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Chen Z, Zhao Y, Xue X, Gu X, Li Y, Hua Y. Predictive Modeling for Functional Outcomes After All-Inside Arthroscopic Anterior Talofibular Ligament Repair of Chronic Ankle Instability. Foot Ankle Int 2024; 45:852-861. [PMID: 38798107 DOI: 10.1177/10711007241252091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
BACKGROUND Arthroscopic anterior talofibular ligament repair (AATFLR) is a surgical strategy to treat chronic ankle instability (CAI) patients. This study identified risk factors that influenced the functional outcomes of AATFLR for CAI and developed prognostic nomogram for predicting functional outcomes in future AATFLR cases. METHODS Patients undergoing AATFLR from January 2016 to June 2022 with at least 10 months of follow-up were included in the study. The Karlsson Ankle Functional Score (KAFS) was evaluated preoperatively and at last follow-up visit. A total of 15 potential predictors including age, sex, body mass index, side affected, time from injury to surgery, sports-related injury, osteophyte, loose bodies, distal tibiofibular syndesmosis, ATFL avulsion fracture, Outerbridge classification of osteochondral lesions, postoperative immobilization method, ambulation time, walking time, and follow-up time, were recorded. We first used univariate binary logistic regression analysis to select the potential significant prognostic features, which were then subjected to the least absolute shrinkage and selection operator (LASSO) regression algorithm for final feature selection. A nomogram based on the regression model was developed to estimate the functional outcomes of patients. Models were validated internally using bootstrapping and externally by calculating their performance on a validation cohort. RESULTS Overall, 200 ankles fit inclusion criteria. Of these 200, a total of 185 (92.5%) ankles were eligible and divided into development (n = 121) and validation (n = 64) cohorts. Four predictors were ultimately included in the prognostic nomogram model: age, sex, sports-related injury, and postoperative immobilization method. CONCLUSION We found in our cohort that the significant predictors of poorer functional outcomes of AATFLR were postoperative immobilization with lower-leg cast, female sex, non-sports-related ankle sprain, and increasing age. Prognostic nomograms were created.
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Affiliation(s)
- Ziyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yujie Zhao
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao'ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xicheng Gu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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Guiraud K, Nunes GA, Vega J, Cordier G. High body mass index is not a contraindication for an arthroscopic ligament repair with biological augmentation in case of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2023; 31:5222-5227. [PMID: 37713126 DOI: 10.1007/s00167-023-07557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Obesity remains frequently mentioned as a contraindication for lateral ankle ligament repair. The aim of the study was to compare the clinical results of an arthroscopic lateral ligament repair with biological augmentation between patients with a body mass index (BMI) of more than 30 and less than 30. METHODS Sixty-nine patients with an isolated lateral ankle instability were treated with an arthroscopic anterior talofibular ligament (ATFL) repair with biological augmentation using the inferior extensor retinaculum (IER). Patients were divided into two groups according to their BMI: ≥ 30 (Group A; n = 26) and < 30 (Group B; n = 43). Patients were pre-and post-operatively evaluated, with a minimum of 2 years follow-up, and using the Karlsson Score. Characteristics of the patients, complications, ankle instability symptoms recurrence, and satisfaction score were recorded. RESULTS In group A, the median Karlsson Score increased from 43.5 (Range 22-72) to 85 (Range 37-100) at follow-up. Complications were observed in seven patients (27%). Nineteen patients (73%) reported that they were "very satisfied". One patient (4%) described persistent ankle instability symptoms. In group B, the median Karlsson Score increased from 65 (Range 42-80) to 95 (Range 50-100) at follow-up. Complications were observed in four patients (9%). Thirty-three patients (77%) reported that they were "very satisfied". Two patients (5%) described persistent ankle instability symptoms. Pre-operative and at last follow-up Karlsson Score, results were significantly different between the two groups. There was no significant statistical difference in favour of satisfaction score, complications and recurrence of ankle instability between the two groups. CONCLUSION ATFL repair with biological augmentation using IER gives excellent results for patients with BMI ≥ 30. Compared to patients with BMI < 30, they present a slightly lower preoperative and postoperative Karlsson score, however, with a similar satisfaction rate, but are at higher risk of transient superficial peroneal nerve dysesthesia. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Kevin Guiraud
- Pôle de Santé du Villeneuvois, Villeneuve-sur-Lot, France.
