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Anatomical Tenodesis Reconstruction Using Free Split Peroneal Brevis Tendon for Severe Chronic Lateral Ankle Instability. Keio J Med 2021; 71:44-49. [PMID: 34759124 DOI: 10.2302/kjm.2021-0014-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Many operative procedures have been reported for the management of chronic lateral ankle instability, and anatomical reconstructions are an excellent option. However, if the remnants of the ligaments are considerably damaged, anatomical reconstructions using such remnants can be difficult. In cases such as these, tenodesis stabilization may be required. However, tenodesis stabilization often restricts the range of ankle movement. The purpose of this study was to determine the effectiveness of a new procedure that we developed to mitigate the problems associated with tenodesis stabilization procedures. We installed grafts in the original anatomical position by devising a system for positioning the drill holes in the bones so that our procedure did not restrict the range of ankle movement. A retrospective review of 37 patients (13 men, 24 women) with a mean age of 30.2 (range, 16-66) years was performed at an average of 69 (range, 47-77) months after the surgery. The average American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved significantly from 65.6 (range, 47-77) points preoperatively to 98.0 (range, 87-100) points postoperatively (P < 0.001). With the number of subjects available, no significant differences were detected between the postoperative mean ranges of movement of the ankle and subtalar joints and those of the preoperative ankle. Patients who underwent anatomical tenodesis reconstructions with a free split peroneal brevis tendon showed good outcomes after a 69-month follow-up period.
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Ziaei Ziabari E, Lubberts B, Chiou D, Razi M, Haghpanahi M, Ashkani-Esfahani S, DiGiovanni CW. Biomechanics Following Anatomic Lateral Ligament Repair of Chronic Ankle Instability: A Systematic Review. J Foot Ankle Surg 2021; 60:762-769. [PMID: 33712375 DOI: 10.1053/j.jfas.2020.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/03/2020] [Accepted: 09/01/2020] [Indexed: 02/03/2023]
Abstract
One of the most common orthopedic injuries in the general population, particularly among athletes, is ankle sprain. We investigated the literature to evaluate the known pre- and postoperative biomechanical changes of the ankle after anatomic lateral ligament repair in patients suffering from chronic ankle instability. In this systematic review, studies published till January 2020 were identified by using synonyms for "kinetic outcomes," "kinematic outcomes," "Broström procedure," and "lateral ligament repair." Included studies reported on pre- and postoperative kinematic and/or kinetic data. Twelve articles, including 496 patients treated with anatomic lateral ligament repair, were selected for critical appraisal. Following surgery, both preoperative talar tilt and anterior talar translation were reduced similarly to the values found in the uninjured contralateral side. However, 16 of 152 (10.5%) patients showed a decrease in ankle range of motion after the surgery. Despite the use of these various techniques, there were no identifiable differences in biomechanical postoperative outcomes. Anatomic lateral ligament repair for chronic ankle instability can restore ankle biomechanics similar to that of healthy uninjured individuals. There is currently no biomechanical evidence to support or refute a biomechanical advantage of any of the currently used surgical ligament repair techniques mentioned among included studies.
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Affiliation(s)
- Elaheh Ziaei Ziabari
- Research Fellow, Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; PhD Candidate, School of Mechanical Engineering, Iran University of Science and Technology, Narmak, Tehran, Iran.
| | - Bart Lubberts
- Director, Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Instructor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Foot & Ankle Service, Massachusetts General Hospital, Boston, MA
| | - Daniel Chiou
- Research Intern, Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mohammad Razi
- Associate Professor of Orthopedic Surgery and President of Iranian Orthopaedic Association, Department of Orthopaedic Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Haghpanahi
- Professor of Biomechanical Engineering, School of Mechanical Engineering, Iran University of Science and Technology, Narmak, Tehran, Iran
| | - Soheil Ashkani-Esfahani
- Physician-Researcher, Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Orthopaedic Surgery Research Fellow, Department of Orthopaedic Surgery, Foot & Ankle Service, Massachusetts General Hospital, Boston, MA
| | - Christopher W DiGiovanni
- Professor of Orthopaedic Surgery, Foot and Ankle Research and Innovation Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Chief of Division of Foot & Ankle Surgery, Department of Orthopaedic Surgery, Foot & Ankle Service, Massachusetts General Hospital, Boston, MA; President-Elect, American Orthopaedic Foot and Ankle Society, Newton-Wellesley Hospital, Harvard Medical School, Massachusetts General Hospital, Boston, MA
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Kim TY, Hwang YG, Ahn J, Baek JH, Jeong BO. Evaluation of Stress Radiographs Taken Before and After Spinal Anesthesia in Patients With Chronic Ankle Instability. J Foot Ankle Surg 2020; 59:53-58. [PMID: 31882149 DOI: 10.1053/j.jfas.2019.01.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/10/2019] [Accepted: 01/31/2019] [Indexed: 02/03/2023]
Abstract
Stress radiography is known as an important diagnostic tool for confirming mechanical instability in patients with chronic ankle instability. However, there are no reports on how muscle guarding caused by the stress applied on the ankle during stress radiography affects test outcomes. Thus, this study aimed to analyze the effects of muscle guarding caused by stress radiography on outcomes by performing stress radiography before and after anesthesia. This is a prospective study involving 32 patients who were diagnosed with chronic ankle instability through patient history, physical examination, and magnetic resonance imaging studies. Varus and anterior drawer stress radiographs were taken before and after anesthesia in the operating room, and the findings were compared. On the post-anesthesia stress radiographs of the affected ankle, talar tilt and talar anterior translation were significantly increased by 2.55° ± 2.64° and 1.54 ± 2.03 mm, respectively (mean ± standard deviation; p < .05). These parameters were also significantly increased by 2.08° ± 2.62° and 1.27 ± 1.37 mm, p < .05, on the post-anesthesia radiographs of the unaffected ankle. Before anesthesia, 26 of 32 patients had positive stress radiographs, but 31 patients had positive results after anesthesia. Talar tilt and talar anterior translation significantly increased after anesthesia. Therefore, in CAI patients, efforts to reduce muscle guarding should be made before stress radiographs are taken. Moreover, when interpreting results, it should be noted that muscle guarding might have reduced the measurements of stress radiographs, leading to diagnostic false negatives.
