1
|
Roytman GR, Salameh M, Rizzo SE, Dhodapkar MM, Tommasini SM, Wiznia DH, Yoo BJ. Sustentaculum fracture fixation with lateral plate or medial screw fixation are equivalent. Injury 2024; 55:111532. [PMID: 38614015 DOI: 10.1016/j.injury.2024.111532] [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: 12/07/2023] [Revised: 03/25/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Fixation of sustentaculum tali fractures is important to maintain the biomechanical function of the subtalar joint. A common method of fixation is securing the sustentacular fragment by way of a laterally based locking plate (LP). A medial approach with a single screw (MS) has been proposed as an alternative method of fixation. METHODS Five pairs of formalin-preserved cadaveric ankles with the subtalar joint and interosseous ligaments intact ("osseous cadavers") and four pairs of fresh-frozen cadaveric ankles with soft-tissue preserved dissected from mid-tibia down ("soft tissue cadavers") were used in the study. The left ankle was randomly assigned to one of the two fixation methods (LP or MS), while the right ankle was the opposite. These same steps for fixation were repeated for six synthetic ankle models. All models were loaded with a body mass of 80 kg. Statistical differences between LP and MS stiffness were determined using a paired t-test in cadavers and un-paired t-tests in synthetic ankles. RESULTS For osseous cadaveric ankles, LP demonstrated a mean stiffness of 232.95(SD: 59.96) N/mm, while MS was 239.72(SD:131.09) N/mm (p = 0.9293). For soft tissue cadaveric ankles, LP mean stiffness was 133.58(SD:37.84) N/mm, while MS was 134.88(SD:20.75) N/mm (p = 0.9578). For synthetic ankles, LP mean stiffness was 220.40(SD:81.93) N/mm, while MS was 261.50(SD:100.21) N/mm (p = 0.6116). CONCLUSIONS Across all three models, there was no significant difference between LP and MS methods. Retrospective observational studies are recommended to assess patient outcomes from each of the methods.
Collapse
Affiliation(s)
- Gregory R Roytman
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Biomedical Engineering, Yale University School of Engineering & Applied Science, New Haven, CT, USA.
| | - Motasem Salameh
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah E Rizzo
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Meera M Dhodapkar
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Steven M Tommasini
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Biomedical Engineering, Yale University School of Engineering & Applied Science, New Haven, CT, USA
| | - Daniel H Wiznia
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA; Mechanical Engineering & Materials Science, Yale University School of Engineering & Applied Science, New Haven, CT, USA
| | - Brad J Yoo
- Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
2
|
Wang A, Jiang Y, Su T, Xie X, Jiao C, Hu Y, Zhang Z, Guo Q, Jiang D. Clinical Outcomes and Return to Preinjury Sports After Anatomic Reconstruction With a Gracilis Autograft Versus the Modified Broström Procedure in Patients With Generalized Joint Laxity. Orthop J Sports Med 2024; 12:23259671241229443. [PMID: 38455150 PMCID: PMC10919140 DOI: 10.1177/23259671241229443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/21/2023] [Indexed: 03/09/2024] Open
Abstract
Background Generalized joint laxity (GJL) is a risk factor for inferior outcomes after the modified Broström procedure for chronic lateral ankle instability, while anatomic reconstruction with tendons is more inclined to be recommended. However, whether anatomic reconstruction could achieve better results than the modified Broström procedure in patients with GJL is unknown. Purpose To compare clinical outcomes and return to sports between anatomic reconstruction and the modified Broström procedure in patients with GJL. Study Design Cohort study; Level of evidence, 3. Methods Patients with GJL (Beighton score ≥4) who underwent either the modified Broström procedure or anatomic reconstruction with gracilis autografts between 2017 and 2020 were reviewed. Included were 19 patients who underwent anatomic reconstruction (reconstruction group) and 49 patients who underwent the modified Broström procedure (MBP group). Clinical outcomes were compared using the Foot and Ankle Outcome Score (FAOS) and the Karlsson score. The rates of return to preinjury level in high-demand sports, sprain recurrence, and range of motion between the 2 groups were also compared. Results The mean follow-up duration was 38.3 months in the reconstruction group and 43.7 months in the MBP group. The FAOS and Karlsson scores improved significantly after surgery in both groups (P < .001 for all), with the reconstruction group having significantly higher postoperative FAOS-Sports scores (87.9 ± 8.9 vs 80.5 ± 11.6; P = .015) and Karlsson scores (86.9 ± 6.1 vs 82 ± 8.4; P = .025) than the MBP group. The rate of return to preinjury high-demand sports was higher in the reconstruction group than in the MBP group (73.3% vs 38.9%; P = .034). The MBP group had a significantly higher rate of sprain recurrence (22.4% vs 0%; P = .027). More patients reported dorsiflexion restriction in the reconstruction group (n = 4; 21.1%) than in the MBP group (n = 1; 2%) (P = .019); nonetheless, there was no noticeable effect on daily life and sports. Conclusion Better clinical outcomes, less sprain recurrence, and a higher rate of return to preinjury high-demand sports were found after anatomic reconstruction with free tendons compared with the modified Broström procedure in patients with GJL. Anatomic tendon reconstruction can be recommended for such patients, especially those participating in high-demand sports.
Collapse
Affiliation(s)
- Anhong Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yanfang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Xing Xie
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Yuelin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Zhu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| |
Collapse
|
3
|
Li Y, Su T, Hu Y, Jiao C, Guo Q, Jiang Y, Jiang D. Return to Sport After Anatomic Lateral Ankle Stabilization Surgery for Chronic Ankle Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:555-566. [PMID: 37252803 DOI: 10.1177/03635465231170699] [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: 06/01/2023]
Abstract
BACKGROUND Chronic lateral ankle instability that develops after ankle sprains has a severe, negative influence on the patient's lower extremity function. Anatomic repair or reconstruction of the lateral ankle ligament is an effective treatment for people with chronic lateral ankle instability who want to regain their preinjury levels of work and sport. PURPOSE To determine the rate of return to sport (RTS) and related factors after anatomic lateral ankle stabilization (ALAS) surgery. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Electronic databases including Medline, Embase, the Cochrane Library, and EBSCO Rehabilitation & Sports Medicine Source were searched from the earliest feasible entrance until August 2021. Articles reporting the number of patients who returned to sport after ALAS surgery and analyzing the relevant factors were included. The results were combined using proportion meta-analyses. RESULTS A total of 25 publications were reviewed, with a total of 1384 participants. Results showed that 95% of patients (95% CI, 91%-99%) returned to any sport, 83% (95% CI, 73%-91%) returned to their preinjury level of sport, and 87% (95% CI, 71%-98%) returned to competitive sport after surgery. The mean time to RTS was 12.45 weeks (95% CI, 10.8-14.1 weeks). Each decade of age increased the likelihood of RTS failure by 6%, and increases in body mass index (BMI) of 5 kg/m2 raised the risk of RTS failure by 4%. The rate of RTS was higher in professional and competitive athletes (93%; 95% CI, 73%-100%) than in recreational athletes (83%; 95% CI, 76%-89%). Analysis showed no differences for arthroscopy versus open surgery, repair versus reconstruction, and early versus late weightbearing. CONCLUSION In most cases, patients may return to some kind of sport after ALAS surgery, and some patients RTS at their preinjury level. The relative risk of RTS failure increases according to the magnitude of the increase in age and BMI. Elite athletes are more likely to return compared with nonelite athletes.
Collapse
Affiliation(s)
- Yanzhang Li
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Yuelin Hu
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Yanfang Jiang
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| |
Collapse
|
4
|
Yang L, Wang Q, Wang Y, Ding X, Liang H. Comparative clinical study of the modified Broström procedure for the treatment of the anterior talofibular ligament injury-outcomes of the open technique compared to the arthroscopic procedure. INTERNATIONAL ORTHOPAEDICS 2024; 48:409-417. [PMID: 37668726 PMCID: PMC10799830 DOI: 10.1007/s00264-023-05963-y] [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: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To observe the clinical efficacy and safety of arthroscopic-modified Broström surgery for the treatment of anterior talofibular ligament injury. METHODS The clinical data of 51 cases with anterior talofibular ligament injury were retrospectively analyzed, in which 23 patients were treated by arthroscopic-modified Broström surgery (arthroscopic surgery group) and 28 patients were treated by open-modified Broström surgery (open surgery group). The time to surgery, hospital stay, visual analog scale (VAS) scores of ankle pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot scores, and incidence rate of complications were compared between the two groups. RESULTS (1) General results: compared with open surgery group, arthroscopic surgery group had shorter time to surgery and hospital stay ((33.8 ± 6.7) min, (42.1 ± 8.5) min, t = 1.468, P = 0.001; (2.2 ± 1.4) d, (5.8 ± 1.6) d, t = 1.975, P = 1.975, P = 0.002). (2) VAS scores of ankle pain: there was an interaction effect between the time and group factors (F = 0.378, P = 0.018); overall, there was no statistically significant difference in VAS scores of ankle pain between the two groups, i.e., there was no grouping effect (F = 1.865, P = 0.163); there was statistically significant difference in VAS score of ankle pain at different time points before and after operation, i.e., there was a time effect (F = 1.675, P = 0.000); the VAS scores of ankle pain showed a decreasing trend with time in both groups, but the decreasing trend was not completely consistent between the two groups ((7.78 ± 1.23), (1.23 ± 1.24), (1.03 ± 0.35), (1.01 ± 0.28), F = 0.568, P = 0.000. (7.45 ± 1.43), (1.45 ± 1.87), (1.23 ± 0.55), (1.04 ± 0.37), F = 1.358, P = 0.000); there was no statistically significant difference in VAS score of ankle joint pain between the two groups six and 12 months before and after surgery (t = 2.987, P = 0.055; t = 1.654, P = 2.542; t = 0.015, P = 0.078); the VAS scores of ankle pain in the arthroscopic surgery group was lower than that in the open surgery group three months after operation (t = 1.267, P = 0.023). (3) AOFAS ankle and hindfoot scores: there was an interaction effect between time and grouping factors (F = 2.693, P = 0.027); overall, there was no statistically significant difference in the AOFAS ankle and hindfoot scores between the two groups, i.e., there was no grouping effect (F = 1.983, P = 0.106); there was statistically significant difference in the AOFAS ankle and hindfoot scores at different time points before and after surgery, i.e., there was a time effect (F = 34.623, P = 0.000); the AOFAS ankle and hindfoot scores of the two groups showed an increasing trend with time, but the increasing trend of the two groups was not completely consistent ((48.19 ± 12.89), (89.20 ± 8.96), (90.24 ± 7.89), (91.34 ± 9.67), F = 25.623, P = 0.000; (49.35 ± 13.28), (86.78 ± 12.34), (88.78 ± 9.78),(91.43 ± 7.98), F = 33.275, P = 0.000); there was no statistically significant difference in the AOFAS ankle and hindfoot scores between the two groups 12 months before/after surgery (t = 2.145,P = 0.056;t = 2.879,P = 0.389); compared with open surgery group, the arthroscopic surgery group had higher AOFAS ankle and hindfoot scores 3/6 months after surgery (t = 1.346, P = 0.014; t = 1.874, P = 0.028). CONCLUSION For the treatment of anterior talofibular ligament injury, arthroscopic surgery group is superior to open surgery group in ankle pain relief and functional recovery and has shorter operation time and hospital stay compared with open surgery group.