| | - Gustavo Araujo Nunes
- COTE Brasília Clinic, Brasília, Distrito Federal, Brazil
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- Foot and Ankle Unit, iMove Traumatology-Clinica Tres Torres, Barcelona, Spain
- Chirurgie du Sport - Clinique du Sport - Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by Grecmip (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Jordi Vega
- Laboratory of Arthroscopic and Surgical Anatomy. Department of Pathology and Experimental Therapeutics (Human Anatomy Unit), University of Barcelona, Barcelona, Spain
- Foot and Ankle Unit, iMove Traumatology-Clinica Tres Torres, Barcelona, Spain
- Chirurgie du Sport - Clinique du Sport - Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by Grecmip (Minimally Invasive Foot and Ankle Society), Merignac, France
| | - Guillaume Cordier
- Chirurgie du Sport - Clinique du Sport - Vivalto Santé, Bordeaux-Merignac, France
- MIFAS by Grecmip (Minimally Invasive Foot and Ankle Society), Merignac, France
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Fan D, Liu X, Zhang L. Single anchor versus double anchor for arthroscopic anterior talofibular ligament repair: A systematic review and mate-analysis of cohort studies. J Orthop Surg (Hong Kong) 2023; 31:10225536231217914. [PMID: 37992222 DOI: 10.1177/10225536231217914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
PURPOSE To determine whether a double anchor is more effective than a single anchor in the surgical repair of the anterior talofibular ligament (ATFL) in patients with ankle instability. METHODS This study searched PubMed, Embase and the Cochrane Library to identify potential studies that compared the clinical outcomes of double anchors and single anchors for ATFL repair from inception to July 31st, 2023. The study aligned with the 2020 Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and checklist. The Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) tool was used to evaluate methodologic quality and risk of bias. The meta-analysis was performed with random effects. Outcomes, including American Orthopaedic Foot & Ankle Society Score (AOFAS), Karlsson Ankle Functional Score (KAFS), Tegner activity score, return to sport rate, complications and revision surgery events, were recorded. RESULTS A total of 845 articles were identified after an initial search of the three databases. Four retrospective studies involving 231 individuals were included for further analysis. There was no significant difference between the single-anchor group and the two-anchor group in terms of the AOFAS (risk ratio, -0.44, [-2.22; 1.34]) or KAFS (mean difference, -2.81, [-6.87; 1.25]). However, in terms of the Tegner activity score and the return to sport rate, the single-anchor group had significantly lower scores and longer times than the double-anchor group. No complications or revision surgery events were reported. CONCLUSIONS In patients with chronic ankle instability, both single anchors and double anchors can provide good functional outcomes. For patients who participate in physically demanding sports, double anchors may be a superior option. LEVEL OF EVIDENCE Level Ⅲ, meta-analysis of Level Ⅲ.
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Affiliation(s)
- DingYuan Fan
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Beijing University of Chinese Medicine, Beijing, China
- University College London, London, UK
| | - XiaoHua Liu
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, Beijing, China
| | - Lei Zhang
- The First Department of Joint Surgery and Sports Medicine, Wangjing Hospital, Beijing, China
- Academy of Chinese Medical Sciences, Beijing, China
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Chen Z, Xue X, Li Q, Song Y, Xu H, Wang W, Hua Y. Outcomes of a novel all-inside arthroscopic anterior talofibular ligament repair for chronic ankle instability. INTERNATIONAL ORTHOPAEDICS 2023; 47:995-1003. [PMID: 36790535 DOI: 10.1007/s00264-023-05721-0] [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: 10/12/2022] [Accepted: 02/04/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE This study aimed to introduce a novel all-inside arthroscopic anterior talofibular ligament (ATFL) repair for chronic ankle instability (CAI) with a knotless suture anchor technique-Hugging Repair, evaluate clinical outcomes, and analyze the associated risk factors. METHODS A total of 84 patients (42 males and 42 females, mean age: 36.1 ± 11.2 years, range: 19-68 years) who underwent Hugging Repair from January 1, 2016 to December 31, 2018, were enrolled in this retrospective study. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Foot and Ankle Outcome Score (FAOS), Tegner score, and Numerical Rating Scale (NRS) were evaluated pre-operatively and at final follow-up. The potential risk factors such as age, body mass index (BMI), sex, post-injury duration (time from injury to surgery), follow-up time, number of anchors, concomitant injuries [e.g., osteochondral defects (OCD), sinus tarsi syndrome (STS), anterior ankle impingement (AAI)], first-time treatment, and number of ankle sprains were also analyzed through multiple regression analysis. RESULTS There were 68 (81%) patients followed up for a mean time of 42 (range: 35-50) months. The median AOFAS score increased from 65 (35-72) to 90 (77-100), KAFS increased from 64 (38-71) to 90 (62-100), FAOS increased from 68 (50-70) to 97 (68-100), Tegner score increased from 1 (1-3) to 4 (2-7), and NRS increased from 3.5 (2-5) to 1 (0-3). No correlation was found between the functional scores and risk factors mentioned above. In the multivariate model, age was significantly negatively associated with KAFS, FAOS, and Tegner activity scale (P = 0.013; P = 0.002; P = 0.000); female was significantly associated with poorer Tegner activity scale (P = 0.004); and the presence of concomitant injuries was significantly negatively associated with AOFAS score (P = 0.033). CONCLUSION The novel all-inside arthroscopic ATFL repair for CAI with a knotless suture anchor technique-Hugging Repair is a safe and suitable technique that achieves satisfactory clinical outcomes and provides an effective option for the treatment of CAI. Risk factors for patients who underwent all-inside ATFL repair were older age, female sex, and concomitant injuries.