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Affiliation(s)
- Tae Yong Kim
- Surgeon, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee Univeristy, Seoul, Korea
| | - Yeok Gu Hwang
- Surgeon, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee Univeristy, Seoul, Korea
| | - Jungtae Ahn
- Surgeon, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee Univeristy, Seoul, Korea
| | - Jong Hun Baek
- Surgeon, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee Univeristy, Seoul, Korea
| | - Bi O Jeong
- Surgeon, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee Univeristy, Seoul, Korea.
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Evaluation modalities for the anatomical repair of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:163-176. [PMID: 31646350 DOI: 10.1007/s00167-019-05755-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/07/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Several evaluation modalities are reported in the literature dealing with the operative treatment of chronic ankle instability (CAI) both to establish the CAI diagnosis leading to the surgical indication and to assess the effectiveness of ankle stabilisation procedure. The purpose of this study is to present an overview of the pre- and postoperative evaluation modalities reported in the literature dealing with CAI operative treatment. The comprehensive analysis of the different modalities chosen by researchers is expected to suggest critical points in current evaluation ability of CAI surgical treatment. METHODS Systematic review of the literature on surgical treatment of CAI through anatomic procedures. Pubmed, Embase and Cochrane electronic databases were analysed, from 2004 to 2018. RESULTS One-hundred-and-four studies met inclusion in this systematic review. 88 out of 104 studies analysed preoperative mechanical laxity of the ankle to depict the ligamentous insufficiency related to the subjective feeling of functional instability. Stress radiographs and manual stress examination of the ankle were the two most common modalities to evaluate joint laxity, reported in 67 and 53 studies, respectively. Clinical Outcome Measurement Scales (COMs) is the most common evaluation modality (102 out of 104 studies) to assess CAI surgical outcome. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS) and the Karlsson score are the most frequent COMs, reported in the 66% and 33%, respectively of the included literature. The radiographic analysis of ankle laxity after stabilisation procedures is the second most frequent postoperative evaluation modality, reported in 55 out 104 studies. CONCLUSIONS There is a lack of standardization among researchers related to both the criteria to establish the CAI diagnosis leading to the surgical indication and the modality chosen to evaluate the effectiveness of surgical treatment. Future standardization of evaluation modalities in the CAI population is desirable to increase consistency of reported data. LEVEL OF EVIDENCE Level IV, review of level I, II, III and IV studies.
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Song Y, Li H, Sun C, Zhang J, Gui J, Guo Q, Song W, Duan X, Wang X, Wang X, Shi Z, Hua Y, Tang K, Chen S. Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data. Orthop J Sports Med 2019; 7:2325967119873852. [PMID: 31579683 PMCID: PMC6757505 DOI: 10.1177/2325967119873852] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered. Purpose: To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI. Study Design: A consensus statement of the Chinese Society of Sports Medicine. Methods: A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized. Results: A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded. Conclusion: This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.
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Affiliation(s)
- Yujie Song
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Chao Sun
- Beijing Tongren Hospital, Beijing, China
| | - Jian Zhang
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Jianchao Gui
- Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China
| | - Qinwei Guo
- Peking University Third Hospital, Beijing, China
| | - Weidong Song
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaojun Duan
- Southwest Hospital Affiliated to Army Medical University, Chongqing, China
| | - Xiaoqin Wang
- Huashan Hospital Fudan University, Shanghai, China
| | | | - Zhongming Shi
- Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | | | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Kanglai Tang
- Southwest Hospital Affiliated to Army Medical University, Chongqing, China
| | - Shiyi Chen
- Department of Sports Medicine, Huashan Hospital Fudan University, Shanghai, China
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Dromzée E, Granger B, Rousseau R, Steltzlen C, Stolz H, Khiami F. Long-Term Results for Treatment of Chronic Ankle Instability With Fibular Periosteum Ligamentoplasty and Extensor Retinaculum Flap. J Foot Ankle Surg 2019; 58:674-678. [PMID: 30962108 DOI: 10.1053/j.jfas.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Indexed: 02/03/2023]
Abstract
Long-term results of anatomic reconstruction for chronic ankle instability are good, but no study has shown the results of fibular periosteum ligamentoplasty associated with extensor retinaculum flap at long-term follow-up. To demonstrate the efficacy of fibular periosteum ligamentoplasty and extensor retinaculum flap in chronic lateral instability, 40 patients underwent surgery for ankle instability. Thirty-three (82.5%) patients were reviewed, with a median follow-up duration of 8.2 (range 4 to 13) years. Functional results were assessed using the Karlsson score. Static and dynamic x-ray images were realized to measure varus tilt and anterior drawer, and osteoarthritis was evaluated with the van Dijk classification. The median Karlsson score was 95 (range 80 to 100). The mean decrease in varus laxity was 11° (range 0 to 18) and in anterior drawer was 1 (range -8 to 4) mm. At the last follow-up visit, 3 (7.5%) patients showed an evidence of osteoarthritis according to the preoperative criteria of the van Dijk classification (grade 2) and 6 (15%) patients had radiologic changes, without narrowing of the joint space (grade 1). Studies that have a follow-up time >5 years are rare. This study shows that despite the excellent control of ankle laxity, severe radiographic changes (grade 2) continue to evolve in the long term. This study indicates a good long-term outcome but suggests the need to monitor the occurrence of osteoarthritis over the long term.