Collapse
Affiliation(s)
- LiLi Yang
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China.
| | - QingFu Wang
- Tendon Department of Traumatology The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine, Beijing, China
| | - YuanLi Wang
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China
| | - XiaoFang Ding
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China
| | - Huan Liang
- Department of Orthopedics, Beijing LongFu Hospital, Beijing, 100010, China
| |
Collapse
|
5
|
Mellado-Romero MÁ, Guerra-Pinto F, Ojeda-Thies C, Arroyo-Hernández M, Abarquero-Diezhandino A, Ramos-Pascua L, Vilá-Rico J. Comparison of Direct Repair Versus Anatomic Graft Reconstruction of the Anterior Talofibular Ligament: A Biomechanical Cadaveric Study. J Foot Ankle Surg 2024; 63:36-41. [PMID: 37633486 DOI: 10.1053/j.jfas.2023.08.008] [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: 02/19/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
The goal of our study is to compare the stability of the anatomic reconstruction of the anterior talofibular ligament (ATFL) with direct repair of the ATFL, in a cadaver model. We performed the following techniques in 18 cadaveric ankles: the intact ATFL was cut, after which a direct repair using 2 anchors was performed. The repair was sectioned, and anatomic reconstruction was then performed with a tendon autograft. We measured angular displacement in 3 anatomic planes (axial, coronal, sagittal) for each situation in response to the anterior drawer test (ADT), talar tilt test (TTT) and pivot test (PT), using a specifically constructed arthrometer. The sectioned ATFL was inferior to the intact ATFL in the axial plane with the ADT (p = .012), in the axial plane with the PT (p = .001) and in the axial and coronal planes with the TTT (p = .013 and p = .016, respectively). Direct anatomic repair was inferior to the intact ATFL in the axial plane upon the PT (p = .009). No differences could be found between anatomic graft reconstructions and the intact ATFL with any manoeuver, nor when comparing anatomic graft reconstruction and direct repair with 2 anchors. We were able to conclude that anatomic graft reconstruction of the ATFL reproduces angular stability of the native ligament in a cadaver model. While we could not detect if anatomic graft reconstruction was superior to direct repair, the latter proved to be less stable in the axial plane upon internal rotation (pivot test) versus the intact ATFL.
Collapse
Affiliation(s)
- María Ángela Mellado-Romero
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Francisco Guerra-Pinto
- Department of Orthopaedics of the Hospital de Sant'Ana, Parede, Portugal; Department of Orthopaedics of the Hospital da Cruz Vermelha, Lisbon, Portugal; NOVA Medical School - Faculdade de Ciências Médicas, Nova University of Lisbon, Lisbon, Portugal
| | - Cristina Ojeda-Thies
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Arroyo-Hernández
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Abarquero-Diezhandino
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Ramos-Pascua
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Jesús Vilá-Rico
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain; Department of Surgery, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
6
|
Hong CC, Tan KJ, Calder J. Chronic lateral ankle ligament instability - Current evidence and recent management advances. J Clin Orthop Trauma 2024; 48:102328. [PMID: 38274643 PMCID: PMC10806209 DOI: 10.1016/j.jcot.2023.102328] [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: 09/16/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Lateral ankle sprain is a common injury with a substantial negative impact on physical function, quality of life and health economic burden. Chronic lateral ankle instability (CLAI) as a sequela of lateral ankle sprain can lead to the development of posttraumatic ankle osteoarthritis in the long term. In this article, we explore the epidemiology, burden and definition of CLAI for the appropriate clinical assessment and imaging evaluation of patients with lateral ankle sprain and CLAI. Following that, recent advances and evidence on management of CLAI is critically distilled and summarized.
Collapse
Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Ken Jin Tan
- OrthoSports Clinic for Orthopedic Surgery and Sports Medicine, Mt Elizabeth Novena Specialist Centre, Singapore
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| |
Collapse
|
7
|
Thès A, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Elkaïm M, Boniface O, Guillo S, Bauer T, Lopes R. Five-year clinical follow-up of arthroscopically treated chronic ankle instability. Orthop Traumatol Surg Res 2023; 109:103649. [PMID: 37364821 DOI: 10.1016/j.otsr.2023.103649] [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: 07/05/2022] [Revised: 03/27/2023] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Arthroscopic treatment of lateral ankle instability is a recent innovation. In 2014, a prospective study was initiated by the French Society of Arthroscopy demonstrating the feasibility, morbidity and short-term results of arthroscopic treatment of ankle instability. HYPOTHESIS The functional results of arthroscopic treatment of chronic ankle instability found after one year were maintained in the medium term. MATERIAL AND METHODS The prospective follow-up of the patients included in the initial cohort was continued. The Karlsson and AOFAS scores, as well as patient satisfaction, were assessed. The causes of failure underwent univariate and multivariate analyzes. The results of 172 patients were included (40.2% ligament repairs; 59.7% ligament reconstructions). The average follow-up was 5years. The average satisfaction was 8.6/10, the average Karlsson score was 85 points and the average AOFAS score was 87.5 points. The reoperation rate was 6.4% of patients. The failures were related to an absence of sports practice, a high BMI and female gender. A high BMI and the intense sports practice were associated to ligament repair failure. The absence of sports practice and the intraoperative presence of the anterior talofibular ligament were associated to ligament reconstruction failure. DISCUSSION Arthroscopic treatment of ankle instability confers high satisfaction in the medium term, as well as long-lasting results with a low reoperation rate. A more detailed evaluation of the failure criteria could help guide the choice of treatment between ligament reconstruction or repair. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- André Thès
- Hôpital privé d'Eure-et-Loir, 2, rue Roland-Buthier, 28300 Mainvilliers, France
| | - Michael Andrieu
- Clinique Pont-de-Chaume, 330, avenue Marcel-Unal, 82000 Montauban, France
| | - Guillaume Cordier
- Clinique du Sport Bordeaux-Mérignac, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - François Molinier
- Clinique des Cèdres, route de Mondonville, 31700 Cornebarrieu, France
| | - Jonathan Benoist
- CHP Saint-Grégoire, 7, boulevard de la Boutière, 35760 Saint-Grégoire, France
| | - Fabrice Colin
- Clinique Mutualiste Catalane, 60, rue Louis-Mouillard, 66000 Perpignan, France
| | - Marc Elkaïm
- Clinique Drouot sport, 20, rue Laffitte, 75009 Paris, France
| | - Olivier Boniface
- Clinique Générale-Annecy, 4, chemin de la Tour-la-Reine, 74000 Annecy, France
| | - Stéphane Guillo
- SOS Pied Cheville Bordeaux, 4, rue Georges-Negrevergne, 33700 Mérignac, France
| | - Thomas Bauer
- Service de chirurgie orthopédique et traumatologique, CHU Ambroise-Paré, groupe hospitalier universitaire Paris Île-de-France Ouest, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France; Francophone Arthroscopic society (SFA), 15, rue Ampère, 92500 Rueil-Malmaison, France
| | - Ronny Lopes
- Francophone Arthroscopic society (SFA), 15, rue Ampère, 92500 Rueil-Malmaison, France; Santé atlantique (Pied Cheville Nantes Atlantique), avenue Claude-Bernard, 44800 Saint-Herblain, France.
| |
Collapse
|
8
|
Ji X, Li H, Li H, Tong J, Hua Y. Safe Talar Tunnel Placement During Reconstruction of the Deep Layer of the Deltoid Ligament: A Comparison of 4 Different Anatomic Landmarks on the Lateral Malleolus. Orthop J Sports Med 2023; 11:23259671231211560. [PMID: 38035217 PMCID: PMC10687947 DOI: 10.1177/23259671231211560] [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: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 12/02/2023] Open
Abstract
Background Deltoid ligament reconstruction of the ankle can be considered when the ruptured ligament is insufficient for direct repair. Purpose To compare the safety of talar tunnels oriented toward 4 different anatomic landmarks on the lateral malleolus during reconstruction of the deep layer of the deltoid ligament (DDL). Study Design Descriptive laboratory study. Methods A total of 30 computed tomography scans of the ankle joint in healthy adults were collected to generate 3-dimensional models. Virtual talar tunnels with a diameter of 5 mm and with different lengths (20.0, 25.0, and 30.0 mm) were created from the talar insertion of the DDL and were oriented toward the talar neck as well as the most anterior, the most distal, and the most posterior points of the distal fibula. The minimal safe distance (MSD) of a drilling route was calculated for the tunnels, and the safe distance from the end of the tunnel to the bone surface was measured for each tunnel. The nonpaired Student t test was used to detect differences among the safe distances of the 4 different bone tunnels. Results For the 20.0-mm tunnels, the safe distance of the tunnel oriented toward the talar neck (5.90 ± 1.16 mm) did not meet the MSD (6.0 mm). For the 25.0-mm tunnels, the safe distances of the tunnels oriented toward the talar neck (4.53 ± 1.13 mm) and the anterior point of the fibula (5.91 ± 1.52 mm) did not meet the MSD (6.9 mm). Conclusion Tunnels that were 5 mm in diameter and 20.0 and 25.0 mm in length, oriented toward the most distal or most posterior point of the distal fibula, were safe for DDL reconstruction. Clinical Relevance Knowledge of safe talar tunnel placement is important, especially to avoid bone surface penetration during DDL reconstruction.
Collapse
Affiliation(s)
- Xiaoxi Ji
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hong Li
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiahui Tong
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Sports Medicine Center, Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
9
|
Su T, Wang AH, Guo QW, Zhu YC, Jiang YF, Hu YL, Jiao C, Jiang D. Both Open and Arthroscopic All-Inside Anatomic Reconstruction With Autologous Gracilis Tendon Restore Ankle Stability in Patients With Chronic Lateral Ankle Instability. Arthroscopy 2023; 39:1035-1045. [PMID: 36631354 DOI: 10.1016/j.arthro.2022.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/07/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the return to sports and short-term clinical outcomes between the arthroscopic all-inside and the open anatomic reconstruction with gracilis tendon autograft for chronic lateral ankle instability (CLAI) patients. METHODS From March 2018 to January 2020, 57 CLAI patients were prospectively included with arthroscopic all-inside anatomic reconstruction (n = 31) or open anatomic reconstruction (n = 26) with gracilis tendon autograft. The patients were evaluated before operation and at 3 months, 6 months, 12 months, and 24 months after surgery. The American Orthopaedic Foot and Ankle Society score (AOFAS), visual analog scale (VAS), and Karlsson-Peterson score were evaluated at each time point, and stress radiography with a Telos device was performed before surgery and at final follow-up. The time to return to full weightbearing walking, jogging, sports, and work, Tegner activity score, and complications were recorded and compared. RESULTS All the subjective scores significantly improved after surgery from the preoperative level. Compared with the open group, the arthroscopic group demonstrated significantly earlier return to full weightbearing walking (8.9 vs 11.7 weeks, P < .001), jogging (17.9 vs 20.9 weeks, P = .012), and recreational sports (22.4 vs 26.5 weeks, P = .001) with significantly better AOFAS score and Karlsson score at 3 to 6 months, and better VAS score at 6 months after surgery. The 2 groups demonstrated no significant difference in the surgical duration or surgical complications. No significant difference was found in the clinical scores or stress radiographic measurements at 24 months after surgery (P > .05). CONCLUSION Compared with the open procedure, the arthroscopic all-inside anatomic lateral ankle ligament reconstruction with autologous gracilis tendon could achieve earlier return to full weightbearing, jogging, and recreational sports with less pain and better ankle functional scores at 3 to 6 months after surgery. Similar favorable short-term clinical outcomes were achieved for both techniques at 2 years after surgery. STUDY DESIGN Level I, randomized controlled trial.
