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Takao M, Ozeki S, Kubo M, Oliva XM, Yamazaki T, Lowe D, Matsui K, Katakura M, Takeuchi Y, Glazebrook M. Directly measured strain patterns of the anterior talofibular and calcaneofibular ligaments after isolated ATFL repair in a combined ATFL and CFL injury: A cadaver study. J Orthop Sci 2024:S0949-2658(24)00102-7. [PMID: 38890095 DOI: 10.1016/j.jos.2024.06.002] [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: 03/07/2024] [Revised: 04/15/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Even though 20% of chronic lateral ankle instability results from a combined anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, only the ATFL is sutured using arthroscopic ligament repair techniques. Although some biomechanical and clinical studies have proved that isolated ATFL repair yields excellent results, previous biomechanical studies were performed using systems that only allow indirect estimations. The purpose of this study was to clarify strain patterns by directly measuring repaired ATFL and CFL strain patterns on cadaveric models that underwent isolated ATFL repair of a combined ATFL and CFL injury. METHODS The miniaturization ligament performance probe (MLPP) system was used for directly measuring the strain patterns to insert the strain gauges into the mid-substance of normal and repaired ATFL and CFL fibers in five cadaveric specimens to allow measurement of strain patterns in the axial and three-dimensional motion of the ankle. RESULTS The normal and repaired ATFL showed similar strain patterns in axial and three-dimensional motions. During the axial range of motion of the ankle, the repaired CFL showed a strain pattern almost similar to that of normal CFL, but the strain increased as the plantar flexion or dorsiflexion angle increased to the maximum value of 100 at 30° plantarflexion or strain values of 17-55/100 at 15°dorsiflexion. During three-dimensional motion, the repaired CFL was under the maximum value of 100 during dorsiflexion-inversion and exhibited less strain (7-38/100) during plantar flexion-eversion. CONCLUSION The repaired CFL did not show a strain pattern that was completely consistent with a normal strain pattern; however, it did have some degree of tension similar to a normal strain pattern, even though it was not directly repaired.
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Affiliation(s)
- Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, Jujo Hospital, Kisarazu, Chiba, Japan.
| | - Satoru Ozeki
- Department of Orthopaedic Surgery, Lake Town Hospital of Orthopaedics, Koshigaya, Japan
| | - Maya Kubo
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Xavier M Oliva
- Department of Human Anatomy, University of Barcelona, Barcelona, Spanish, Japan
| | | | - Dani Lowe
- Department of Orthopaedic Surgery, Lions Gate Hospital, North Vancouver, Canada
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University, Tokyo, Japan
| | - Mai Katakura
- Department of Joint Surgery and Sports Mdicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan
| | | | - Mark Glazebrook
- Department of Orthopaedic Surgery, Dalhousie University, Nova Scotia, Canada
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Leckie I, Thomas L, Weiler R. Rehabilitation of a lateral ankle reconstruction in a male professional football player - A narrative case report. Phys Ther Sport 2023; 62:32-38. [PMID: 37300971 DOI: 10.1016/j.ptsp.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Lateral ankle sprains involving the ATFL and CFL are common injuries in football with a high recurrence rate. There is a lack of research to guide post-operative rehabilitation of football players following lateral ligament ankle reconstructive surgery. This narrative case report discusses the management of a lateral ligament reconstruction in a male professional football player. METHODS A 25-year-old professional footballer underwent a lateral ankle reconstruction following recurrent lateral ankle sprains leading to an unstable ankle. RESULTS Following 11-weeks of rehabilitation the player was cleared to return to full-contact training. The player competed in his first competitive match 13-weeks post-injury and completed a 6-month full-training block, without episodes of pain or instability. CONCLUSION This case report illustrates the rehabilitation process of a football player following a lateral ankle ligament reconstruction within a timeframe expected in elite sport.