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Affiliation(s)
- Eric Dromzée
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, University Hospital of Geneva, Geneva, Switzerland
| | - Benjamin Granger
- Biostatician, Department of Biostatistics, Public Health and Medical Information, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Rousseau
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Camille Steltzlen
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hadrien Stolz
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, University Hospital of Geneva, Geneva, Switzerland
| | - Frédéric Khiami
- Surgeon, Department of Orthopedic Surgery and Sport Trauma, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Tourné Y, Peruzzi M. Lateral collateral ligament repair. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:169-179. [DOI: 10.1007/s00064-019-0599-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Crombé A, Borghol S, Guillo S, Pesquer L, Dallaudiere B. Arthroscopic reconstruction of the lateral ankle ligaments: Radiological evaluation and short-term clinical outcome. Diagn Interv Imaging 2018; 100:117-125. [PMID: 30446413 DOI: 10.1016/j.diii.2018.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/27/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to describe the positioning of bone tunnels of arthroscopic anatomical reconstruction of lateral ankle ligaments (AAR-LAL) and identify radiological measurements associated with short-term clinical outcome one year after surgery. MATERIALS AND METHODS A total of 61 patients were included in this IRB-approved retrospective study. There were 52 men and 9 women, with a mean age of 36.3 ± 10.8 (SD) years. AAR-LAL was performed to treat chronic instability secondary to strain sequelae after failure of conservative treatment. Good short-term clinical outcome was defined by Karlsson-score≥80 (n=40) one year after surgery. Sixteen radiological measurements were studied to characterize the positionings of fibular, talar and calcaneal tunnels (FT, TT and CT, respectively). Feasibility and inter-observer agreement were calculated for each measurement. Receiver operating characteristic curves were used to identify optimal thresholds for measurements associated with outcome at univariate analysis. A binary logistic regression was used to identify independent predictors. RESULTS Two measurements were associated with good outcome: distance from the proximal FT entrance to the distal end of the fibula on anteroposterior (AP) view (called 'AP distal FT', P=0.005), and the ratio between the distance from TT entrance to the talo-navicular joint and the talus length on lateral view (P=0.009). Optimal thresholds were of >35mm and<0.445, respectively. At multivariate anlysis, only 'AP distal FT'>35mm remained independent predictor of good outcome (P=0.002). CONCLUSION Radiological evaluation of bone tunnels following AAR-LAL is feasible, reproducible, and helps predict short-term outcome after reconstruction of lateral ankle ligaments.
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Affiliation(s)
- A Crombé
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France; Department of Radiology, Institut Bergonié, 229, cours de l'Argonne, 33000 Bordeaux, France.
| | - S Borghol
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - S Guillo
- Orthopedic Department, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - L Pesquer
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France
| | - B Dallaudiere
- Musculoskeletal Imaging Center, Bordeaux-Mérignac Sport Clinic, 2, rue Georges Negrevergne, 33700 Mérignac, France; Department of Musculoskeletal Radiology, Hôpital Pellegrin, Bordeaux University, 2, place Amélie Raba-Leon, 33000 Bordeaux, France
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So E, Preston N, Holmes T. Intermediate- to Long-Term Longevity and Incidence of Revision of the Modified Broström-Gould Procedure for Lateral Ankle Ligament Repair: A Systematic Review. J Foot Ankle Surg 2018. [PMID: 28645550 DOI: 10.1053/j.jfas.2017.05.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Broström-Gould procedure is an effective procedure for chronic lateral ankle instability. However, long-term studies are limited, and the durability of this procedure remains unclear. A systematic review of the published data was undertaken to determine the outcomes and incidence of revision after long-term follow-up. Eleven studies involving 669 Broström-Gould procedures met the inclusion criteria. The revision rate was 1.2% at a weighted mean follow-up period of 8.4 years. Our systematic review of the available data revealed that the Broström-Gould procedure results in low revision rates for chronic lateral ankle instability. However, additional prospective comparative analyses are needed regarding this topic.
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Affiliation(s)
- Eric So
- Resident, Grant Medical Center, Columbus, OH.
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Noailles T, Lopes R, Padiolleau G, Gouin F, Brilhault J. Non-anatomical or direct anatomical repair of chronic lateral instability of the ankle: A systematic review of the literature after at least 10 years of follow-up. Foot Ankle Surg 2018; 24:80-85. [PMID: 29409255 DOI: 10.1016/j.fas.2016.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 07/11/2016] [Accepted: 10/27/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION A lateral ankle sprain is one of the most frequent reasons for consultation at the emergency trauma unit. Numerous surgical procedures have been described with long-term outcomes that differ. HYPOTHESIS The long-term results of anatomical repair of the anterior talofibular ligament (ATFL) and the calcaneofibular (CFL) ligament are better, with less secondary radiological osteoarthritis than non-anatomical repair. MATERIALS AND METHODS A review of the literature after a minimum follow-up of 10 years was performed to analyze the clinical and radiological results of direct anatomical repair (Broström, Duquennoy) and non-anatomical repair (Watson Jones, Evans, Castaing). Thirteen articles were selected. RESULTS Eight hundred and one ankles were evaluated after a mean follow-up of 15.3 years. The functional outcome was better after anatomical repair but with recurrent instability. Loss of range of motion and secondary osteoarthritis was more frequent after non-anatomical repair. CONCLUSION Anatomical repair of the lateral collateral ligament of the ankle resulted in a better functional outcome and less secondary osteoarthritis than non-anatomical repair. STUDY DESIGN Review of the literature; level of proof IV.
