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Huang L, Wu W, Wang N, Zhou X, Peng W, Jiang S, Chen X, Xiong B, Wang J, Wang G, Zhang L. Skeletal Features of Talus in Hepple V Lesion. J Foot Ankle Surg 2024:S1067-2516(24)00086-3. [PMID: 38679411 DOI: 10.1053/j.jfas.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
The present study was to determine the characteristics of the ankle skeletal structure in patients with talus Hepple V type. We conducted a retrospective study on the skeletal structure of the talus in 110 patients with Hepple V osteochondral lesions of the talus and in control participants. The radiographic measurements taken include the following: in the coronal plane - depth of talus frontal curvature, length of the lateral and medial malleolus; in the sagittal plane - radius and height of talus, angle of tibial lateral surface, tibiotalar sector, and vertical neck angle. The osteochondral lesion of the talus showed a significantly larger mean radius (mean ± SD, 21.4 ± 2.5 mm; p < .001) and height (mean ± SD, 26.0 ± 2.7 mm; p < .005). It also demonstrated a longer mean medial malleolus length (mean ± SD, 15.7 ± 2.4 mm; p < .005), a larger mean vertical neck angle (mean ± SD, 86.2 ± 5.4°; p < .050), and a greater mean tibial lateral surface angle (mean ± SD, 80.0 ± 4.5°; p < .001). And there was a greater mean frontal curvature depth (mean ± SD, 3.9 ± 0.6 mm; p < .005). Overall, this study found that patients with Hepple V osteochondral lesions of the talus had a larger vertical neck angle and tibial lateral surface angle, a longer talus radius and medial malleolus length, a higher talus height, and a deeper frontal curvature depth. STUDY DESIGNS: Retrospective Case-Control Study.
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Affiliation(s)
- Lei Huang
- School of Physical Education, Southwest Medical University, Luzhou, 646000, China
| | - Wangyu Wu
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Nan Wang
- School of Traditional Chinese and Western Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China; Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China; Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, 646000, China
| | - Wanlin Peng
- Department of Imaging Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Songtao Jiang
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Xu Chen
- Department of Pediatrics, Southwest Medical University, Luzhou, 646000, China
| | - Bin Xiong
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Jiarui Wang
- School of Clinical Medicine, Southwest Medical University, Luzhou, 646000, China
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China; Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China; Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, 646000, China
| | - Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China; Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, China; Luzhou Key Laboratory of Orthopedic Disorders, Luzhou, 646000, China.
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Ceritoglu KU, Danisman M. Can Anatomical Differences Contribute to the Etiology of Danis-Weber Type B Lateral Malleolus Fractures? Cureus 2024; 16:e55808. [PMID: 38463402 PMCID: PMC10923548 DOI: 10.7759/cureus.55808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Lateral malleolus fractures are among the most common ankle fractures, but the anatomical factors that may predispose individuals to this specific type of fracture are not fully understood. This study aims to explore whether distinct anatomical characteristics of the ankle joint contribute to an increased susceptibility to lateral malleolar fractures. Methods A retrospective analysis was conducted on 73 patients diagnosed with isolated lateral malleolar fractures between 2020 and 2023. An array of radiologic parameters, including distal tibial articular surface (DTAS) angle, bimalleolar tilt (BMT), medial malleolar length (MML), lateral malleolar length (LML), medial malleolar relative length (MMRL), lateral malleolar relative length (LMRL), medial malleolar slip angle (MMSA), talocrural angle (TCA), anterior inclination of the tibia (AI), and fibular position (FP), were meticulously measured on anteroposterior and lateral ankle radiographs for each study participant. We also measured the same parameters in 126 individuals who had not experienced an ankle fracture for comparison. Results Statistically significant differences were observed between the fracture group and the control group for DTAS angle, BMT, MML, MMRL, LMRL, TCA, AI, and FP (p<.05). Conversely, LML and MMSA displayed no significant variations between the two groups (p=0.745 and p=0.623). Effect sizes were notably large for DTAS and TCA, medium for MMRL, BMT, and AI, and small for LMRL, MML, and FP. Conclusion Our findings indicate an increased risk of lateral malleolus fractures in individuals with a relatively longer medial malleolus, a valgus-oriented ankle, reduced anterior inclination of the tibia, and an anteriorly positioned fibula. Taking protective measures during risky activities in individuals with these differences may help to prevent fractures.