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Affiliation(s)
| | | | - Richard Weiler
- University Medical Centres, Netherlands; University College London, Instistute Sport, Exercise and Health, Division of Surgery and Interventional Science, United Kingdom; Fortius Clinic London, United Kingdom
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Chen RP, Wang QH, Li MY, Su XF, Wang DY, Liu XH, Li ZL. Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament. World J Clin Cases 2023; 11:3395-3407. [PMID: 37383912 PMCID: PMC10294195 DOI: 10.12998/wjcc.v11.i15.3395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/07/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
Injury to the anterior talofibular ligament (ATFL) is a common acute injury of the lateral foot ligament. Untimely and improper treatment significantly affects the quality of life and rehabilitation progress of patients. The purpose of this paper is to review the anatomy and the current methods of diagnosis and treatment of acute injury to the ATFL. The clinical manifestations of acute injury to the ATFL include pain, swelling, and dysfunction. At present, non-surgical treatment is the first choice for acute injury of the ATFL. The standard treatment strategy involves the “peace and love” principle. After initial treatment in the acute phase, personalized rehabilitation training programs can be followed. These may involve proprioception training, muscle training, and functional exercise to restore limb coordination and muscle strength. Static stretching and other techniques to loosen joints, acupuncture, moxibustion massage, and other traditional medical treatments can relieve pain, restore range of motion, and prevent joint stiffness. If the non-surgical treatment is not ideal or fails, surgical treatment is feasible. Currently, arthroscopic anatomical repair or anatomical reconstruction surgery is commonly used in clinical practice. Although open Broström surgery provides good results, the modified arthroscopic Broström surgery has many advantages, such as less trauma, rapid pain relief, rapid postoperative recovery, and fewer complications, and is more popular with patients. In general, when treating acute injury to the ATFL, treatment management and methods should be timely and reasonably arranged according to the specific injury scenario and attention should be paid to the timely combination of multiple therapies to achieve the best treatment results.
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Affiliation(s)
- Run-Peng Chen
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Qing-Hua Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Ming-Yue Li
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Xiao-Fang Su
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
| | - Dong-Yang Wang
- School of Nursing, Binzhou Medical University, Yantai 264003, Shandong Province, China
- Faculty of Nursing, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Xing-Hui Liu
- Department of Office, Shandong Vheng Data Technology Co., Ltd, Yantai 264003, Shandong Province, China
| | - Zhi-Li Li
- Department of Office, Shandong Vheng Data Technology Co., Ltd, Yantai 264003, Shandong Province, China
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Takao M, Lowe D, Ozeki S, Oliva XM, Inokuchi R, Yamazaki T, Takeuchi Y, Kubo M, Matsui K, Katakura M, Glazebrook M. Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study. BMC Musculoskelet Disord 2021; 22:558. [PMID: 34144675 PMCID: PMC8214304 DOI: 10.1186/s12891-021-04444-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022] Open
Abstract
Background Inversion ankle sprains, or lateral ankle sprains, often result in symptomatic lateral ankle instability, and some patients need lateral ankle ligament reconstruction to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using the miniaturization ligament performance probe (MLPP) system. Methods The MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three freshly frozen cadaveric lower-extremity specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex. Results The normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During the axial motion, the normal ATFLs started to gradually tense at 0° plantar flexion, with the strain increasing as the plantar flexion angle increased, to a maximal value (100) at 30° plantar flexion; the reconstructed ATFLs showed similar strain patterns. Further, the normal CFLs exhibited maximal strain (100) during plantar flexion-abduction and relative strain values of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain values of 29–62 during plantar flexion-abduction. During the axial motion, the normal CFLs started to gradually tense at 20° plantar flexion and 5° dorsiflexion. Conclusion Our results showed that the strain patterns of reconstructed ATFLs and CFLs are not similar to those of normal ATFLs and CFLs.
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Affiliation(s)
- Masato Takao
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.
| | - Danielle Lowe
- Department of Orthopaedic Surgery, Lions Gate Hospital, North Vancouver, BC, Canada
| | - Satoru Ozeki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Xavier M Oliva
- Department of Human Anatomy, University of Barcelona, Calle Casanova, 143, 08038, Barcelona, Spain
| | - Ryota Inokuchi
- Clinical and Research Institute for Foot and Ankle Surgery, 341-1, Mangoku, Kisarazu, Chiba, 292-0003, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, 1-1-1 Tenno-dai, Tsukuba, Ibaraki, Japan
| | - Takayuki Yamazaki
- Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, Japan
| | - Yoshitaka Takeuchi
- Tokyo National College of Technology, 1220-2, Kunugida-machi, Hachioji, Tokyo, Japan
| | - Maya Kubo
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopaedic Surgery, Teikyo University, 2-11-1 Kaga, Itabashi, Tokyo, Japan
| | - Mai Katakura
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, Japan
| | - Mark Glazebrook
- Division of Orthopaedic Surgery, Dalhousie University, Queen Elizabeth II Health Sciences Center Halifax Infirmary (Suite 4867), 1796 Summer Street, Halifax, NS, B3H3A7, Canada
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