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Affiliation(s)
- Thibaut Noailles
- Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44000 Nantes, France.
| | - Ronny Lopes
- Clinique Brétéché, 3 rue de la Béraudière, 44000 Nantes, France
| | - Giovanni Padiolleau
- Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - François Gouin
- Centre Hospitalier Universitaire de Nantes, 1 Place Alexis Ricordeau, 44000 Nantes, France
| | - Jean Brilhault
- Université F. Rabelais & C.H.R.U Tours, 1 Hôpital Trousseau, 37044 Tours Cedex 09, France.
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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.
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Lopes R, Noailles T, Brulefert K, Geffroy L, Decante C. Anatomic validation of the lateral malleolus as a cutaneous marker for the distal insertion of the calcaneofibular ligament. Knee Surg Sports Traumatol Arthrosc 2018; 26:869-874. [PMID: 27497693 DOI: 10.1007/s00167-016-4250-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE An anatomic study was performed to confirm whether the lateral malleolus could serve as a simple and reproducible anatomic reference for the distal insertion of the calcaneofibular ligament (CFL). METHODS Dissection was performed after placement of a Kirschner wire to simulate the calcaneal tunnel for the distal insertion of the CFL. The skin was penetrated 1 cm distal and posterior to the tip of the lateral malleolus. The main information recorded was the distance from the Kirschner wire to the centre of the distal insertion of the CFL. Other elements were noted (characteristics of the CFL, distance between the distal insertion of the CFL-peroneal tubercle, nerve or tendon injuries). RESULTS Thirty ankles were dissected. The mean distance from the Kirschner wire to the centre of the distal insertion of the CFL was 2.4 ± 1.8 mm. Only one case of peroneal injury was noted. The sural nerve was usually located a mean 1.8 ± 1.1 mm from the Kirschner wire. The posterior tibial vascular pedicle was a mean 27.8 ± 3.5 mm from the point of exit of the Kirschner wire. CONCLUSION Using the lateral malleolus as the cutaneous reference for the distal insertion of the CFL seems to be more reliable than the pure arthroscopic technique. This study describes a percutaneous technique to obtain a calcaneal tunnel for distal insertion of the CFL. The sural nerve is at the greatest risk of injury with this technique and requires careful subcutaneous incision to prevent injury. This new percutaneous technique is less invasive than a purely arthroscopic technique and more accurately identifies the location of the tunnel. It can be used to do calcaneal tunnel in clinical practice during anatomic ligament reconstruction for chronic ankle instability.
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Affiliation(s)
- R Lopes
- Department of Orthopaedic Surgery, Breteche Clinic, 3 rue de la Béraudière, 44000, Nantes, France.
| | - T Noailles
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - K Brulefert
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - L Geffroy
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
| | - C Decante
- Department of Orthopaedic Surgery, Centre hospitalier Universitaire de Nantes, Hotel Dieu Hospital, 1 place Alexis Ricordeau, 44000, Nantes, France
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Yasui Y, Murawski CD, Wollstein A, Kennedy JG. Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures. Knee Surg Sports Traumatol Arthrosc 2017; 25:1908-1915. [PMID: 27311448 DOI: 10.1007/s00167-016-4207-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/08/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE Over 50 % of the patients with chronic lateral ankle instability present with some degree of intra-articular pathology. To date, no consensus regarding the concomitant ankle arthroscopy procedures along with ankle ligament procedures has been reached. The purpose of current study was to investigate reoperation rates and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures. METHODS Reoperations and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures were investigated using the PearlDiver Patient Record Database (PearlDiver Technologies, Inc.; Fort Wayne, IN, USA) between 2007 and 2011. Ankle ligament procedures, including ligament repair and reconstruction, and ankle arthroscopic procedures were investigated as primary surgery. Subsequently, the reoperation procedures, including ankle ligament procedures, arthroscopic procedures, autologous osteochondral transplantation, and ankle arthrodesis, as well as wound complications and nerve injury following primary ankle ligament procedures were identified. RESULTS In 8014 patients receiving ligament repair, the arthroscopic group had a significantly higher reoperation rate in comparison with the non-arthroscopic group (8.8 vs. 6.5 %, odds ratio: 1.1, [p < 0.01], 95 % confidence interval (CI) 1.2-1.7). However, the non-arthroscopic group included 29 open arthrodesis procedures following the primary surgery, whereas arthroscopic group had none. Of the 8055 patients who received a ligament reconstruction, there was no significant difference in reoperation rate between the groups (5.9 vs. 5.9 %, odds ratio: 1.0, [n.s], 95 % CI 0.8-1.2). As seen in the ligament repair group, the non-arthroscopic group had a 4.9 % rate of ankle arthrodesis as a secondary procedure. Arthroscopic group had a significantly lower rate of wound dehiscence following ankle ligament procedures than non-arthroscopic group. CONCLUSION Concomitant ankle arthroscopy procedures performed with ankle ligament procedures did not decrease the rate of reoperation. However, there was a lower incidence of ankle arthrodesis and a lower rate of wound complications in the arthroscopic group when compared to those in non-arthroscopic group. Based on the results of the study, which analysed 16.069 patients, concomitant ankle arthroscopy is recommended. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Youichi Yasui
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Christopher D Murawski
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adi Wollstein
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John G Kennedy
- Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA.