Collapse
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, Beijing, China
| | - An-Hong Wang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, 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, Beijing, 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, Beijing, 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, Beijing, 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, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital. Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China.
| |
Collapse
|
10
|
Michels F, Taylan O, Stockmans F, Vereecke E, Scheys L, Matricali G. The different subtalar ligaments show significant differences in their mechanical properties. Foot Ankle Surg 2022; 28:1014-1020. [PMID: 35190275 DOI: 10.1016/j.fas.2022.02.008] [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: 12/27/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Today, the relative contribution of each ligamentous structure in the stability of the subtalar joint is still unclear. The purpose of this study is to assess the material properties of the different ligamentous structures of the subtalar joint. METHODS Eighteen paired fresh-frozen cadaveric feet were used to obtain bone-ligament-bone complexes of the calcaneofibular ligament (CFL), the cervical ligament (CL) and the anterior capsular ligament-interosseous talocalcaneal ligament complex (ACaL-ITCL). The samples were subjected to uniaxial testing to calculate their respective stiffness and failure load. RESULTS The stiffness of ACaL-ITCL complex (mean: 150 ± 51 N/mm, 95% confidence interval (CI): 125.0-176.6 N/mm) was significantly higher than both CFL (mean: 55.8 ± 23.0 N/mm, CI: 43.8-67.7 N/mm) and CL (mean: 63.9 ± 38.0 N/mm, CI: 44.4-83.3 N/mm). The failure load of both the ACaL-ITCL complex (mean:382.5 ± 158 N, CI: 304.1-460.8 N) and the CFL (mean:320.4 ± 122.0 N, CI: 257.5-383.2 N) were significantly higher than that of the CL (mean:163.5 ± 58.0 N, CI: 131.3-195.7 N). The injury pattern demonstrated a partial rupture in all CFL and ACaL-ITCL specimens and in 60% of the CL specimens. CONCLUSION The CFL, CL and ACaL-ITCL show significant differences in their intrinsic mechanical properties. Both the CFL and CL are more compliant ligaments and seem to be involved in the development of subtalar instability. Based on the material properties, a gracilis tendon graft seems more appropriate than a synthetic ligament to reconstruct a CL or CFL. A partial rupture was the most commonly seen injury pattern in all ligaments. A fibular avulsion of the CFL was only rarely seen. The injury patterns need further investigation as they are important to optimize diagnosis and treatment.
Collapse
Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France; ESSKA-AFAS Ankle Instability Group; Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Orçun Taylan
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500 Kortrijk, Belgium; Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Evie Vereecke
- Dept. Development and Regeneration, Faculty of Medicine, University of Leuven campus Kortrijk, Etienne Sabbelaan 53, 8500 Kortrijk, Belgium.
| | - Lennart Scheys
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium.
| | - Giovanni Matricali
- Institute for Orthopaedic Research and Training (IORT), Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium; Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| |
Collapse
|
11
|
Biomechanical Study of Arthroscopic All-Inside Anterior Talofibular Ligament Suture Augmentation Repair, Plus Suture Augmentation Repair and Anterior Tibiofibular Ligament's Distal Fascicle Transfer Augmentation Repair. J Clin Med 2022; 11:jcm11175235. [PMID: 36079163 PMCID: PMC9456712 DOI: 10.3390/jcm11175235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To explore the biomechanical efficacy of arthroscopic all-inside anterior talofibular ligament (ATFL) suture augmentation repair, plus suture augmentation repair and anterior tibiofibular ligament-distal fascicle (ATiFL-DF) transfer augmentation repair, so as to provide a basis for the accurate selection of ATFL repair in clinical practice. Methods: Twenty-four (12 pairs) fresh frozen human cadaver ankle specimens were used. Six of the ankle specimens were set as the normal group, and the other 18 ankle specimens were used to establish ATFL injury models. The ATFL was then repaired using arthroscopic all-inside ATFL suture augmentation repair (suture augmentation group), plus suture augmentation repair (plus suture augmentation group) and ATiFL-DF transfer augmentation repair (biological augmentation group), respectively. After the repaired ATFL was separated, the ankle specimens were fixed on an electronic universal testing machine with a customized fixture for the tensile test, and the ultimate failure load (N) and stiffness (N/mm) of the ankle specimens were compared. Results: The ultimate failure load of the plus suture augmentation group (229.3 ± 66.7 N) was significantly higher than that in the normal group (148.2 ± 39.4 N, p = 0.045) and the biological augmentation group (131.3 ± 38.8 N, p = 0.013). There was no statistical difference in ultimate failure load between the suture augmentation group (167.2 ± 47.2 N), the normal group and the biological augmentation group. The stiffness of the plus suture augmentation group (26.2 ± 8.2 N/mm) was significantly higher than that in the normal group (12.1 ± 3.8 N/mm, p = 0.005) and the biological augmentation group (12.7 ± 5.2 N/mm, p = 0.007). The stiffness of the suture augmentation group (23.6 ± 7.0 N/mm) was significantly higher than that in the normal group (p = 0.024) and the biological augmentation group (p = 0.033). There was no statistical difference in stiffness between the plus suture augmentation group and the suture augmentation group, and no statistical difference in stiffness between the normal group and the biological augmentation group. Conclusions: The tensile strength and rigidity of plus suture augmentation repair were significantly better than those of normal ATFL, suture augmentation repair and ATiFL-DF transfer augmentation repair. Suture augmentation repair can obtain tensile strength similar to normal ATFL and ATiFL-DF transfer augmentation repair, and suture augmentation repair can obtain rigidity significantly better than normal ATFL and ATiFL-DF transfer augmentation repair. ATiFL-DF transfer augmentation repair can obtain tensile strength and rigidity similar to normal ATFL.
Collapse
|
12
|
Sakakibara Y, Teramoto A, Takagi T, Yamakawa S, Shoji H, Okada Y, Kobayashi T, Kamiya T, Fujimiya M, Fujie H, Watanabe K, Yamashita T. Effects of the Ankle Flexion Angle During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft. Foot Ankle Int 2022; 43:725-732. [PMID: 35023381 DOI: 10.1177/10711007211069327] [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: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the effects of the ankle flexion angle during anterior talofibular ligament (ATFL) reconstruction on ankle kinematics, laxity, and in situ force of a graft. METHODS Twelve cadaveric ankles were evaluated using a 6-degrees of freedom robotic system to apply passive plantar flexion and dorsiflexion motions and multidirectional loads. A repeated measures experiment was designed using the intact ATFL, transected ATFL, and reconstructed ATFL. During ATFL reconstruction (ATFLR), the graft was fixed at a neutral position (ATFLR 0 degrees), 15 degrees of plantar flexion (ATFLR PF15 degrees), and 30 degrees of plantar flexion (ATFLR PF30 degrees) with a constant initial tension of 10 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ force of the ATFL and reconstructed grafts were calculated using the principle of superposition. RESULTS The in situ forces of the reconstructed grafts in ATFLR 0 degrees and ATFLR PF 15 degrees were significantly higher than those of intact ankles. The ankle kinematics and laxity produced by ATFLR PF 30 degrees were not significantly different from those of intact ankles. The in situ force on the ATFL was 19.0 N at 30 degrees of plantar flexion. In situ forces of 41.0, 33.7, and 21.9 N were observed at 30 degrees of plantar flexion in ATFLR 0, 15, and 30 degrees, respectively. CONCLUSION ATFL reconstruction with the peroneus longus (PL) tendon was performed with the graft at 30 degrees of plantar flexion resulted in ankle kinematics, laxity, and in situ forces similar to those of intact ankles. ATFL reconstructions performed with the graft fixed at 0 and 15 degrees of the plantar flexion resulted in higher in situ forces on the reconstructed graft. CLINICAL RELEVANCE Fixing the ATFL tendon graft at 30 degrees of plantar flexion results in an in situ force closest to that of an intact ankle and avoids the excessive tension on the reconstructed graft.
Collapse
Affiliation(s)
- Yuzuru Sakakibara
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Hiroaki Shoji
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohei Okada
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuma Kobayashi
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| |
Collapse
|
13
|
Clinical outcomes of anterior tibiofibular ligament's distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients. Arch Orthop Trauma Surg 2022; 142:2829-2837. [PMID: 34846587 PMCID: PMC9474461 DOI: 10.1007/s00402-021-04214-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Treatment of chronic ankle instability (CAI) for ankle sprain patients remains a challenge. If initial treatments fail, surgical stabilization techniques including ligament reconstruction should be performed. Anterior tibiofibular ligament (ATiFL) distal fascicle transfer for CAI was recently introduced. The goal of the study is to assess the 1-year clinical effectiveness of ATiFL's distal fascicle transfer versus ligament reconstruction with InternalBrace™ (Fa. Arthrex, Naples). METHODS Between October 2019 and February 2021, 25 patients (14 males and 11 females) scheduled for ligament reconstruction treatment of CAI were enrolled after propensity score matching. Twelve underwent ligament reconstruction with InternalBrace™ (InternalBrace™ group) and thirteen underwent ATiFL's distal fascicle transfer (ATiFL's distal fascicle transfer group). We recorded the American Orthopedic Foot & Ankle Society (AOFAS) score, Visual Analogue Scale (VAS), anterior drawer test grade, patient satisfaction and complications. All results of this study were retrospectively analyzed. RESULTS Statistically significant (p = 0.0251, independent-samples t test) differences in the AOFAS can be found between the ATiFL's distal fascicle transfer group and the InternalBrace™ group. No substantial changes in the VAS (p = 0.1778, independent-samples t test), patient satisfaction (p = 0.1800, independent-samples t test) and anterior drawer test grade (p = 0.9600, independent-samples t test) were found between the two groups. There was one patient with superficial wound infection and one patient with sural nerve injury in the InternalBrace™ group and ATiFL's distal fascicle transfer group, respectively. CONCLUSION This is the first study that assessed a cohort of CAI patients and suggests that the ATiFL's distal fascicle transfer operation has the potential to attain good-to-excellent clinical outcomes after 1-year recovery. The AOFAS scores were significantly higher for patients with ATiFL's distal fascicle transfer, indicating that this technique may be considered a viable option for both patients and their surgeon, while long-term outcomes should be investigated in the future.
