki Shoji
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan.
| | - Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, South 1 West 17, Chuo-ku, Sapporo, Hokkaido 060-8556, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Yuzuru Sakakibara
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Takashi Matsumura
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Tomoyuki Suzuki
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Sciences, South 1 West 17, Chuo-ku, Sapporo, Hokkaido 060-8556, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan
| |
Collapse
|