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Khazaei F, Sayyed-Hosseinian SH, Miri HH, Zeinalzadeh A, Nazary-Moghadam S. Prognostic Values of Clinical and Anthropometric Characteristics in Lateral Ankle Sprain Following Physiotherapy. J Foot Ankle Surg 2024; 63:495-501. [PMID: 38641313 DOI: 10.1053/j.jfas.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/06/2024] [Accepted: 04/06/2024] [Indexed: 04/21/2024]
Abstract
Lateral ankle sprain (LAS) is a common injury in sports and daily activities. The present study aimed to determine the prognostic value of clinical and anthropometric parameters in predicting LAS recovery after physiotherapy. Twenty-seven patients with acute LAS were included in this cohort study. First, prognostic factors and anthropometric variables were assessed, along with the time elapsed since the injury, pain score on a visual analogue scale (VAS), navicular drop, ankle range of motion (ROM), and ambulation status. Second, patients received physiotherapy, and their recovery status was assessed using the foot and ankle outcome score (FAOS) questionnaire immediately (first evaluation) and one month after physiotherapy (second evaluation). Univariate regression analysis and stepwise regression were used to evaluate the association between prognostic factors and outcome predictability. The results of this paper have shown that ambulation status was significantly correlated with all FAOS subscales in both the first and second evaluations, except for the FAOS-symptoms (FAOS-Sx) and FAOS-quality of life (FAOS-QOL) subscales in the first evaluation. The eversion ROM was significantly correlated with the FAOS-Sx and FAOS-Sports and Recreational activities (FAOS-Sport/Rec) subscales in the first evaluation. Additionally, age, height, and VAS were significantly correlated with FAOS-activity of daily living (FAOS-ADL) in the first evaluation, so this means that ambulation status is a valuable predictor of treatment success immediately and one month after physiotherapy intervention and compared to other FAOS subscales, the FAOS-QOL subscale is a more reliable predictor of the effectiveness of physiotherapy.
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Affiliation(s)
- Farzaneh Khazaei
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsaneh Zeinalzadeh
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Salman Nazary-Moghadam
- Department of Physical Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopaedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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Abstract
Since its introduction in 1966, the Bröstrom repair has been the workhorse for the treatment of chronic ankle instability. The procedure has expanded with the advent of arthroscopy, ultrasound, and other techniques. Because chronic ankle sprains/instability pose a barrier to athletes who perform high-level activities for a living, discussions concerning postoperative recovery and return to play criteria are important. Here we present an update on the Bröstrom-Gould procedure from preoperative management to return to play.Level of Evidence: Level V.
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Affiliation(s)
- Daniel Chiou
- Warren Alpert Medical School, Providence, Rhode Island
| | - Brandon Morris
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory Waryasz
- Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Lee SH, Kim SH, Park SB, Oh SR, Choi SJ, Lee YK. All-Inside Arthroscopic and Open Techniques of the Modified Broström Procedure for the Treatment of Lateral Ankle Instability: Comparison of the Times to Return to Play. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:921. [PMID: 38929538 PMCID: PMC11206078 DOI: 10.3390/medicina60060921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic modification of the Broström operation (AMBO) was developed; many studies have shown that there are no significant differences in clinical and radiological outcomes between the two surgical methods. However, no studies have been conducted comparing the two surgical methods in terms of return to play (RTP) time. This study assesses the time to RTP and the functional clinical outcomes. Materials and Methods: Sixty patients were enrolled from January 2012 to July 2014. They were segregated into two cohorts: the AMBO group comprised 30 patients, while the OMBO group comprised another 30 patients. Each participant underwent standardized treatment and rehabilitation regimens and RTP time was measured using seven questions that explored the times to return of painless walking, running, jumping, squatting, climbing stairs, and rising up on the heels and toes. We compared the time intervals from the onset of instability to the date of surgery. Clinical outcomes were evaluated before the surgery, 6 weeks after surgery, and 6 months after surgery. The assessments included the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the pain visual analog scale (VAS) score, subjective satisfaction with rehabilitation, and activity level. Results: In terms of RTP, AMBO was associated with a shorter interval to walking without pain (7.07 ± 2.96 weeks) relative to OMBO (11.03 ± 8.58 weeks). No disparities were observed in the time to return to play (RTP) between OMBO and AMBO. While there were no discrepancies in the 6-month postoperative AOFAS or VAS scores, the 6-week postoperative VAS score was notably lower in the AMBO group compared to the OMBO group. AMBO provided a faster RTP in terms of two of the seven questions in a group exhibiting high-level physical activity. The rate of subjective satisfaction with rehabilitation was higher for AMBO than for OMBO. Conclusions: Aside from walking, the duration to return to play and the clinical outcomes were similar between AMBO and OMBO treatments for lateral ankle instability. AMBO is a good treatment option and should be carefully considered for athletes with lateral ankle instability. AMBO demonstrated positive outcomes in a group with higher activity levels compared to others, particularly in terms of time to RTP, subjective satisfaction, and postoperative pain.
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Affiliation(s)
- Sang Heon Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
| | - Sung Hwan Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
| | - Sung Bum Park
- Department of Orthopaedic Surgery, Bonebridge Hospital, 214, Dogok-ro, Gangnam-gu, Seoul 06272, Republic of Korea;
| | - Seong Rok Oh
- Department of Orthopaedic Surgery, Gurosamsung Orthopedic Surgery Clinic, 204, Gyeongin-ro, Guro-gu, Seoul 04323, Republic of Korea;
| | - Seung Jin Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
| | - Young Koo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, 170, Jomaru-ro, Wonmi-gu, Bucheon-si 14584, Republic of Korea; (S.H.L.); (S.H.K.); (S.J.C.)