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Yasui Y, Murawski CD, Wollstein A, Takao M, Kennedy JG. Operative Treatment of Lateral Ankle Instability. JBJS Rev 2016; 4:01874474-201605000-00006. [DOI: 10.2106/jbjs.rvw.15.00074] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Best R, Mauch F, Fischer KM, Rueth J, Brueggemann GP. Radiographic monitoring of the distal insertion of the calcaneofibular ligament in anatomical reconstructions of ankle instabilities: A preliminary cadaveric study. Foot Ankle Surg 2015; 21:245-9. [PMID: 26564725 DOI: 10.1016/j.fas.2015.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 01/08/2015] [Accepted: 01/15/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of the study therefore was to determine radiographic landmarks that support the identification of the insertion site of the distal calcaneofibular ligament (CFL) in anatomic ankle ligament reconstructions. METHODS In 10 lower limb cadaver specimens the midpoint of the distal CFL insertion was dissected and marked with a nail inserted orthogonally. On a standardized lateral radiograph in neutral ankle position a horizontal tangent was aligned to the deepest visible concavity of the tarsal sinus and one vertical tangent to the farthest posterior convexity of the talus. Additionally, a line was drawn from the radiographically marked distal CFL to the fibular insertion of the CFL to determine the CFL-fibular angle. RESULTS In relation to the radiographic tangents intersection the mean deviation of the depicted CFL nails was 2.2mm [SD ± 1.1 mm] leading to an angular, circular to slightly oval 6 mm insertion. The scatter-plot of the marked positions convened along a line from the supposed fibular CFL insertion to the intersection in all cases. The mean CFL-fibular angle was 131.7° [SD ± 3.16°]. CONCLUSIONS Determining a virtual intersection between a horizontal tangent aligned to the deepest visible concavity of the tarsal sinus and one vertical tangent aligned to the farthest posterior convexity of the talus on a standardized lateral radiograph in neutral ankle position supports an anatomic insertion of the distal calcaneofibular ligament most probably.
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Affiliation(s)
- R Best
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372 Stuttgart, Germany.
| | - F Mauch
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372 Stuttgart, Germany
| | - K M Fischer
- Department of Orthopaedics and Biomechanics, German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - J Rueth
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372 Stuttgart, Germany
| | - G P Brueggemann
- Department of Orthopaedics and Biomechanics, German Sports University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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Jeong BO, Kim TY, Song WJ. Effect of Preoperative Stress Radiographic Findings on Radiographic and Clinical Outcomes of the Modified Broström Procedure for Chronic Ankle Instability. J Foot Ankle Surg 2015; 55:125-8. [PMID: 26433870 DOI: 10.1053/j.jfas.2015.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Indexed: 02/03/2023]
Abstract
The purpose of the present study is to evaluate whether findings of instability on preoperative stress radiographs of patients with chronic ankle instability affects the radiographic and clinical outcomes after a modified Broström procedure. A total of 45 consecutive patients (45 ankles) who had undergone the modified Broström procedure for unilateral ankle joint instability and were followed up for ≥2 years were selected. The patients were classified into 2 groups according to the results of the preoperative stress radiographs: 1 group with positive findings (35 [77.8%] patients; stress-positive group) and 1 group with negative findings (10 [22.2%] patients; stress-negative group). The radiographic and clinical outcomes were compared between the 2 groups. The mean preoperative talar tilt measured on the stress radiograph was 14.4° ± 4.2° and 4.8° ± 2.6° in the stress-positive and stress-negative groups, respectively, a statistically significant difference. Postoperative talar tilt improved in both groups, with a mean final talar tilt of 5.4° ± 3.4° in the stress-positive group (p < .001) and 3.0° ± 1.5° in the stress-negative group (p = .038). The average American Orthopaedic Foot and Ankle Society ankle-hindfoot score in the stress-positive and stress-negative groups improved from 65.1 ± 14.6 to 90.0 ± 6.3 (p < .001) and 72.5 ± 9.3 to 92.6 ± 7.8 (p = .007), respectively. The mean postoperative satisfaction rate was 83.9 ± 11.9 and 85.0 ± 11.8 in the 2 groups. No statistically significant differences were seen in the preoperative and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scores or in postoperative satisfaction rates between the 2 groups.
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Affiliation(s)
- Bi O Jeong
- Associate Professor, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea.