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Affiliation(s)
- Ziyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiao'ao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiaoru Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yujie Song
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hanlin Xu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenjuan Wang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
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One double-loaded suture anchor is sufficient for all-inside arthroscopic anterior talofibular ligament repair. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07348-5. [PMID: 36810947 DOI: 10.1007/s00167-023-07348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE All-inside anterior talofibular ligament (ATFL) repair using anchors is frequently used to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. It remains unclear whether there are differences in the functional results between the use of one or two double-loaded anchors. METHODS This retrospective cohort study included 59 CLAI patients who underwent an all-inside arthroscopic ATFL repair procedure from 2017 to 2019. Patients were divided into two groups according to the number of anchors used. In the one-anchor group (n = 32), the ATFL was repaired with one double-loaded suture anchor. In the two-anchors group (n = 27), the ATFL was repaired with two double-loaded suture anchors. At the last follow-up time point, the Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports in both groups were compared. RESULTS All the patients were followed up for at least 24 months. Improvement in the functional results (VAS, AOFAS, KAFS, ATT, and AJPS) were recorded at the final follow-up time point. No significant differences were observed regarding VAS, AOFAS, KAFS, ATT, and AJPS between the two groups. CONCLUSION In patients with CLAI undergoing all-inside arthroscopic ATFL repair, the use of either one or two double-loaded suture anchors produces comparable and predictably good functional outcomes. LEVEL OF EVIDENCE Level III.
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Feng SM, Shao CQ, Sun QQ, Oliva F, Maffulli N. Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture. J Orthop Surg Res 2022; 17:502. [PMCID: PMC9675186 DOI: 10.1186/s13018-022-03402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background Anatomic repair of anterior talofibular ligament (ATFL) is used to manage chronic lateral ankle instability (CLAI). However, the optimal suture configuration used to repair the ATFL is not yet determined. It remains unclear whether suture configuration affects clinical outcomes in such patients. Purpose To compare the functional outcomes of all-inside arthroscopic ATFL repair using either a loop suture and or a free-edge suture configuration in CLAI patients. Study Design Cohort study; Level of evidence, 3. Methods This retrospective cohort study included 71 patients with CLAI who had undergone an all-inside arthroscopic ATFL repair procedure with either loop suture (n = 36) or free-edge suture (n = 35) from February 2016 to July 2018. Comparable pre-operatively, the Visual analogy score (VAS), American Orthopedic Foot and Ankle Society scoring system (AOFAS), Karlsson Ankle Functional Score (KAFS) scoring system, Anterior Talar Translation (ATT) and Active Joint Position Sense (AJPS) were used to evaluate postoperative ankle function. Results There were no postoperative wound complications, implant reactions, or neurological or vascular injuries. Postoperative hospitalization, VAS, AOFAS, KAFS, AJPS and the time of return to sport were similar between the loop suture group and free-edge suture group. Requiring a longer procedure time, patients with loop suture configuration achieved better ATT. Conclusion All-inside arthroscopic ATFL repair procedure for CLAI treatment provides better ATT and comparable functional outcomes when a loop suture configuration is used instead of a free-edge suture configuration. A statistical difference in ATT was observed. Given the relatively short follow-up, it is questionable whether this will have any clinical relevance.