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Affiliation(s)
| | - Murat Danisman
- Orthopaedics and Traumatology, Giresun University, Giresun, TUR
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Yang Z, Liu F, Cui L, Liu H, Zuo J, Liu L, Li S. Comparison of the effects of reconstruction of the lateral ankle ligaments using peroneus longus and peroneus brevis tendon graft. Medicine (Baltimore) 2020; 99:e22912. [PMID: 33181657 PMCID: PMC7668510 DOI: 10.1097/md.0000000000022912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Peroneus longus and peroneus brevis tendon grafts have been frequently used to reconstruct the lateral ankle ligaments. However, there is no literature comparing the effect of the 2 methods. The purpose of this study was to compare the effects of 2 autologous tendon transplants on ankle joint activity.This retrospective study included 100 adult patients with chronic lateral ankle instability (CLAI) who underwent surgery from January 2014 to December 2017. Group A (50 patients): Reconstruction of the lateral ankle ligaments using the anterior half of peroneus longus tendon graft; Group B (50 patients): Using the anterior half of peroneus brevis tendon graft. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment included talar tilt and anterior talar translation. A sensitive dynamometer was used before and after surgery to assess inversion, valgus, plantarflexion, and dorsiflexion strength to evaluate changes in muscle strength in the patients feet.Postoperatively, 88 patients were followed up for 12 to 24 months, including 46 cases in group A and 42 in group B. No severe complications were recorded in the 2 groups. There were significant pre- to post-operative differences between the groups. No significant differences were observed in the postoperative scores and muscle strength changes between the groups. However, the number of patients with decreased valgus strength in group B was statistically significant compared with group A.Both methods can improve the stability of the ankle joint, but the peroneus longus tendon has little effect on the postoperative muscle strength of the foot and should be used as the preferred surgical treatment for the treatment of CLAI.
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Tarczyńska M, Sekuła P, Gawęda K, Szubstarski M, Przybylski P, Czekajska-Chehab E. Stress radiography in the diagnosis and assessment of the outcomes of surgical treatment of chronic anterolateral ankle instability. Acta Radiol 2020; 61:783-788. [PMID: 31744302 DOI: 10.1177/0284185119882661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND In about 20-40% of patients, damage to the soft tissues surrounding the ankle leads to recurrent and chronic pain with signs of instability of the talus in the tibiofibular fork. PURPOSE The aim of the study was to assess the usefulness of stress X-ray images in the diagnosis of long-term outcomes of conservative versus surgical treatment of anterolateral ankle instability. MATERIAL AND METHODS Thirty patients with chronic ankle instability (CAI) were recruited for the study. The participants were divided into two groups. The first group consisted of 15 non-operatively treated individuals diagnosed with anterior talofibular ligament (ATFL) damage. The second group consisted of 15 patients who had undergone surgical reconstruction of the ATFL. In both groups of patients, the contralateral normal limb was used as a control. In all patients, anteroposterior and lateral view stress radiographs of both ankles were taken using the TELOS Stress Device (GA - III/E, Hungen, Germany). RESULTS Statistical tests showed that the surgically treated patients had a significantly greater ankle stability compared to the non-surgically treated patients (P = 0.001 for talar tilt angle and P = 0.009 for anterior drawer distance). The results obtained in this study indicate that this method can also be used in postoperative assessment of the function of the reconstructed lateral ankle ligaments. CONCLUSIONS Stress radiography is a reliable and safe tool for diagnosing CAI. This imaging method is an objective instrument that can be successfully used in postoperative assessment of the function of the reconstructed ATFL.