| | - Tae Yong Kim
- Orthopedic Doctor, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Wook Jae Song
- Orthopedic Doctor, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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Boukhris J, Mojib R, Mezghani S, Jaeger JH. [Castaing procedure in the surgical treatment of chronic lateral ankle instability (about a series of 52 cases)]. Pan Afr Med J 2014; 18:288. [PMID: 25469182 PMCID: PMC4247862 DOI: 10.11604/pamj.2014.18.288.3772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 08/10/2014] [Indexed: 11/22/2022] Open
Abstract
L'instabilité chronique de la cheville est l'une des évolutions possibles dans l'histoire naturelle de l'entorse aigüe de cheville. Elle représente 10% à 30% des séquelles d'entorses. Le traitement chirurgical est réservé aux patients ayant une instabilité de cheville persistante après rééducation à l'origine d'une gêne invalidante. La technique de ligamentoplastie utilisant le court fibulaire selon Castaing est la plus répondue en France. La simplicité du geste et ses bons résultats nous ont incités à poursuivre cette voie. Il s'agit d´une étude rétrospective à propos de 52 patients ayant bénéficié d'une ligamentoplastie au court fibulaire selon Castaing entre Janvier 2000 et Décembre 2010. Le recul minimum était d'un an. L’évaluation des patients reposait sur le score de Karlson et le “Ankle score” Molander et Olerud. Les patients sont satisfaits ou très satisfaits de l'intervention dans 80% des cas revus. Les résultats fonctionnels de nos patients sont comparables à ceux publiés dans la littérature. Le prélèvement du transplant du court fibulaire ne semble pas avoir de retentissement sur la stabilité de la cheville. Les patients conservent une éversion du pied satisfaisante avec une force comparable au côté opposé. L’évolution arthrosique de la cheville ne semble pas significative après cette chirurgie. Le point faible de notre étude est le nombre des patients perdus de vue, cela est lié à la jeunesse de la population opérée et au recrutement du service d'envergure nationale.
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Affiliation(s)
- Jalal Boukhris
- Service de Chirurgie Orthopédique du Genou et Traumatologie du Sport- CHU Strasbourg, Strasbourg, France
| | - Rifi Mojib
- Service de Chirurgie Orthopédique du Genou et Traumatologie du Sport- CHU Strasbourg, Strasbourg, France
| | - Sami Mezghani
- Service de Chirurgie Orthopédique du Genou et Traumatologie du Sport- CHU Strasbourg, Strasbourg, France
| | - Jean Henri Jaeger
- Service de Chirurgie Orthopédique du Genou et Traumatologie du Sport- CHU Strasbourg, Strasbourg, France
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Lee KM, Chung CY, Kwon SS, Chung MK, Won SH, Lee SY, Park MS. Relationship between stress ankle radiographs and injured ligaments on MRI. Skeletal Radiol 2013; 42:1537-42. [PMID: 23955557 DOI: 10.1007/s00256-013-1704-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/10/2013] [Accepted: 07/25/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study was performed to investigate the relationship between the injured lateral ankle ligaments on MRI and stress ankle radiographs. MATERIALS AND METHODS Two hundred and twenty-nine consecutive patients (mean age 35.5 years, SD 14.6 years; 136 males and 93 females) that underwent ankle stress radiographs and MRI for lateral ankle instability were included. Tibiotalar tilt angle and anterior translation of talus were measured on stress ankle radiographs. Degree of lateral ligaments (anterior talofibular, calcaneofibular, and posterior talofibular) and deltoid ligament injuries were evaluated and scored as intact (0), partial injury (1), and complete injury (2) on MR images. Effusion of ankle joint was also recorded. The effects of gender, age, injuries of ligaments, and ankle joint effusion on stress radiographs were statistically analyzed. RESULTS Gender (p = 0.010), age (p = 0.020), and anterior talofibular ligament (ATFL) injury (p < 0.001) were the factors significantly affecting tibiotalar tilt angle. Posterior talofibular ligament (PTFL) injury (p = 0.014) was found to be the only significant factor affecting the anterior translation on the anterior drawer radiographs. CONCLUSIONS ATFL injury and PTFL injury on MRI significantly affected tibiotalar tilt angle and anterior drawer on stress radiographs. Other factors, such as age and gender, need to be considered in evaluating radiographic lateral ankle instability.
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Affiliation(s)
- Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Sungnam, Kyungki, 463-707, South Korea
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Hogan MV, Dare DM, Deland JT. Is deltoid and lateral ligament reconstruction necessary in varus and valgus ankle osteoarthritis, and how should these procedures be performed? Foot Ankle Clin 2013; 18:517-27. [PMID: 24008216 DOI: 10.1016/j.fcl.2013.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Varus and valgus ankle deformities represent a challenge to the foot and ankle surgeons. The presence of degenerative changes of the tibiotalar joint articular surfaces introduces an additional layer of complexity. Reconstruction of such deformities requires a customized approach to each patient. Surgical intervention often requires joint-sparing realignment, arthroplasty, and/or arthrodesis, depending on the severity of deformity and the joint surface integrity. The ligamentous stability of the ankle plays an essential role in the preservation and optimization of function. This article reviews the role of deltoid and lateral ligament reconstruction in the treatment of varus and valgus ankle osteoarthritis.
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Affiliation(s)
- Macalus V Hogan
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 5200 Centre Avenue, Pittsburgh, PA 15232, USA.
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Tourné Y, Mabit C, Moroney PJ, Chaussard C, Saragaglia D. Long-term follow-up of lateral reconstruction with extensor retinaculum flap for chronic ankle instability. Foot Ankle Int 2012. [PMID: 23199857 DOI: 10.3113/fai.2012.1079] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic instability is a common complication of lateral ankle sprains. Furthermore, patients often have unrecognized associated lesions affecting the ankle and subtalar joints. Many stabilizing surgical techniques have been described, each with variable results. This article reports the long-term results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap. PATIENTS AND METHODS This is a retrospective, multicenter study. One hundred fifty cases were reviewed at a mean follow-up of 11 years. Functional results were assessed using the Karlsson score. Pre- and postoperative radiological assessment employed stress x-rays to measure varus tilt and anterior drawer and the Van Dijk classification to grade osteoarthrosis. The Stata 10 program was used for statistical analysis. RESULTS A thorough preoperative workup identified ligamentous lesions of the subtalar joint in 30% of cases. At review, 93% of patients were satisfied. Residual instability was present in only 4.8%. Radiographic analysis of both ankles revealed a differential in varus tilt of only 0.12° and in anterior drawer of 0.17~mm. There was no deterioration of the articular surfaces after 11 years of follow-up. CONCLUSION To the authors' knowledge, this is the largest series reported with such a follow-up. This technique addressed both lateral ankle and subtalar instability without sacrificing the peroneal tendons. It protected against progression of posttraumatic arthrosis and provided superior results to other reported techniques in terms of patient satisfaction and residual instability.