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Affiliation(s)
- Shi-Ming Feng
- grid.417303.20000 0000 9927 0537Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009 Jiangsu People’s Republic of China
| | - Chang-Qing Shao
- grid.417303.20000 0000 9927 0537Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009 Jiangsu People’s Republic of China
| | - Qing-Qing Sun
- grid.417303.20000 0000 9927 0537Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009 Jiangsu People’s Republic of China
| | - Francesco Oliva
- grid.11780.3f0000 0004 1937 0335Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- grid.11780.3f0000 0004 1937 0335Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy ,grid.9757.c0000 0004 0415 6205Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire ST4 7QB England, UK ,grid.439227.90000 0000 8880 5954Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG England, UK
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Liu J, Chen M, Xu T, Tian Z, Xu L, Zhou Y. Functional results of modified Mason-Allen suture versus horizontal mattress suture in the arthroscopic Broström-Gould procedure for chronic ankle instability. J Orthop Surg Res 2022; 17:459. [PMID: 36266690 PMCID: PMC9585854 DOI: 10.1186/s13018-022-03354-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The arthroscopic Broström–Gould procedure (ABG) gained particular attention among clinicians and researchers due to its high rate of satisfactory results. There is a lack of evidence regarding the differences in clinical outcomes for the various suture techniques. The purpose of this study was to compare the differences in clinical effect in patients treated with one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture for chronic ankle instability (CAI). Methods This retrospective cohort study examined CAI patients who underwent either one-anchor modified Mason–Allen suture or two-anchor horizontal mattress suture ABG between January 2018 and January 2020. Patients were divided into two groups based on the suture knot type used and the associated number of anchors. The operative time, surgical cost, Visual Analog Scale (VAS), American Orthopedic Foot & Ankle Society (AOFAS) Score, Karlsson Ankle Functional Score (KAFS), the rate of return to sports, complications, and measured biomechanical strength using standardized equipment were compared between groups. Results Sixty-four CAI patients were included (one-anchor modified Mason–Allen suture group n = 30, two-anchor horizontal mattress suture group n = 34). Compared to the two-anchor horizontal mattress suture group, the one-anchor modified Mason–Allen suture group had significantly shorter operative time (p < .001) and lower surgical cost (p < .001). There were no postoperative complications in the two groups, and no significant differences in the VAS, AOFAS, KAFS, and rate of return to sports in postoperative follow-up between the two groups at 1 and 2 years after surgery. There was no statistically significant difference in biomechanical strength anterior drawer test displacement (p > .05) between the one-anchor modified Mason–Allen suture and two-anchor horizontal mattress suture at 2 years after surgery. Conclusion ABG using a one-anchor modified Mason–Allen suture showed comparable clinical results to a two-anchor horizontal mattress suture in the treatment of CAI at intermediate-term follow-up time. However, one-anchor modified Mason–Allen suture may be a faster, simpler, cost-effective substitute technology. Level of evidence Level III, comparative study.
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Affiliation(s)
- Jinlang Liu
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Mingliang Chen
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Tao Xu
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Zhipeng Tian
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - Liuhai Xu
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China
| | - You Zhou
- Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, Yichang, 443001, Hubei, China.
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Connecting fibers between ATFL's inferior fascicle and CFL transmit tension between both ligaments. Knee Surg Sports Traumatol Arthrosc 2021; 29:2511-2516. [PMID: 33646371 DOI: 10.1007/s00167-021-06496-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/05/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE The lateral ligament complex of the ankle has been extensively studied. Recently an anatomical study described a connection between anterior talofibular ligament inferior fascicle (ATFLif) and calcaneofibular ligament (CFL). The applicability and the mechanical role of these connections have not yet been studied and need to be clarified. The purpose of this study is to evaluate the connection between ATFLif and CFL through a dynamic measurement analysis. METHODS An anatomical study was performed in 13 fresh-frozen below-the-knee ankle specimens. Each specimen was dissected in a protocolized manner until the lateral ligaments were exposed. A complete injury to both ATFL's fascicles was created in the proximal third of the ligament. A displacement transducer specifically design was inserted in the CFL and in the lateral part of the calcaneus to test its lengthening. A traction of 1 kg weight (9.8 N) was applied to ATFLif while the transducer measured the lengthening that this force created in the CFL. RESULTS A total of 13 ankle specimens were carefully dissected. One specimen with signals of a prior traumatic injury of the ATFLif was excluded. A total of 12 specimens were included, 7 females and 5 males with an average age of 74 years (52-88 years). The right ankle was dissected in 6 specimens. ATFL was identified as a two-fascicled ligament in all cases. The fibers connecting the ATFLif and CFL were observed in all specimens. The displacement transducer showed lengthening in the CFL in all measurements with a median of 0.59 mm (SD ± 0.34). CONCLUSION Connecting fibers between ATFLif and CFL are robust enough to transmit tension from one structure to the other. In the case of associated proximal lesions of the ATFLif and CFL, ligaments repair with a single suture may be considered. This can be applied in surgical procedures in patients with lateral ankle instability.