Collapse
|
14
|
Spennacchio P, Seil R, Mouton C, Scheidt S, Cucchi D. Anatomic reconstruction of lateral ankle ligaments: is there an optimal graft option? Knee Surg Sports Traumatol Arthrosc 2022; 30:4214-4224. [PMID: 35916928 PMCID: PMC9668940 DOI: 10.1007/s00167-022-07071-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle. METHODS A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient's subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures. RESULTS Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes. CONCLUSIONS The systematic analysis of validated CAI outcome measures and the patient's subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient's subjective satisfaction. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Pietro Spennacchio
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg ,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, Luxembourg, Luxembourg ,Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Sebastian Scheidt
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany.
| |
Collapse
|
15
|
Larkins CG, Brady AW, Aman ZS, Dornan GJ, Haytmanek CT, Clanton TO. Evaluation of the Intact Anterior Talofibular and Calcaneofibular Ligaments, Injuries, and Repairs With and Without Augmentation: A Biomechanical Robotic Study. Am J Sports Med 2021; 49:2432-2438. [PMID: 34110933 DOI: 10.1177/03635465211018645] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute ankle sprains are common injuries. The anterior talofibular (ATFL) and calcaneofibular ligaments (CFL) are the most injured lateral structures. However, controversy exists on the optimal surgical treatment when the injury is both acute and severe or becomes chronic and unstable. Studies have evaluated the biomechanics of these ligaments, but no studies have robotically evaluated injury effects and surgical treatment of ATFL or ATFL and CFL injuries. PURPOSE To quantitatively evaluate biomechanical effects of ATFL and CFL lesions, ATFL repair, ATFL and CFL repair, and augmentation of ATFL on ankle stability. STUDY DESIGN Controlled laboratory study. METHODS Ten nonpaired cadaveric ankles were tested using a 6 degrees of freedom robot. Each ankle underwent testing in the following states sequentially: (1) intact, (2) ATFL cut, (3) CFL cut, (4) ATFL repair + CFL cut, (5) ATFL repair + CFL repair, and (6) ATFL repair with augmentation with suture tape + CFL repair. Testing included 88 N anterior drawer and 5 N·m varus talar tilt tests at 0° and 30° of plantarflexion, and 88 N Cotton test at 0° of plantarflexion. RESULTS After all surgical treatments ankles still had increased laxity compared with intact state testing, except after augmented ATFL repair + CFL repair in anterior drawer testing at 30° of plantarflexion (P = .393). Sectioning the CFL caused a significant increase in talar tilt compared with the ATFL cut state at 0° (P < .001) and 30° of plantarflexion (P < .001), but no increase in anterior drawer or Cotton tests. CONCLUSION Complete native stability may not be attainable at time zero repair with the tested treatments. The option that best returned stability in anterior translation was augmented ATFL repair with nonaugmented CFL repair. The importance of the CFL as a primary ligamentous stabilizer for talar tilt was confirmed. CLINICAL RELEVANCE Evaluating lateral ankle stability and treatment with a 6 degrees of freedom robot should help delineate optimal treatment options. Findings in this study show that none of the repair methods at time zero restored kinematics to the intact state. Of the tested states, the augmented ATFL repair with CFL repair was the best option for controlling anterior translation at time zero. The importance of addressing the CFL to correct talar tilt instability was suggested as was the importance of a period of immobilization before beginning protected rehabilitation. The benefit of ATFL repair augmentation with suture tape is in limiting the postoperative motion in an anterior drawer motion to just 0.5 to 1 mm, but there was no significant improvement to talar tilt even with CFL repair, suggesting that further consideration should be given to CFL augmentation in future studies.
Collapse
Affiliation(s)
| | - Alex W Brady
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Zachary S Aman
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | | |
Collapse
|
16
|
Karahan N, Kaya M, Yılmaz B, Kurdal DP, Keskinoz EN, Çiçek EED. Hamstring autograft and anatomical footprint evaluation for anterior talofibular ligament reconstruction: Cadaveric study. J Orthop Surg (Hong Kong) 2021; 28:2309499020974830. [PMID: 33272074 DOI: 10.1177/2309499020974830] [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: 11/17/2022] Open
Abstract
PURPOSE The aim of the study was to evaluate whether or not there was any incompatibility between two-strand hamstring tendons taken from the same knee and the ATFL and it was the determination of suitable footprint points in the fibula and talus for anatomical ATFL reconstruction. METHODS 16 fresh frozen cadaver specimens were dissected to gracilis and semitendinosus tendons and the anterior talofibular ligament. The origins, insertions, distances from osseous landmarks of fibular talus of ATFL were determined. The diameters of gracilis, semitendinosus and ATFL were calculated. There was a moderate correlation between body height and the distance between the distal of inferior lateral malleolus and the fibular adhesion site of ATFL (r: 36.5 p: 0.036). There was a weak correlation between body height and the distance between the apex of the lateral talar process and the talus adhesion site of ATFL in a single bundle (r: 28.4 p: 0.002). There was no correlation between the distance from proximal and distal adhesion side of ATFL and body height in the double bundle (p: 0.241). RESULTS There was no significant relationship between ATFL diameter and gracilis, semitendinosus and both hamstring in women. A significant relationship at 80.5% was determined between the ATFL and the gracilis diameter in man. A significant relationship at 92.6% was determined between the ATFL and the semitendinosus diameter in man. CONCLUSION It was determined that there is not compatibility between the gracilis tendons, the semitendinosus tendon and ATFL in women. It should be supported by biomechanical and clinical studies whether this incompatibility has a clinical effect or not.
Collapse
Affiliation(s)
- Nazım Karahan
- Department of Orthopaedics and Traumatology, Corlu State Hospital, Çorlu/Tekirdağ, Turkey
| | - Murat Kaya
- Department of Orthopaedics and Traumatology, Marmara University, Pendik/İstanbul, Turkey
| | - Barış Yılmaz
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Research and Training Hospital, Ataşehir/İstanbul, Turkey
| | - Demet Pepele Kurdal
- Department of Orthopaedics and Traumatology, Fatih Sultan Mehmet Research and Training Hospital, Ataşehir/İstanbul, Turkey
| | | | - Esma Esin Derin Çiçek
- Deparment of Radiology, Fatih Sultan Mehmet Research and Training Hospital, Ataşehir/İstanbul, Turkey
| |
Collapse
|
17
|
Vopat ML, Wendling A, Lee B, Hassan M, Morris B, Tarakemeh A, Zackula R, Mullen S, Schroeppel P, Vopat BG. Early Versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Reconstruction: A Systematic Review and Meta-Analysis. Kans J Med 2021; 14:141-148. [PMID: 34178244 PMCID: PMC8222086 DOI: 10.17161/kjm.vol1415028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. However, some patients experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization, which can include primary lateral ligament reconstruction with a graft to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament reconstruction remains unknown, as surgeons vary in how long they immobilize their patients post-operatively. The aim of this review was to provide insight into early mobilization (EM) versus delayed mobilization (DM) post-operative protocols in patients undergoing primary lateral ankle ligament reconstructions to determine if an optimal evidence-based post-operative rehabilitation protocol exists in the literature. Methods Following PRIMSA criteria, a systematic review/meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947 – 1/28/2020). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical, and non-English language were excluded. Protocols were reviewed and divided into two categories: early mobilization (within three weeks of surgery) and delayed mobilization (after three weeks of surgery). Functional outcome scores (American Orthopedic Foot and Ankle Society Score (AOFAS), Karlsson scores), radiographic measurements (anterior drawer, talar tilt), and complications were evaluated using weighted mean differences (pre- and post-operative scores) and mixed-effect models. Results After our search, twelve out of 1,574 studies met the criteria for the final analysis, representing 399 patients undergoing lateral ankle reconstruction. Using weighted mean differences the DM group showed superior AOFAS functional scores compared to the EM group (28.0 (5.5) vs. 26.3 (0.0), respectively; p < 0.001), although sample size was small. Conversely, no significant differences were found for Karlsson functional score (p = 0.246). With regards to radiographic outcome, no significant differences were observed; anterior drawer was p = 0.244 and talar tilt was p = 0.937. A meta-analysis using mixed-effects models confirmed these results, although heterogeneity was high. Conclusions While there are some conflicting results, the findings indicated the timing of post-operative mobilization made no difference in functional outcomes or post-operative stability for patients undergoing lateral ankle ligament reconstruction. Because heterogeneity was high, future studies are needed to evaluate these protocols in less diverse patient groups and/or more consistent techniques for lateral ankle ligament reconstruction.
Collapse
Affiliation(s)
- Matthew L Vopat
- Department of Orthopaedics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Alexander Wendling
- Department of Orthopaedics, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Brennan Lee
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Maaz Hassan
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Brandon Morris
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Armin Tarakemeh
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Rosey Zackula
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Scott Mullen
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Paul Schroeppel
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| | - Bryan G Vopat
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS
| |
Collapse
|
18
|
Mellado-Romero MÁ, Guerra-Pinto F, Guimarães-Consciência J, Sánchez-Morata EJ, Vacas-Sánchez E, Arroyo-Hernández M, Abarquero-Diezhandino A, Vázquez Osorio MT, Ramos-Pascua L, Vilá-Rico J. Biomechanical study of autograft anatomic reconstruction in lateral ankle instability. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
19
|
Allen T, Kelly M. Modern Open and Minimally Invasive Stabilization of Chronic Lateral Ankle Instability. Foot Ankle Clin 2021; 26:87-101. [PMID: 33487245 DOI: 10.1016/j.fcl.2020.11.003] [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: 02/02/2023]
Abstract
Chronic lateral ankle instability is the sensation of the ankle giving way along with recurrent sprains, chronic pain and swelling of the ankle for 1 year. The lateral ankle complex comprises the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. The anterior talofibular ligament is the most commonly injured ligament of the lateral ankle. Evaluation comprises a history and physical with concomitant imaging to confirm the diagnosis and can be used to evaluate for concurrent pathology. The most popular treatment is a direct anatomic repair; however, additional options can be used in specific patient populations.
Collapse
Affiliation(s)
- Tyler Allen
- University of Nevada Reno School of Medicine, 1890 Van Ness Avenue, Reno, NV 89503, USA
| | - Meghan Kelly
- Department of Orthopedic Surgery University of California at Davis; Department of Orthopedic Surgery, Mount Sinai Icahn School of Medicine, 425 West 59th Street 5th Floor, New York, NY 10019, USA.
| |
Collapse
|
20
|
Hu Y, Zhang Y, Li Q, Xie Y, Lu R, Tao H, Chen S. Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability. Am J Sports Med 2021; 49:737-746. [PMID: 33555910 DOI: 10.1177/0363546520982240] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes. PURPOSE To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)-repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores. RESULTS There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles (P = .031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P = .311). CONCLUSION Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction.
Collapse
Affiliation(s)
- Yiwen Hu
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuyang Zhang
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianru Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxue Xie
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Rong Lu
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyue Tao
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuang Chen
- Department of Radiology and Institute of Medical Functional and Molecular Imaging, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
21
|
Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence. J Am Acad Orthop Surg 2021; 29:3-16. [PMID: 33347006 DOI: 10.5435/jaaos-d-20-00145] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023] Open
Abstract
Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. Current data suggest that accurate assessment of ligament integrity during physical examination requires the ankle to ideally be held in 16° of plantar flexion when performing the anterior drawer test and 18° of dorsiflexion when performing the talar tilt test, respectively. Stress radiographs are limited by their low sensitivity, and MRI is limited by its static nature. Surgically, both arthroscopic and open repair techniques appear biomechanically equivalent in their ability to restore ankle stability, although sufficient evidence is still lacking for any particular procedure to be considered a superior construct. When performing reconstruction, grafts should be tensioned at 10 N and use of nonabsorbable augmentations lacking viscoelastic creep must factor in the potential for overtensioning. Anatomic lateral ligament surgery provides sufficient biomechanical strength to safely enable immediate postoperative weight bearing if lateral ankle stress is neutralized with a boot. Further research and comparative clinical trials will be necessary to define which of these ever-increasing procedural options actually optimizes patient outcome for chronic lateral ankle instability.