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Affiliation(s)
- Marta Tarczyńska
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Przemysław Sekuła
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Krzysztof Gawęda
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Mateusz Szubstarski
- Department and Clinic of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - Piotr Przybylski
- 1st Department of Medical Radiology, Medical University of Lublin, Lublin, Poland
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Assessing mechanical ankle instability via functional 3D stress-MRI - A pilot study. Clin Biomech (Bristol, Avon) 2019; 70:107-114. [PMID: 31472302 DOI: 10.1016/j.clinbiomech.2019.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/16/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quantitative measurement of the mechanical deficit in chronic ankle instability (CAI) is difficult. Therefore, the distinction between functional (FAI) and mechanical ankle instability (MAI) as well as the evaluation of surgical techniques is difficult. This pilot study uses a novel method of functional 3-dimensional stress ankle-MRI to test its applicability for assessing mechanical ankle instability. METHODS We used a custom-built ankle arthrometer that allows a stepless positioning of the foot and an axial in situ loading with up to 500 N combined with a 3-dimensional MRI protocol. We assessed four parameters (3D cartilage contact area (CCA) fibulotalar, tibiotalar horizontal and vertical and intermalleolar distance) under six different conditions (neutral-null, plantarflexion-supination and dorsiflexion-pronation each with and without loading) in n = 10 individuals (7 suffering from MAI and 3 healthy controls). FINDINGS The MAI group showed a substantially increased reduction of lateral osseous constraint compared to healthy controls when the foot was positioned in plantarflexion-supination (CCA fibulotalar 69% vs. 30% in controls). The reduction of the weight bearing surface in plantarflexion-supination was also more pronounced (CCA tibiotalar horizontal -49% in MAI vs. -28% in controls). INTERPRETATION This novel technique is valuable for assessing mechanical ankle instability in the target population and has a potential clinical benefit for assessing the mechanical deficit of individual patients. Further studies are needed to provide evidence for a possible prognostic value of this novel technique.
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Park BS, Chung CY, Park MS, Sung KH, Choi Y, Park C, Koo S, Lee KM. Inverse Relationship Between Radiographic Lateral Ankle Instability and Osteochondral Lesions of the Talus in Patients With Ankle Inversion Injuries. Foot Ankle Int 2019; 40:1368-1374. [PMID: 31452390 DOI: 10.1177/1071100719868476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Insufficient or excessive bony constraint surrounding the talus might contribute to the occurrence of ligamentous injury or bone contusion, respectively, at the time of ankle inversion injuries. This study aimed to investigate the relationship between radiographic lateral ankle instability and osteochondral lesions of the talus (OLT) following ankle inversion injuries. METHODS A total of 195 patients (113 men and 83 women; mean age, 38.7 years) with a history of ankle inversion injuries were included in this study. All patients underwent ankle magnetic resonance imaging (MRI) and stress radiography. The tibiotalar tilt angle on varus stress radiograph, anterior translation of the talus on anterior-drawer lateral radiographs, bimalleolar tilt angle, and fibular position were radiographically determined. The radiographic lateral ankle instability was defined as tibiotalar tilt angle ≥10 degrees, and the presence of OLT was confirmed on MR images. The relationship between the radiographic lateral ankle instability and the presence of OLT was statistically analyzed. RESULTS The presence of radiographic lateral ankle instability (tibiotalar tilt angle ≥10 degrees) showed an inverse relationship with that of OLT in the chi-squared test (P = .003). An increased tibiotalar tilt angle was associated with lower incidence of OLT (P = .011) in the multiple regression analysis, and the presence of OLT was associated with a decreased tibiotalar tilt angle (P = .016) in the binary logistic regression analysis. CONCLUSIONS This study showed an inverse relationship between lateral ankle instability and the development of OLT following ankle inversion injury. The role of bony constraint in the development of sports injuries in the ankle should be considered with these injuries. LEVEL OF EVIDENCE Level III, diagnostic, comparative study.