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Abstract
INTRODUCTION Ankle arthroscopy has come a long way since it was thought, it is not feasible because of tight joint and anatomical characteristics of ankle joint. The same anatomical features like capsular attachment and safe accessory portals are used to access the whole joint even with a rigid arthroscope. Ankle distraction method was routinely used to access the anterior ankle. However, nowadays, anterior arthroscopy is done in dorsiflexion as this increases the anterior ankle joint volume, and thereby easy access to various anatomical structures. On the other hand, intermittent traction is used to access the posterior ankle. Initially used as a diagnostic tool, ankle arthroscopy is now used extensively as a therapeutic and reconstruction tool. New evidence is published for all inside ligament reconstructions, effective management of impingement syndromes, and osteochondral lesions. The indications are being extended to fracture management and arthrodesis. METHODOLOGY This narrative review was performed following a literature search in the Pubmed database and Medline using the following keywords: ankle arthroscopy, portals, ankle OCD, functional outcome. Related articles were then reviewed. CONCLUSION Complications rate is reduced with a better understanding of the relative anatomy of surrounding neurovascular structures and tendons with regard to the position of ankle joint. This review on ankle arthroscopy focuses on anatomy, indications, and complications. Ankle arthroscopy is a safe and elegant tool as any other joint arthroscopy.
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Feng SM, Han M, Wang AG, Fan JQ. Functional Comparison of Horizontal Mattress Suture Versus Free-Edge Suture in the All-Inside Arthroscopic Broström-Gould Procedure for Chronic Lateral Ankle Instability. Orthop Surg 2020; 12:1799-1810. [PMID: 33073506 PMCID: PMC7767785 DOI: 10.1111/os.12817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 12/13/2022] Open
Abstract
Objective To compare the clinical outcomes of horizontal mattress suture vs free‐edge suture in the all‐inside arthroscopic Broström–Gould procedure. Methods This retrospective cohort study included 68 chronic lateral ankle instability (CLAI) patients who underwent either a horizontal mattress suture or a free‐edge suture all‐inside arthroscopic Broström–Gould procedure from January 2014 to January 2017. Patients were divided into two groups based on the suture fashion during the all‐inside arthroscopic Broström–Gould procedure. In the horizontal mattress suture group (n = 31), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in horizontal mattress suture fashion. In the free‐edge suture group (n = 37), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in free‐edge suture fashion. The Visual Analogue Scale (VAS) score, the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), the rate of return to sports, and ankle proprioceptive recovery were compared in both groups. Results The operative times and duration of hospitalization between the two groups were comparable (all P > 0.05). The VAS, AOFAS, ATT, the rate of return to sports, and ankle proprioceptive recovery were comparable between the horizontal mattress suture and free‐edge suture groups at 1 and 2 years after surgery. Patients of the free‐edge suture group achieved better KAFS 1 and 2 years after the surgery compared with those of the horizontal mattress suture group. In both groups, incisions were healed by first intention, and complications such as infection, implant reactions, tendon injury, and nervous or vascular injuries were not observed. The ankle proprioceptive recovery in horizontal mattress suture and free‐edge suture groups showed no significant differences at 1 and 2 years after surgery. The mean time of the return to full activity for patients in the horizontal mattress suture group was 10.38 ± 2.02 (range 8 to 12) weeks vs 8.63 ± 2.31 (range 8 to 12) weeks for those in the free‐edge suture group (P = 0.001, power = 0.907). The exercise participation rates were comparable between groups (P > 0.05). At the 2‐year follow‐up, all patients regained normal activities and ankle stability, and no recurrence of CLAI or revision surgery was recorded. Conclusion All‐inside arthroscopic Broström–Gould surgery for the treatment of CLAI ensures a better functional effect (KAFS) and better recovery time when free‐edge suture is used instead of horizontal mattress suture.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou, China.,Orthopaedic Department, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Meng Han
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou, China
| | - Ai-Guo Wang
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou, China.,Orthopaedic Department, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Jia-Qiang Fan
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou, China
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Woo BJ, Lai MC, Koo K. Response to "Letter Regarding: Arthroscopic Versus Open Broström-Gould Repair for Chronic Ankle Instability". Foot Ankle Int 2020; 41:656-657. [PMID: 32538192 DOI: 10.1177/1071100720929286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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12
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Zhong M, Xu J, Li H. Letter Regarding: Arthroscopic Versus Open Broström-Gould Repair for Chronic Ankle Instability. Foot Ankle Int 2020; 41:654-655. [PMID: 32538193 DOI: 10.1177/1071100720929283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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