Collapse
|
22
|
Mellado-Romero MÁ, Guerra-Pinto F, Guimarães-Consciência J, Sánchez-Morata EJ, Vacas-Sánchez E, Arroyo-Hernández M, Abarquero-Diezhandino A, Vázquez Osorio MT, Ramos-Pascua L, Vilá-Rico J. Biomechanical study of autograft anatomic reconstruction in lateral ankle instability. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 65:124-131. [PMID: 33334722 DOI: 10.1016/j.recot.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION The purpose of this work is perform a biomechanical comparison of anatomic reconstruction of the anterior talofibular ligament (ATFL) with the intact ATFL. MATERIALS AND METHODS We studied 18 fresh cadaveric ankles with intact ATFL. Each specimen was clinically assessed with the anterior drawer (AD) and varus tilt (VT) tests and the angular movement in the three spatial planes (axial, coronal and sagittal) was measured with an arthrometer using a sensor located in the talus. RESULTS Statistically significant differences were found in the axial plane, between the intact ATFL versus the sectioned ATFL for AD test with p = 0.012, and for VT test with p = 0.013. Regarding the coronal plane, we also observed a statistically significant difference for VT test with p = 0.016. In the sagittal plane, there are no statistically significant differences in both maneuvers. No statistically significant differences were found when comparing the biomechanics of anatomic ligament reconstruction versus the intact ATFL. CONCLUSION Autograft anatomic reconstruction of the ATFL showed biomechanical properties similar to those of the native ATFL, at the zero moment in a cadaveric model.
Collapse
Affiliation(s)
- María Ángela Mellado-Romero
- Unidad de Pie y Tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España.
| | - Francisco Guerra-Pinto
- Hospital Ortopédico de Sant'Ana, Parede, Portugal; Nova Medical School, Universidad de Portugal, Lisboa, Portugal
| | | | - Enrique J Sánchez-Morata
- Unidad de Pie y Tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Elena Vacas-Sánchez
- Unidad de Pie y Tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Marta Arroyo-Hernández
- Unidad de Pie y Tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Ana Abarquero-Diezhandino
- Unidad de Pie y Tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - Luis Ramos-Pascua
- Unidad de Pie y Tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Jesús Vilá-Rico
- Unidad de Pie y Tobillo, Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario 12 de Octubre, Madrid, España
| |
Collapse
|
23
|
Sigonney F, Lopes R, Bouché PA, Kierszbaum E, Moslemi A, Anract P, Stein A, Hardy A. The ankle ligament reconstruction-return to sport after injury (ALR-RSI) is a valid and reproducible scale to quantify psychological readiness before returning to sport after ankle ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:4003-4010. [PMID: 32356045 PMCID: PMC7669765 DOI: 10.1007/s00167-020-06020-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/21/2020] [Indexed: 11/12/2022]
Abstract
PURPOSE Chronic ankle instability is the main complication of ankle sprains and requires surgery if non-operative treatment fails. The goal of this study was to validate a tool to quantify psychological readiness to return to sport after ankle ligament reconstruction. METHODS The form was designed like the anterior cruciate ligament-return to sport after injury scale and "Knee" was replaced by the term "ankle". The ankle ligament reconstruction-return to sport after injury (ALR-RSI) scale was filled by patients who underwent ankle ligament reconstruction and were active in sports. The scale was then validated according to the international COSMIN methodology. The AOFAS and Karlsson scores were used as reference questionnaires. RESULTS Fifty-seven patients (59 ankles) were included, 27 women. The ALR-RSI scale was strongly correlated with the Karlsson score (r = 0.79 [0.66-0.87]) and the AOFAS score (r = 0.8 [0.66-0.87]). A highly significant difference was found in the ALR-RSI between the subgroup of 50 patients who returned to playing sport and the seven who did not: 68.8 (56.5-86.5) vs 45.0 (31.3-55.8), respectively, p = 0.02. The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.92; 95% CI [0.86-0.96]). CONCLUSION The ALR-RSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after ankle ligament reconstruction. This scale may help to identify athletes who will find sport resumption difficult. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- François Sigonney
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Ronny Lopes
- Orthopaedic Department, Pied Cheville Nantes Atlantique (Santé Atlantique Et Clinique Bretéché), Nantes, France
| | - Pierre-Alban Bouché
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Elliott Kierszbaum
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Aymane Moslemi
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Philippe Anract
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Alexandra Stein
- Orthopaedic Department, Cochin University Hospital, AP-HP Paris, Paris Descartes University, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Alexandre Hardy
- Clinique du Sport, 36 boulevard Saint-Marcel, 75005, Paris, France
| |
Collapse
|
24
|
Gautschi M, Bachmann E, Shirota C, Götschi T, Renner N, Wirth SH. Biomechanics of Ankle Ligament Reconstruction: A Cadaveric Study to Compare Stability of Reconstruction Techniques Using 1 or 2 Fibular Tunnels. Orthop J Sports Med 2020; 8:2325967120959284. [PMID: 33150191 PMCID: PMC7585988 DOI: 10.1177/2325967120959284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/29/2020] [Indexed: 12/26/2022] Open
Abstract
Background Anatomic lateral ankle ligament reconstruction has been proposed for patients with chronic ankle instability. A reliable approach is a reconstruction technique using an allograft and 2 fibular tunnels. A recently introduced approach that entails 1-fibular tunnel reconstruction might reduce the risk of intraoperative complications and ultimately improve patient outcome. Hypothesis We hypothesized that both reconstruction techniques show similar ankle stability (joint laxity and stiffness) and are similar to the intact joint condition. Study Design Controlled laboratory study. Methods A total of 10 Thiel-conserved cadaveric ankles were divided into 2 groups and tested in 3 stages-intact, transected, and reconstructed lateral ankle ligaments-using either the 1- or the 2-fibular tunnel technique. To quantify stability in each stage, anterior drawer and talar tilt tests were performed in 0°, 10°, and 20° of plantarflexion (anterior drawer test) or dorsiflexion (talar tilt test). Bone displacements were measured using motion capture, from which laxity and stiffness were calculated together with applied forces. Finally, reconstructed ligaments were tested to failure in neutral position with a maximal applicable torque in inversion. A mixed linear model was used to describe and compare the outcomes. Results When ankle stability of intact and reconstructed ligaments was compared, no significant difference was found between reconstruction techniques for any flexion angle. Also, no significant difference was found when the maximal applicable torque of the 1-tunnel technique (9.1 ± 4.4 N·m) was compared with the 2-tunnel technique (8.9 ± 4.8 N·m). Conclusion Lateral ankle ligament reconstruction with an allograft using 1 fibular tunnel demonstrated similar biomechanical stability to the 2-tunnel approach. Clinical Relevance Demonstrating similar stability in a cadaveric study and given the potential to reduce intraoperative complications, the 1-fibular tunnel approach should be considered a viable option for the surgical therapy of chronic ankle instability. Clinical randomized prospective trials are needed to determine the clinical outcome of the 1-tunnel approach.
Collapse
Affiliation(s)
| | - Elias Bachmann
- Laboratory for Orthopedic Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Camila Shirota
- Laboratory for Rehabilitation Engineering, ETH Zürich, Zürich, Switzerland
| | - Tobias Götschi
- Laboratory for Orthopedic Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Niklas Renner
- Investigation performed at Universitätsklinik Balgrist, Zürich, Switzerland
| | - Stephan H Wirth
- Investigation performed at Universitätsklinik Balgrist, Zürich, Switzerland
| |
Collapse
|
25
|
Paletta GA, Milner J. Repair and InternalBrace Augmentation of the Medial Ulnar Collateral Ligament. Clin Sports Med 2020; 39:537-548. [PMID: 32446573 DOI: 10.1016/j.csm.2020.04.001] [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] [Indexed: 11/29/2022]
Abstract
"For more than 4 decades, reconstruction of the ulnar collateral ligament (UCL) using some type of autograft tissue has been the standard of care for UCL-injured athletes. This article reviews the history of UCL repair including the rationale for the revival of interest in primary repair of the UCL as an option for the treatment of select athletes as well as the early clinical results indicating the short-term successful outcomes of the procedure in properly selected athletes."
Collapse
Affiliation(s)
- George A Paletta
- The Orthopedic Center of St. Louis, 14825 North Outer 40 Road, Chesterfield, MO 63017, USA.
| | - John Milner
- Brown University School of Medicine, 222 Richmond Street, Providence, RI 02903, USA
| |
Collapse
|
26
|
Hamstring Autograft for Lateral Ligament Stabilization. Curr Rev Musculoskelet Med 2020; 13:289-297. [PMID: 32367429 DOI: 10.1007/s12178-020-09623-1] [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: 10/24/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to review the current literature and trends regarding use of hamstring autograft for lateral ankle instability. RECENT FINDINGS Reconstruction of the lateral ankle ligaments using hamstring autograft has been found to be an effective method to treat ankle instability in terms of patient-reported outcomes and objective measures. Biomechanically, reconstruction has been shown to be stronger (load to failure) when compared with the Broström procedure. Clinical studies have demonstrated non-inferiority when compared with the Broström procedure, with one synthetic reconstruction technique demonstrating superior outcomes. Reconstruction of the lateral ankle ligaments using hamstring autograft is especially useful in patients who are at high risk of failure (insufficient soft tissue available for repair, ligamentous laxity, previous failed ligament repair, ossicle > 1 cm, or in the heavier, high-demand athletes).
Collapse
|
27
|
Park S, Kim T, Lee M, Park Y. Absence of ATFL remnant does not affect the clinical outcomes of the modified broström operation for chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:213-220. [PMID: 30887064 DOI: 10.1007/s00167-019-05464-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/04/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The modified Broström operation for chronic ankle instability has demonstrated good clinical results. Absence of ligamentous tissue is a risk factor for recurrence of ankle instability after surgery. This study evaluated the effect of quality of ligament tissue (anterior talofibular ligament, ATFL) on prognosis, in a cohort of patients with chronic ankle instability after the modified Broström operation. METHODS This was a retrospective case series. Overall, 60 patients underwent the modified Broström operation for chronic ankle instability (mean follow-up, 30.1 [range, 24-47] months). Presence of ATFL remnant was assessed on ultrasound, magnetic resonance imaging, and arthroscopy in all patients. Foot and ankle outcome score (FAOS) was used to evaluate functional outcomes. Clinical outcomes were compared by the condition of the ligament remnant. Association with other risk factors was evaluated using multiple linear regression analysis. RESULTS ATFL was visible in 51/60 cases on ultrasound. Thirty, 22, and eight patients had thin or absent; normal thickness; and thick ATFL on magnetic resonance imaging, respectively. ATFL was visible in 15 patients on arthroscopy and nonvisible or not clear in 45. No significant differences occurred in FAOS with the presence of ATFL remnant on ultrasound, arthroscopy, and the grade of ATFL thickness on magnetic resonance imaging. No correlation was found between FAOS and the thickness of ATFL. CONCLUSION The results suggest that the modified Broström operation for patients with chronic ankle instability was good, regardless of the presence or absence of ATFL remnant. LEVEL OF EVIDENCE III, Retrospective cohort study.