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Affiliation(s)
- Yves Tourné
- Groupe Chirurgical République-Grenoble-France, Foot and Ankle Surgery, Grenoble, France.
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Schepers T, Vogels LMM, Van Lieshout EMM. Hemi-Castaing ligamentoplasty for the treatment of chronic lateral ankle instability: a retrospective assessment of outcome. INTERNATIONAL ORTHOPAEDICS 2011; 35:1805-12. [PMID: 21637958 PMCID: PMC3224610 DOI: 10.1007/s00264-011-1284-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 05/17/2011] [Indexed: 12/26/2022]
Abstract
PURPOSE In the treatment of chronic ankle instability, most non-anatomical reconstructions use the peroneus brevis tendon. This, however, sacrifices the natural ankle stabilising properties of the peroneus brevis muscle. The aim of this study was to evaluate the functional outcome of patients treated with a hemi-Castaing procedure, which uses only half the peroneus brevis tendon. METHODS We performed a retrospective cohort study of patients who underwent hemi-Castaing ligamentoplasty for chronic lateral ankle instability between 1993 and 2010, with a minimum of one year follow-up. Patients were sent a postal questionnaire comprising five validated outcome measures: Olerud-Molander Ankle Score (OMAS), Karlsson Ankle Functional Score (KAFS), Tegner Activity Level Score (pre-injury, prior to surgery, at follow-up), visual analog scale on pain (VAS) and the Short Form 36 (SF-36). RESULTS Twenty patients completed the questionnaire on functional outcome. The OMAS showed good to excellent outcome in 80% and the KAFS in 65%, the Tegner Score improved from surgery but did not reach pre-injury levels, the VAS on pain was 1 of 10 and the SF-36 returned to normal compared with the average population. CONCLUSIONS Even though most patients were satisfied with the results, outcome at long-term follow-up was less favourable compared with the literature on anatomical reconstructions. In accordance with the literature, we therefore conclude that the initial surgical treatment of chronic lateral ankle instability should be an anatomical repair with augmentation (i.e. the Broström-Gould technique) and the non-anatomical repair should be reserved for unsuccessful cases after anatomical repair or in cases where no adequate ligament remnants are available for reconstruction.
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Affiliation(s)
- Tim Schepers
- Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Ibrahim SA, Hamido F, Al Misfer AK, Ghafar SA, Awad A, Salem HK, Alhran H, Khirait S. Anatomical reconstruction of the lateral ligaments using Gracillis tendon in chronic ankle instability; a new technique. Foot Ankle Surg 2011; 17:239-46. [PMID: 22017894 DOI: 10.1016/j.fas.2010.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 06/25/2010] [Accepted: 07/25/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many surgical technique have been described to assess the outcome of anatomical reconstruction of the lateral ligaments using Gracillis tendon. This technique aims to restore the stability of the ankle by reconstruction of the talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) using the Gracillis tendon. METHODS From January 2004 to February 2008; inclusive, 16 patients; 11 male and 5 female, underwent an anatomic reconstruction of the lateral ankle ligament for chronic ankle instability. Their ages ranged from 18 to 29 giving a mean age of 25 years. Patients were then subjected to radiologic and clinical assessments for a period of at least 33.5 months. For pain scoring the Americans Orthopaedic Foot and Ankle Society (AOFAS) scores were used; whilst subjective symptom was evaluated using the Olerud and Molander ankle scoring system. RESULTS All patients returned for the final evaluation and subjective excellent or good results were recorded on self-assessment, pain scores, AOFAS and Karissons scores. Additionally Olerud and Molander ankle scoring was also done. During the final follow-up, the mean post-operative AOFAS score was 96 (range 80-100), the Visual analog score was 6 (range 0-4), Karissons score was 94.7 (range 80-100) and last but not least Olerud and Molander score was 87.5 (range 70-100). It was noted that the ankle range of motion was not affected by lateral ankle reconstruction. The talar tilt was reduced from a mean of 12-4° (p<0.0001) and the anterior drawer was reduced from a mean of 11-4mm (p<0.001) by the ankle ligament reconstruction. CONCLUSION Anatomical reconstruction of the lateral ligaments of chronic ankle instability using Gracillis tendon graft resulted in successful results, excellent ankle stability, significant reduction in pain and negligible loss of ankle and hind foot motion.
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Affiliation(s)
- S A Ibrahim
- Al Razi Orthopaedic Hospital, Sports Medical Centre, Clinical Tutor Medical School, Kuwait University, Kuwait.