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Affiliation(s)
- Byeong Seop Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chin Youb Chung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Moon Seok Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Hyuk Sung
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young Choi
- Department of Orthopedic Surgery, Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Chulhee Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seungbum Koo
- Korea Advanced Institute of Science Technology, Daejeon, Republic of Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Sun Y, Wang H, Tang Y, Zhao H, Qin S, Zhang F. Reconstruction of the lateral ankle ligaments using the anterior half of peroneus longus tendon graft. Foot Ankle Surg 2019; 25:242-246. [PMID: 29409185 DOI: 10.1016/j.fas.2017.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study aimed to report our institution's experience in the treatment of chronic lateral ankle instability using the anterior half of the peroneus longus tendon (AHPLT) to reconstruct the lateral ligament. METHODS This retrospective study included 32 consecutive patients with chronic lateral ankle instability who underwent surgery from January 2013 to December 2014. All patients had failed to resolve with conservative treatment. A total of 32 ankles underwent AHPLT transfer. Patients returned for a clinical and radiologic follow-up evaluation at an average of 28 (range, 24-35) months postoperatively. Outcomes were assessed by comparison of pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale pain scores, and Karlsson scores, and the radiographic assessment including talar tilt and anterior talar translation. RESULTS Thirty-two patients (32 ankles) (100%) returned for final evaluation. All patients had an excellent or good outcome on patient subjective self-assessment, pain scores, AOFAS scores, and Karlsson scores at final follow-up. Ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was significantly reduced from a preoperative mean of 14.1±4.2° to 3.4±1.3° postoperatively (P<.001), and the anterior drawer was significantly reduced from a preoperative mean of 13.8±3.4mm to 3.6±1.5mm after lateral ankle ligamentous reconstruction (P<.001). CONCLUSIONS AHPLT transfer to reconstruct the lateral ligament resulted in a high percentage of successful results, with excellent ankle stability and not affected of ankle motion. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Yaning Sun
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Huijuan Wang
- Department of Histology and Embryology, Hebei Medical University, Shijiazhuang 050017, PR China.
| | - Yuchao Tang
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Haitao Zhao
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Shiji Qin
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
| | - Fengqi Zhang
- Department of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China.
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Jolman S, Robbins J, Lewis L, Wilkes M, Ryan P. Comparison of Magnetic Resonance Imaging and Stress Radiographs in the Evaluation of Chronic Lateral Ankle Instability. Foot Ankle Int 2017; 38:397-404. [PMID: 28061547 DOI: 10.1177/1071100716685526] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients who develop chronic ankle instability, clinicians often obtain magnetic resonance imaging (MRI) as part of the evaluation prior to operative referral. The purpose of this study was to analyze the diagnostic efficacy of MRI in the diagnosis of chronic lateral ankle instability. Our hypothesis was that magnetic resonance imaging would not be a specific diagnostic tool in the evaluation of chronic lateral ankle instability. MATERIALS AND METHODS A retrospective chart review of 187 consecutive patients (190 ankles) was performed. Inclusion criteria for the study group required a primary complaint of instability that required operative repair or reconstruction, a documented clinical evaluation consistent with instability, stress radiographs, and MRI. Stress radiographs and clinical examinations for the study group and a control group were reviewed independently by both a musculoskeletal radiologist and a board-certified orthopaedic foot and ankle surgeon. Predictive values in terms of sensitivity, specificity, and prevalence were performed. In total, 112 patients (115 ankles) were identified who underwent an operative reconstruction of their lateral ligaments with a history, physical examination, and stress radiographs consistent with lateral ankle instability. A control group was selected consisting of 75 patients seen in the foot and ankle clinic with a diagnosis other than lateral ankle instability. Thirty-seven of the patients in the control group had stress radiographs performed in the clinic to rule out instability as part of their evaluation, and this allowed for an evaluation of the efficacy of stress radiographs in addition to MRI. Statistical analysis was performed using predictive values from sensitivity, specificity, and prevalence. RESULTS The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in regards to MRI in the evaluation of patients found to have clinical lateral ankle instability and those who did not had statistical significance. Sensitivity of MRI was 82.6%, specificity was 53.3%, NPV was 66.7%, and PPV was 73%. Since 37 patients in the control group also had stress radiographs, a subanalysis was performed to identify the same values with stress radiographs. Sensitivity, specificity, NPV, and PPV were 66%, 97%, 48%, and 98.7%, respectively. The overall accuracy within this study was 71% for MRI and 74% for stress radiographs. CONCLUSION This study demonstrated that MRI has high sensitivity but low specificity in the evaluation of clinical ankle instability. While MRI has value as a screening tool for concomitant ankle pathology, it should not be considered diagnostic in terms of lateral ankle instability. LEVEL OF EVIDENCE Level III, retrospective cohort, comparative series.
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Affiliation(s)
| | | | - Laura Lewis
- 1 Madigan Army Medical Center, Tacoma, WA, USA
| | | | - Paul Ryan
- 2 Tripler Army Medical Center, Honolulu, HI, USA
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