Collapse
Affiliation(s)
- Sunghoon Park
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Taehun Kim
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Myungsub Lee
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea
| | - Younguk Park
- Department of Orthopedic Surgery, Ajou University Hospital, Ajou University School of Medicine, 164, World Cup Road, Yeongtong-gu, Suwon, Gyeonggi-do, 16499, Republic of Korea.
| |
Collapse
|
28
|
Michels F, Matricali G, Guillo S, Vanrietvelde F, Pottel H, Stockmans F. An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL. Knee Surg Sports Traumatol Arthrosc 2020; 28:124-131. [PMID: 31240379 DOI: 10.1007/s00167-019-05583-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE A bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm-diameter tunnel and surrounding bone. METHODS Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30°, 45°, 60° and 90° in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface. RESULTS A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30° offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm-diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region. CONCLUSION An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend drilling an oblique fibular tunnel when reconstructing the ATFL and CFL.
Collapse
Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | - Giovanni Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopaedics, Foot and Ankle Unit, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Institute of Orthopaedic Research and Training, KU Leuven, Leuven, Belgium
| | - Stephane Guillo
- Orthopaedic Department, Mérignac Sports Clinic, 2, Rue Georges Negrevergne, 33700, Mérignac, France
| | - Frederik Vanrietvelde
- Radiology Department, AZ Groeninge Kortrijk, President Kennedylaan 4, 8500, Kortrijk, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care, Catholic University Leuven, Kortrijk, Belgium
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge, President Kennedylaan 4, 8500, Kortrijk, Belgium.,Department of Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
| |
Collapse
|
29
|
Ramdass RS, Grierson KR. A Comparison of Split Peroneus Brevis Tendon and Semitendinosus Allograft Tendon for Lateral Ankle Ligament Reconstruction. J Foot Ankle Surg 2019; 58:1197-1202. [PMID: 31679672 DOI: 10.1053/j.jfas.2019.04.002] [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] [Received: 08/22/2018] [Revised: 01/01/2019] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
Lateral ankle instability is a debilitating condition that is often unresponsive to conservative therapy. Many techniques for operative repair have been proposed, most commonly performed as the Broström or modified Broström procedure. In patients with failed primary repair, hereditary collagen disorders, strenuous work activity, obesity, or ligamentous laxity, the Broström repair is less likely to be successful, and anatomic or nonanatomic reconstruction should be considered. The purpose of this study was to compare the functional outcomes and patient satisfaction between anatomic and nonanatomic reconstruction of the lateral ankle ligament complex for lateral ankle instability using a retrospective cohort study. We evaluated 64 ankles in 62 patients who underwent either a split peroneus brevis tendon (n = 36) or semitendinosus allograft tendon reconstruction (n = 28) for lateral ankle instability performed by the same surgeon. Postoperative American Orthopedic Foot and Ankle Society (p = .943) and patient satisfaction (p = .279) found no significant difference between either technique. Our results suggest that both split peroneus brevis and semitendinosus allograft may be viable alternatives for lateral ankle instability when primary ligamentous repair is not attainable.
Collapse
Affiliation(s)
- Roland S Ramdass
- Surgeon, Winchester Medical Center - Foot and Ankle Center, Winchester, VA
| | | |
Collapse
|
30
|
Abstract
Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.
Collapse
Affiliation(s)
| | | | - Yu Deng
- Department of Foot and Ankle Surgery, Wuhan University, Hubei, China
| | - L. Daniel Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson
- San Antonio Military Medical Center, TX
| |
Collapse
|
31
|
[Lateral ankle ligament bracing]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:191-200. [PMID: 31098649 DOI: 10.1007/s00064-019-0603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/14/2018] [Accepted: 10/16/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Covering the anatomic reconstruction (Broström procedure) with suture tape for more initial stability. Seat belt principle. INDICATIONS Mechanical lateral ankle instability: athletes in sports at risk, patients with uncertain compliance with respect to the postoperative treatment regimen, patients with poor tissue quality, patients with generalized laxity, and patients with failed previous repairs. CONTRAINDICATIONS Known implant intolerance, local or systemic infection, local soft tissue affections, hemorrhagic disorders. SURGICAL TECHNIQUE Epimalleolar 5 cm skin incision. Anatomic repair of the lateral capsuloligamentous structures to the anterior facet of the lateral malleolus (e.g. Broström repair). Dissection down to origin and insertion of the anterior talofibular ligament (ATFL). Close proximal (fibula) and distal (talar neck) to the ATFL attachments to bone a 2.7 mm (fibular) and a 3.4 mm (talar) drill hole is created and taped with the respective tapes from the single use kit (Arthrex, Naples, FL, USA). Placement of a 3.5 mm × 15.8 mm BioComposite SwiveLock® screw, preloaded with suture tape into the fibula. The free ends of this suture tape are inserted into a 4.75 mm × 19.1 mm SwiveLock® anchor, which is screwed into the talar drill hole under moderate tension of the suture tapes. POSTOPERATIVE MANAGEMENT Immobilization for 4-5 days postoperatively in a leg and foot ScotchcastTM. Then, full load bearing within 1-2 days in a stable shoe (OrthoTECH Stabil, OrthoTECH GmbH, Stockdorf, Germany) for 5 postoperative weeks for the day and a night splint (existing ScotchcastTM). Sensorimotor training initiated in the third and running in the eighth postoperative week. Return to competition in sports at risk (football, basketball, volleyball) 10-12 weeks postoperatively. RESULTS Measured with the validated FAAM-G (Foot and Ankle Ability Measure-German version) questionnaire, 9 patients had a preoperative activities of daily living subscale median (minimum-maximum) of 65 (30-100) and increased to 98 (78-100) 12 months postoperatively. Preoperative FAAM-G sport subscale results were 35 (0-75) and 100 (19-100) after 12 months. With the Sefton Grading System, 7 of 8 followed patients had an excellent result and had unrestricted ankle mobility and stable ankles (talar tilt and anterior talar drawer), which is comparable to published suture tape augmentation reports.
Collapse
|
32
|
Anatomical Arthroscopic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction Using an Autogenic Hamstring Tendon: Safe Creation of Anatomical Fibular Tunnel. Arthrosc Tech 2019; 8:e215-e222. [PMID: 31016124 PMCID: PMC6470364 DOI: 10.1016/j.eats.2018.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/19/2018] [Indexed: 02/03/2023] Open
Abstract
Ankle sprains are the most common lower extremity injuries associated with sports activity. Although ligament repair techniques are popular, reconstruction methods using free tendons are considered when the ligament remnant is insufficiently strong, when high-demand athletes sustain repeat ankle sprains, or in revision cases after repair. Recently, some arthroscopic reconstruction techniques have been reported. The distal fibular end is thin; therefore, surgeons must be careful while drilling the fibular tunnel. This report indicates the safe creation method of an anatomical fibular tunnel during anatomical arthroscopic reconstruction of the anterior talofibular ligament and calcaneofibular ligament. This also provides a stronger reconstruction using a 2-strand tendon graft for the anterior talofibular ligament substitute, which is thought to have less risk for postoperative graft failure.
Collapse
|
33
|
Sakurai R, Fukushi JI, Mizu-uchi H, Hanada M, Momii K, Nakashima Y. Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report. FOOT & ANKLE ORTHOPAEDICS 2019; 4:2473011418794677. [PMID: 35097310 PMCID: PMC8500390 DOI: 10.1177/2473011418794677] [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] [Indexed: 11/16/2022] Open
Abstract
Extensive soft tissue defects of the ankle are an uncommon but challenging problem that require a combination of reconstructive options. We report the case of a complex injury involving the skin, lateral ankle ligaments, and peroneal tendons that were anatomically reconstructed. A 15-year-old girl was injured in an automobile accident resulting in extensive soft tissue defects and marked instability of her right ankle. The lower two-thirds of the anterior talofibular ligament (ATFL) had segmental defects, and calcaneofibular ligament (CFL) was completely torn, and both peroneal longus and brevis tendons were severely damaged. Initial debridement was performed on the day on injury. Two weeks after injury, the ATFL and CFL were reconstructed using a semitendinosus autograft and suture tape augmentation. Both peroneal tendons were reconstructed using a gracilis autograft. The skin defect (10 × 10 cm) was covered with an anterolateral thigh flap. After removing a short leg cast at 3 weeks postoperatively, the patient started range of motion exercises without using any brace. Weightbearing was allowed at 4 weeks. At the 24-month follow-up examination, she had returned to her preoperative level of work and sports activities.
Collapse
Affiliation(s)
- Ryuta Sakurai
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Jun-ichi Fukushi
- Department of Artificial Joints and Biomaterials, Kyushu University, Fukuoka, Japan
| | - Hideki Mizu-uchi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Masuo Hanada
- Department of Plastic Surgery, Kyushu University, Fukuoka, Japan
| | - Kenta Momii
- Department of Emergency Center, Kyushu University, Fukuoka, Japan
| | | |
Collapse
|
34
|
Clement CP, Guberman R, Lee E, DeJesus LP. Use of Cadaveric Graft in Reconstruction of Peroneus Brevis Rupture and Lateral Ankle Instability A Case Report. J Am Podiatr Med Assoc 2019; 109:70-74. [PMID: 30964309 DOI: 10.7547/17-113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This case study presents a novel technique of end-to-end implantation of cadaver graft for the repair of a complete transversely torn peroneus brevis tendon and partially torn peroneus longus tendon in a 58-year-old woman with chronic lateral ankle instability and associated lateral collateral tears. She had a history of multiple ankle sprains and had previously undergone a failed peroneus brevis tendon retubularization procedure. The use of cadaver graft is well documented in the literature for tendon repairs but not well documented in end-to-end repair of the peroneal tendons. A review of the literature revealed only one 2013 study reporting on the benefits and clinical outcomes of cadaver allograft use in peroneal reconstruction.
Collapse
Affiliation(s)
- Cory P. Clement
- Wyckoff Heights Medical Center, Brooklyn, NY. Dr. Clement is now with Queenscare Health Centers, Los Angeles, CA. Dr. Lee is now with Neville Foot and Ankle Centers, The Woodlands, TX. Dr. DeJesus is now with Elite Stride Foot and Ankle Center, Palm Beach Gardens, FL
| | - Ronald Guberman
- Wyckoff Heights Medical Center, Brooklyn, NY. Dr. Clement is now with Queenscare Health Centers, Los Angeles, CA. Dr. Lee is now with Neville Foot and Ankle Centers, The Woodlands, TX. Dr. DeJesus is now with Elite Stride Foot and Ankle Center, Palm Beach Gardens, FL
| | - Edward Lee
- Wyckoff Heights Medical Center, Brooklyn, NY. Dr. Clement is now with Queenscare Health Centers, Los Angeles, CA. Dr. Lee is now with Neville Foot and Ankle Centers, The Woodlands, TX. Dr. DeJesus is now with Elite Stride Foot and Ankle Center, Palm Beach Gardens, FL
| | - Lady P. DeJesus
- Wyckoff Heights Medical Center, Brooklyn, NY. Dr. Clement is now with Queenscare Health Centers, Los Angeles, CA. Dr. Lee is now with Neville Foot and Ankle Centers, The Woodlands, TX. Dr. DeJesus is now with Elite Stride Foot and Ankle Center, Palm Beach Gardens, FL
| |
Collapse
|
35
|
All arthroscopic remnant-preserving reconstruction of the lateral ligaments of the ankle: A biomechanical study and clinical application. Biochem Biophys Res Commun 2018; 505:985-990. [DOI: 10.1016/j.bbrc.2018.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/29/2022]
|
36
|
Abstract
Surgical procedures for managing chronic lateral ankle instability include anatomic direct repair, anatomic reconstruction with an autograft or allograft, and arthroscopic repair. Open direct repair is commonly used for patients with sufficient ligament quality. Reconstruction incorporating either an autograft or an allograft is another promising option in the short term, although the longevity of this procedure remains unclear. Use of an allograft avoids donor site morbidity, but it comes with inherent risks. Arthroscopic repair of chronic lateral ankle instability can provide good to excellent short- and long-term clinical outcomes, but the evidence supporting this technique is limited. Deterioration of the ankle joint after surgery is also a concern. Studies are needed on not only treating ligament insufficiency but also on reducing the risk of ankle joint deterioration.