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Crim JR, Beals TC, Nickisch F, Schannen A, Saltzman CL. Deltoid ligament abnormalities in chronic lateral ankle instability. Foot Ankle Int 2011; 32:873-8. [PMID: 22097163 DOI: 10.3113/fai.2011.0873] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of patients with repeated ankle sprains and chronic lateral ankle instability tends to focus on the lateral collateral ligaments. We reviewed records to ascertain the prevalence of abnormalities of the deltoid ligament in this population. METHODS Retrospective review of MR images and surgical reports was performed for all patients during a 3-year period that underwent surgical treatment of chronic ankle instability at a single institution. Forty-seven ankles (46 patients) met inclusion criteria. None had medial ankle pain. RESULTS On MRI, all patients had anterior talofibular ligament tear, plus injury to one or more additional ligaments. Ninety-one percent had injury of calcaneofibular ligament. Injury to the posterior talofibular ligament was less common (49%). Deltoid ligament injuries were seen in 72% of cases (23% superficial deltoid only, 6% deep deltoid only, 43% both superficial and deep components). Of patients with injury to the superficial deltoid, 32% had an intact deep deltoid ligament. MRI correlated well to surgical findings. CONCLUSION Deltoid ligament injuries were common in patients with lateral ankle instability who underwent reconstruction.
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Affiliation(s)
- Julia R Crim
- University of Utah, Radiology and Orthopaedics, 67 E Dorchester Dr, Salt Lake City, UT 84103, USA.
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Ellis SJ, Williams BR, Pavlov H, Deland J. Results of anatomic lateral ankle ligament reconstruction with tendon allograft. HSS J 2011; 7:134-40. [PMID: 22754413 PMCID: PMC3145865 DOI: 10.1007/s11420-011-9199-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 02/07/2011] [Indexed: 02/07/2023]
Abstract
Chronic ankle instability can be addressed surgically through direct lateral ligament repair, non-anatomic reconstruction, or anatomic reconstruction. The goal of this study was to assess the radiographic, functional, and clinical results of patients undergoing an anatomic lateral ankle ligament reconstruction using an anterior tibial tendon allograft. Eleven patients (12 feet; mean age, 48.9 ± 11.4 years) undergoing lateral ankle ligament reconstruction were followed at a mean of 3.5 ± 1.7 years after surgery (range, 1.2 to 5.0 years). Indications for surgery were previous failed repair (i.e., Broström; one case), hyperlaxity (seven cases), and high-demand patients (four cases). Subjective outcomes including the Foot and Ankle Outcome Score (FAOS), SF-36, and activity level were assessed. Mortise and lateral ankle stress radiographs were performed. The FAOS daily activity and sports activity subscores were 93.4 (range, 77.9 to 100) and 78.6 (range, 30 to 100), respectively. The SF-36v2 physical health and mental health components were 50.4 (range, 30.6 to 65.7) and 45.0 (range, 24.8 to 68.0), respectively. Four patients (five feet) reported no restriction; six patients reported mild restrictions, and one patient reported moderate activity restrictions. Tibiotalar tilt improved significantly from 20.2° to 4.6° after surgery (p < 0.01). The radiographic anterior displacement of the talus from the tibia was 6.5 mm postoperatively. The technique described restores mechanical stability in patients with chronic lateral ankle instability and may be considered in a select group of patients.
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Affiliation(s)
- Scott J. Ellis
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Benjamin Roller Williams
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Helene Pavlov
- Department of Radiology and Imaging, Hospital for Special Surgery, 535 East 70th Street, New York, NY USA
| | - Jonathan Deland
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Mabit C, Tourné Y, Besse JL, Bonnel F, Toullec E, Giraud F, Proust J, Khiami F, Chaussard C, Genty C. Chronic lateral ankle instability surgical repairs: the long term prospective. Orthop Traumatol Surg Res 2010; 96:417-23. [PMID: 20493799 DOI: 10.1016/j.otsr.2010.04.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 03/15/2010] [Indexed: 02/02/2023]
Abstract
UNLABELLED The present study sought to assess the clinical and radiological results and long-term joint impact of different techniques of lateral ankle ligament reconstruction. MATERIAL AND METHODS A multicenter retrospective review was performed on 310 lateral ankle ligament reconstructions, with a mean 13-year-follow-up (minimum FU: 5 years). Male subjects (53%) and sports trauma (78%) predominated. Mean duration of instability was 92 months; mean age at surgery was 28 years. Twenty-eight percent of cases showed subtalar joint involvement. Four classes of surgical technique were distinguished: C1, direct capsular ligamentous complex reattachment; C2, augmented repair; C3, ligamentoplasty using part of the peroneus brevis tendon and C4, ligamentoplasty using the whole peroneus brevis tendon. Clinical and functional assessment used Karlsson and Good-Jones-Livingstone scores; radiologic assessment combined centered AP and lateral views, hindfoot weight-bearing Méary views and dynamic views (manual technique, Telos or self-imposed varus). RESULTS The majority of results (92%) were satisfactory. The mean Karlsson score of 90 [19-100] (i.e., 87% good and very good results) correlated with the subjective assessment, and did not evolve over time. Postoperative complications (20%), particularly when neurologic, were associated with poorer results. Control X-ray confirmed the very minor progression in degenerative changes, with improved stability; there was, however, no correlation between functional result and residual laxity on X-ray. Unstable and painful ankles showed poorer clinical results and more secondary osteoarthritis. Analysis by class of technique found poorer results in C4-type plasties and poorer control of laxity on X-ray in C1-type tension restoration. DISCUSSION The present results confirm the interest of lateral ankle ligamentoplasty in the management of instability and protection against secondary osteoarthritis, and of precise lesion assessment (CT-scan/MRI) to adapt surgery to the ligamentary and associated lesions. LEVEL OF EVIDENCE Level IV. Retrospective therapeutic study.
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Affiliation(s)
- C Mabit
- Orthopedic and Traumatologic Surgery Department, Dupuytren Teaching Hospital, Limoges, France.
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