Collapse
|
37
|
All Arthroscopic Remnant-Preserving Technique to Reconstruct the Lateral Ankle Ligament Complex. Arthrosc Tech 2017; 6:e549-e557. [PMID: 28706799 PMCID: PMC5495154 DOI: 10.1016/j.eats.2016.11.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/30/2016] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic lateral ankle ligament reconstruction has been recently advocated. But this technique has not been popularized because of the technical complexity and potential iatrogenic injury. Because the talocalcaneal and calcaneofibular ligaments are extra-articular structures, how to efficiently view and address them is a difficult task. Limited dissection outside the capsule to form a working space is required, but aggressive dissection is harmful for tissue healing although it is helpful for visualization and instrumentation. Because almost the entire talar body is covered by articular cartilage, it is very difficult to safely make a bone tunnel without damaging the cartilage. The remnants of the lateral ankle ligament have proprioceptive sensors that are important for functional stability, but it is difficult to perform anatomical reconstruction arthroscopically while preserving them because of the narrow working space. Furthermore, how to properly tension the reconstructed ligaments in such a narrow working space is also a very difficult task. We have designed a technique that preserves the remnants of lateral ankle ligaments, and all of the above-mentioned problems have been successfully addressed. We have used this technique clinically, and only minor complications occurred.
Collapse
|
38
|
Regauer M, Mackay G, Lange M, Kammerlander C, Böcker W. Syndesmotic InternalBrace TM for anatomic distal tibiofibular ligament augmentation. World J Orthop 2017; 8:301-309. [PMID: 28473957 PMCID: PMC5396014 DOI: 10.5312/wjo.v8.i4.301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/22/2016] [Accepted: 02/13/2017] [Indexed: 02/06/2023] Open
Abstract
Reconstruction of unstable syndesmotic injuries is not trivial, and there is no generally accepted treatment guidelines. Thus, there still remain considerable controversies regarding diagnosis, classification and treatment of syndesmotic injuries. Syndesmotic malreduction is the most common indication for early re-operation after ankle fracture surgery, and widening of the ankle mortise by only 1 mm decreases the contact area of the tibiotalar joint by 42%. Outcome of ankle fractures with syndesmosis injury is worse than without, even after surgical syndesmotic stabilization. This may be due to a high incidence of syndesmotic malreduction revealed by increasing postoperative computed tomography controls. Therefore, even open visualization of the syndesmosis during the reduction maneuver has been recommended. Thus, the most important clinical predictor of outcome is consistently reported as accuracy of anatomic reduction of the injured syndesmosis. In this context the TightRope® system is reported to have advantages compared to classical syndesmotic screws. However, rotational instability of the distal fibula cannot be safely limited by use of 1 or even 2 TightRopes®. Therefore, we developed a new syndesmotic InternalBraceTM technique for improved anatomic distal tibiofibular ligament augmentation to protect healing of the injured native ligaments. The InternalBraceTM technique was developed by Gordon Mackay from Scotland in 2012 using SwiveLocks® for knotless aperture fixation of a FiberTape® at the anatomic footprints of the augmented ligaments, and augmentation of the anterior talofibular ligament, the deltoid ligament, the spring ligament and the medial collateral ligaments of the knee have been published so far. According to the individual injury pattern, patients can either be treated by the new syndesmotic InternalBraceTM technique alone as a single anterior stabilization, or in combination with one posteriorly directed TightRope® as a double stabilization, or in combination with one TightRope® and a posterolateral malleolar screw fixation as a triple stabilization. Moreover, the syndesmotic InternalBraceTM technique is suitable for anatomic refixation of displaced bony avulsion fragments too small for screw fixation and for indirect reduction of small posterolateral tibial avulsion fragments by anatomic reduction of the anterior syndesmosis with an InternalBraceTM after osteosynthesis of the distal fibula. In this paper, comprehensively illustrated clinical examples show that anatomic reconstruction with rotational stabilization of the syndesmosis can be realized by use of our new syndesmotic InternalBraceTM technique. A clinical trial for evaluation of the functional outcomes has been started at our hospital.
Collapse
|
39
|
Yeo ED, Lee KT, Sung IH, Lee SG, Lee YK. Comparison of All-Inside Arthroscopic and Open Techniques for the Modified Broström Procedure for Ankle Instability. Foot Ankle Int 2016; 37:1037-1045. [PMID: 27623732 DOI: 10.1177/1071100716666508] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND No reported study has compared clinical and radiologic outcomes between an all-inside arthroscopic modified Broström operation (MBO) and an open MBO. The purpose of this study was to compare clinical and radiologic outcomes of all-inside arthroscopic and open MBOs. METHODS From August 2012 to July 2014, 48 patients were included. They were divided into 2 groups: all-inside arthroscopic MBO (25 patients) and open MBO (23 patients). The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale (VAS) score, and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. MBO was performed in 87 patients. Of these, 50 patients met the inclusion criteria. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Patients were randomized into 2 groups, all-inside arthroscopic MBO and open MBO, using a permuted block randomization method. Clinical outcome evaluations were performed preoperatively, at 6 weeks and 6 months postoperatively, and at a final follow-up at a minimum of 12 months postoperatively using the Karlsson score, the AOFAS ankle-hindfoot score, and pain VAS scores. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. RESULTS After randomization, 25 ankles were allocated to the all-inside arthroscopic MBO group and 25 to the open MBO group. Two ankles in the open MBO group were excluded from the analysis because they were lost to follow-up. Thus, evaluations were performed for 25 ankles in the all-inside arthroscopic MBO group and 23 in the open MBO group. There was no difference in age, gender, symptom duration, preoperative AOFAS, VAS, Karlsson scores, anterior talar translation, or talar tilt between the 2 groups (all P > .05). At the final follow-up, the AOFAS, VAS, and the Karlsson scores had improved significantly in both groups (P < .001). There was no difference in the Karlsson, AOFAS, or VAS scores, anterior talar translation, or talar tilt between the 2 groups at final follow-up (all P > .05). CONCLUSIONS There was no difference in the clinical or radiologic outcome between the all-inside arthroscopic MBO and open MBO for the treatment of lateral ankle instability at up to 1 year after surgery. An all-inside arthroscopic MBO should be considered carefully in patients who have lateral ankle instability. LEVEL OF EVIDENCE Level I, randomized controlled trial.
Collapse
Affiliation(s)
- Eui Dong Yeo
- Department of Orthopedic Surgery, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Kyung-Tai Lee
- Foot and Ankle Clinic, KT Lee's Orthopedic Hospital, Republic of Korea
| | - Il-Hoon Sung
- Department of Orthopedics, Hanyang University Hospital, Republic of Korea
| | - Sun Geun Lee
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Republic of Korea
| | - Young Koo Lee
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Republic of Korea
| |
Collapse
|
40
|
|
41
|
Michels F, Cordier G, Guillo S, Stockmans F. Endoscopic Ankle Lateral Ligament Graft Anatomic Reconstruction. Foot Ankle Clin 2016; 21:665-80. [PMID: 27524711 DOI: 10.1016/j.fcl.2016.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Chronic instability is a common complication of lateral ankle sprains. If nonoperative treatment fails, a surgical repair or reconstruction may be indicated. Today, endoscopic techniques to treat ankle instability are becoming more popular. This article describes an endoscopic technique, using a step-by-step approach, to reconstruct the ATFL and CFL with a gracilis graft. The endoscopic technique is reproducible and safe with regard to the surrounding anatomic structures. Short and midterm results confirm the benefits of this technique.
Collapse
Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge Kortrijk, Burg Vercruysselaan 5, Kortrijk 8500, Belgium.
| | - Guillaume Cordier
- Orthopaedic Department, Mérignac Sport Clinic, 2 Rue Georges Negrevergne, Mérignac 33700, France
| | - Stéphane Guillo
- Orthopaedic Department, Mérignac Sport Clinic, 2 Rue Georges Negrevergne, Mérignac 33700, France
| | - Filip Stockmans
- Orthopaedic Department, AZ Groeninge Kortrijk, Loofstraat 43, Kortrijk 8500, Belgium; Department of Development and Regeneration, Faculty of Medicine, University of Leuven Campus Kortrijk, Etienne Sabbelaan 53, Kortrijk 8500, Belgium
| | | |
Collapse
|
42
|
Matheny LM, Johnson NS, Liechti DJ, Clanton TO. Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction. Am J Sports Med 2016; 44:1301-8. [PMID: 26920434 DOI: 10.1177/0363546515627817] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Few studies have compared outcomes of Broström-Gould repair and allograft reconstruction. HYPOTHESIS/PURPOSE The purpose of this study was to compare outcomes and revision rates after Broström-Gould lateral ankle ligament repair versus anatomic allograft reconstruction in patients with lateral ankle instability. The hypothesis was that patients who underwent lateral ankle ligament repair would have outcomes and revision rates similar to those of patients who underwent anatomic allograft reconstruction. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All patients who underwent surgical repair or reconstruction of the anterior talofibular ligament and/or the calcaneofibular ligament by a single surgeon between September 2009 and February 2013 were included in this study. Patients completed a subjective questionnaire at minimum 2 years after ankle surgery. Outcomes measures included the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Lysholm score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form-12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, Tegner activity scale, and patient satisfaction with outcome. Detailed surgical data and intraoperative findings were documented at the time of surgery. All data were collected prospectively and reviewed retrospectively. RESULTS A total of 86 patients were included in this study: 45 men and 41 women (mean age, 38 years; range, 19-68 years) with a mean body mass index of 26.5 (range, 17.5-47.1). There were 61 (71%) patients in the repair cohort and 25 (29%) in the reconstruction cohort. There was no significant difference in age or sex between cohorts. Seventy-six (88%) patients had minimum 2-year follow-up (mean follow-up, 3.0 years; range, 2.0-5.3 years). There was no significant difference in FADI (87 vs 91; P = .553), AOFAS (77 vs 82; P = .372), Lysholm score (83 vs 87; P = .110), Tegner activity scale (6 vs 4; P = .271), patient satisfaction (9 vs 10; P = .058), WOMAC (8 vs 5; P = .264), or Short Form-12 PCS (51.3 vs 54.6; P = .169) or MCS (54.8 vs 51.5; P = .239) score between the repair cohort and the reconstruction cohort, respectively. No patient in either cohort underwent revision lateral ligament surgery. CONCLUSION When compared with lateral ankle repair, anatomic allograft reconstruction produced similarly favorable outcomes, including high patient satisfaction, high function and activity levels, and no revision surgeries in either cohort.
Collapse
Affiliation(s)
- Lauren M Matheny
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Nicholas S Johnson
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Daniel J Liechti
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Thomas O Clanton
- Center for Outcomes-Based Orthopaedic Research, Steadman Philippon Research Institute, Vail, Colorado, USA
| |
Collapse
|
43
|
Michels F, Cordier G, Burssens A, Vereecke E, Guillo S. Endoscopic reconstruction of CFL and the ATFL with a gracilis graft: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 2016; 24:1007-14. [PMID: 26410096 DOI: 10.1007/s00167-015-3779-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 09/08/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate a step-by-step approach to endoscopic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL). METHODS Fourteen lower extremity cadaveric specimens were used. Four standard portals were defined and used. A step-by-step approach using several anatomical landmarks was used to reconstruct the ATFL and CFL. The feasibility of visualising the anatomical landmarks and both ligaments and their footprints was assessed. Both ligaments were reconstructed using a gracilis graft fixed in bone tunnels. The lateral side of the ankle was completely exposed and dissected. The specimen was assessed for clinical stability of the reconstruction and damage to the surrounding anatomical structures. The distance between the centre of the tunnel and the anatomical insertions of the ligaments was measured. The distance between the portals and the nerves was measured. RESULTS The step-by-step approach allowed a good visualisation of the entire course of the ATFL and CFL. An endoscopic reconstruction of both ligaments was performed, and good stability was obtained. The measurements revealed a good positioning of the reconstructed ligament insertions with a maximal error of 2 mm in most specimens. Anatomical dissection revealed no damage to the surrounding anatomical structures that were at risk. The average distance to the superficial peroneal nerve was 11.9 ± 5.3 mm (standard deviation), and the average distance to the sural nerve was 17.4 ± 3.2 mm (standard deviation). A safe zone was defined with regard to the surrounding nerves. CONCLUSION The described technique, which involves an anatomical endoscopic reconstruction of the ATFL and CFL, using a gracilis graft, is a viable option to treat lateral ankle instability. This technique is reproducible and safe with regard to the surrounding anatomical structures.
Collapse
Affiliation(s)
- Frederick Michels
- Orthopaedic Department, AZ Groeninge Kortrijk, Burg Vercruysselaan 5, 8500, Kortrijk, Belgium.
| | - Guillaume Cordier
- Orthopaedic Department, Mérignac Sport Clinic, 2, Rue Georges Negrevergne, 33700, Mérignac, France
| | - Arne Burssens
- Orthopaedic Department, AZ Groeninge Kortrijk, Burg Vercruysselaan 5, 8500, Kortrijk, Belgium
| | - Evie Vereecke
- Department Development and Regeneration, Faculty of Medicine, Kulak, Catholic University Leuven, Etienne Sabbelaan 53, 8500, Kortrijk, Belgium
| | - Stéphane Guillo
- Orthopaedic Department, Mérignac Sport Clinic, 2, Rue Georges Negrevergne, 33700, Mérignac, France
| |
Collapse
|
44
|
How to drill the talar tunnel in ATFL reconstruction? Knee Surg Sports Traumatol Arthrosc 2016; 24:991-7. [PMID: 26856316 DOI: 10.1007/s00167-016-4018-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Reconstruction of the anterior talofibular ligament may be indicated in cases of residual instability after conservative treatment. Often, a bone tunnel is used for fixation in the talar bone. The purpose of this study is to evaluate possible routes for drilling the talar tunnel. METHODS Virtual tunnels were generated in a 3D bone model, oriented towards the following external landmarks: the talar neck, the most anterior point of the medial malleolus (MM), the most distal point of the MM, the most medial point of the MM, and the most posterior point of the MM. The parameters analysed for tunnels with lengths of 20, 25, and 30 mm were the maximum distance inside the bone and the distance from the tunnel to the bone surface. A minimal safe distance (MSD) was calculated for a tunnel with a diameter of 5 mm. RESULTS The shortest measured distance before arriving outside the talar bone was 16.7 mm. The longest distances were obtained in the tunnels oriented towards the talar neck (mean value of 36.6, SD 2.8) and towards the most posterior point of the MM (mean value of 35.8, SD 0.3). Only one tunnel, measuring 20 mm in depth and oriented towards the most posterior point of the MM, revealed no individual values below the MSD. CONCLUSION External landmarks are useful for drilling a talar tunnel during reconstruction of the anterior talofibular ligament. Only one tunnel, oriented towards the most posterior point of the MM, measuring 5 mm in diameter and with a maximum depth of 20 mm, was safe in all individuals. Surgeons should be aware of these limits when treating patients with ankle instability.
Collapse
|
45
|
|
46
|
The Addition of an “Internal Brace” to Augment the Broström Technique for Lateral Ankle Ligament Instability. TECHNIQUES IN FOOT AND ANKLE SURGERY 2016. [DOI: 10.1097/btf.0000000000000111] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
47
|
Posterolateral ankle ligament injuries affect ankle stability: a finite element study. BMC Musculoskelet Disord 2016; 17:96. [PMID: 26905722 PMCID: PMC4765156 DOI: 10.1186/s12891-016-0954-6] [Citation(s) in RCA: 12] [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: 09/16/2015] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have already discovered 23 patients during the work of the outpatient department and operations whose unstable signs on the posterolateral ankle. The anterior drawer test demonstrated normal during the physical examinations while the spaces of the posterior tibiotalar joints increased in stress X-ray plain films. ATFL intact and posterolateral ligaments lax were found during operations too. It is important to make existence claims and illuminate the mechanism of posterolateral ankle instability. METHODS A finite element model of the ankle was established for simulating to cut off posterolateral ligaments in turn. Ankle movements with tibia rotation under load on five forefoot positions were simulated as well. RESULTS The difference values with tibia external rotation were negative, and the positive results occurred with tibia internal rotation. The tibia-talus difference values in some forefoot positions were 2 ~ 3 mm after PTFL together with CFL or/and PITFL were cut off. The tibula-talus difference values were 2.21 ~ 2.76 mm after both PTFL and CFL were cut off. The tibia-fibula difference values were small. The difference values increased by 2 ~ 5 mm after cutting off the PITFL. CONCLUSIONS Posterolateral ankle ligaments, especially CFL and PITFL, play a significant role in maintaining ankle stability. The serious injuries of both CFL and PITFL would affect posterolateral ankle stabilities. PITFL was important to subtalar joint stability.
Collapse
|
48
|
Fehske K. Erratum zu: Behandlung chronischer Sprunggelenkinstabilität. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
49
|
Cho BK, Park KJ, Kim SW, Lee HJ, Choi SM. Minimal Invasive Suture-Tape Augmentation for Chronic Ankle Instability. Foot Ankle Int 2015; 36:1330-8. [PMID: 26112405 DOI: 10.1177/1071100715592217] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although the modified Brostrom procedure has had excellent clinical results, postoperative complications such as skin irritation by suture material and problematic scar formation occur. This prospective study was performed to evaluate the clinical outcomes of mini-open ligament augmentation (internal brace technique) using suture tape for chronic ankle instability in a select cohort of patients. METHODS Thirty-four young female patients with less than 70 kg of body weight were followed for more than 2 years after suture tape augmentation for lateral ankle instability. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM) score, Sefton grading system, and the period to return to various activities. Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate the longevity of mechanical ankle stability. RESULTS FAOS and FAAM scores had significantly improved to 92.5 points at final follow-up (P < .001). According to the Sefton grading, 31 cases (91.2%) achieved satisfactory functional results. The period to return to exercise was on average 10.2 weeks for jogging and 9.6 weeks for walking on uneven ground. The average subjective satisfaction score of patients was 93.8 points, and satisfaction with the scar was 98.5 points. Talar tilt angle and anterior talar translation had significantly improved to an average of 4.5 degrees and 4.1 mm, respectively, at final follow-up (P < .001). There were no complications such as skin irritation and wound infection, except for 1 case of chronic inflammation. CONCLUSIONS Minimally invasive suture tape augmentation seems to be an effective alternative for young women with chronic ankle instability. Because there is a possibility of progressive elongation over time, the longevity of mechanical ankle stability and the proper indication for using the internal brace technique should be addressed in future studies. LEVEL OF EVIDENCE Level IV, case series study.
Collapse
Affiliation(s)
- Byung-Ki Cho
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Kyoung-Jin Park
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seok-Won Kim
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Hyung-Joon Lee
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Seung-Myung Choi
- Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea
| |
Collapse
|
50
|
Dierckman BD, Ferkel RD. Anatomic Reconstruction With a Semitendinosus Allograft for Chronic Lateral Ankle Instability. Am J Sports Med 2015; 43:1941-50. [PMID: 26159822 DOI: 10.1177/0363546515593942] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The modified Broström procedure has been successful for most patients with chronic lateral ankle instability (CLAI); however, a subset of patients has had unsatisfactory outcomes. For those at risk of failure, anatomic reconstruction of the lateral ankle ligaments using a semitendinosus allograft to augment the modified Broström procedure is available. PURPOSE To report the results of anatomic reconstruction of the lateral ankle with a semitendinosus allograft for the treatment of CLAI. STUDY DESIGN Case series; Level of evidence, 4. METHODS This is a retrospective review of a single surgeon's experience from 2003 to 2011 in performing anatomic lateral ankle ligament reconstruction with a semitendinosus allograft for the treatment of CLAI. Of 38 patients (40 ankles), 31 (33 ankles; 82% of patients) returned for final follow-up and constituted the study group. Preoperatively, all patients completed the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AHS) and a visual analog scale (VAS) for pain and underwent plain and stress talar tilt radiographs. At the most recent follow-up, patients were evaluated by an independent surgeon and completed the postoperative AHS, Foot-Function Index (FFI), VAS for pain, Tegner activity score, and a satisfaction survey. Patients were evaluated with plain and stress talar tilt and anterior drawer radiographs. RESULTS At a mean follow-up of 38 ± 30 months (range, 24-107 months), 100% of patients were completely satisfied with the procedure. AHS values significantly improved from a mean of 60.3 ± 14.4 to 87.5 ± 9.3 (P < .0001). VAS pain scores significantly decreased from 7.3 ± 1.3 to 1.9 ± 1.8 (P < .0001). Twenty-two of 31 patients (71%) either returned to or were 1 level below their previous preoperative or preinjury Tegner activity level. No patients developed arthritic changes beyond grade I on plain radiographs. On stress radiographs, the mean talar tilt decreased from 14.3° ± 5.4° to 3.1° ± 2.4°. The mean postoperative anterior tibiotalar translation was 1.8 ± 1.1 mm, with no patients having greater than 5 mm of translation. CONCLUSION Anatomic lateral ankle ligament reconstruction with a semitendinosus allograft for the treatment of CLAI leads to high patient satisfaction, decreased pain, a stable ankle without arthritic changes, and significantly improved function.
Collapse
Affiliation(s)
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
| |
Collapse
|