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4
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Maria PA, Vuurberg G, Kerkhoffs GMMJ. Exploring influences and risk of bias of studies on return to sport and work after lateral ankle sprain: A systematic review and meta-analysis. World J Meta-Anal 2024; 12:87026. [DOI: 10.13105/wjma.v12.i1.87026] [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: 07/19/2023] [Revised: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity, with an incidence rate of 15%-20%. The high incidence and prevalence highlights the economic impact of this injury. Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses. Up to 40% of patients who suffer from an ankle sprain develop chronic ankle instability. Chronic instability can lead to prolonged periods of pain, immobility and injury recurrence. Identification of factors that influence return to work (RTW) and return to sports (RTS) after a lateral ankle sprain (LAS) may help seriously reduce healthcare costs.
AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.
METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023. Inclusion criteria were as follows: (1) Injury including LAS or chronic ankle instability; (2) Described any form of treatment; (3) Assessment of RTW or RTS; (4) Studies published in English; and (5) Study designs including randomized controlled clinical trials, clinical trials or cohort studies. Exclusion criteria were: (1) Studies involving children (age < 16 year); or (2) Patients with concomitant ankle injury besides lateral ankle ligament damage. A quality assessment was performed for each of the included studies using established risk of bias tools. Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis. A best evidence synthesis was performed in cases of qualitative outcome analysis. For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.
RESULTS A total of 8904 patients were included in 21 studies, 10 randomized controlled trials, 7 retrospective cohort studies and 4 prospective cohort studies. Fifteen studies were eligible for meta-analysis. The overall RTS rate ranged were 80% and 83% in the all treatments pool and surgical treatments pool, respectively. The pooled mean days to RTS ranged from 23-93 d. The overall RTW rate was 89%. The pooled mean time to RTW ranged from 5.8-8.1 d. For patients with chronic ankle instability, higher preoperative motivation was the sole factor significantly and independently (P = 0.001) associated with the rate of and time to RTS following ligament repair or reconstruction. Higher body mass index was identified as a significant factor (P = 0.04) linked to not resuming sports or returning at a lower level (median 24, range 20-37), compared to those who resumed at the same or higher level (median 23, range 17-38). Patients with a history of psychological illness or brain injury, experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains. The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits. We also observed that 10% of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.
CONCLUSION All treatments yielded comparable results, with each treatment potentially offering unique advantages or benefits. Preoperative motivation may influence rehabilitation after LAS. Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.
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Affiliation(s)
- Priscilla A Maria
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Arnhem, Arnhem 6815AD, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam, 1105 AZ, Netherlands
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Li Y, Su T, Hu Y, Jiao C, Guo Q, Jiang Y, Jiang D. Return to Sport After Anatomic Lateral Ankle Stabilization Surgery for Chronic Ankle Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2024; 52:555-566. [PMID: 37252803 DOI: 10.1177/03635465231170699] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Chronic lateral ankle instability that develops after ankle sprains has a severe, negative influence on the patient's lower extremity function. Anatomic repair or reconstruction of the lateral ankle ligament is an effective treatment for people with chronic lateral ankle instability who want to regain their preinjury levels of work and sport. PURPOSE To determine the rate of return to sport (RTS) and related factors after anatomic lateral ankle stabilization (ALAS) surgery. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Electronic databases including Medline, Embase, the Cochrane Library, and EBSCO Rehabilitation & Sports Medicine Source were searched from the earliest feasible entrance until August 2021. Articles reporting the number of patients who returned to sport after ALAS surgery and analyzing the relevant factors were included. The results were combined using proportion meta-analyses. RESULTS A total of 25 publications were reviewed, with a total of 1384 participants. Results showed that 95% of patients (95% CI, 91%-99%) returned to any sport, 83% (95% CI, 73%-91%) returned to their preinjury level of sport, and 87% (95% CI, 71%-98%) returned to competitive sport after surgery. The mean time to RTS was 12.45 weeks (95% CI, 10.8-14.1 weeks). Each decade of age increased the likelihood of RTS failure by 6%, and increases in body mass index (BMI) of 5 kg/m2 raised the risk of RTS failure by 4%. The rate of RTS was higher in professional and competitive athletes (93%; 95% CI, 73%-100%) than in recreational athletes (83%; 95% CI, 76%-89%). Analysis showed no differences for arthroscopy versus open surgery, repair versus reconstruction, and early versus late weightbearing. CONCLUSION In most cases, patients may return to some kind of sport after ALAS surgery, and some patients RTS at their preinjury level. The relative risk of RTS failure increases according to the magnitude of the increase in age and BMI. Elite athletes are more likely to return compared with nonelite athletes.
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Affiliation(s)
- Yanzhang Li
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Tong Su
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Yuelin Hu
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Qinwei Guo
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Yanfang Jiang
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine of Peking University Third Hospital, Institute of Sports Medicine of Peking University, Engineering Research Center of Sports Trauma Treatment Technology and Devices of Ministry of Education, Beijing, China
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Hong CC, Calder J. Ability to return to sports after early lateral ligament repair of the ankle in 147 elite athletes. Knee Surg Sports Traumatol Arthrosc 2023; 31:4519-4525. [PMID: 36480025 DOI: 10.1007/s00167-022-07270-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The literature on elite athletes' ability to return to sports (RTS) after early lateral ligament repair of the ankle remains inadequate. The time needed to RTS after modified Broström repair for acute grade III lateral ligament injuries in a large cohort of elite athletes was evaluated while assessing the impact of other associated injuries. METHODS Prospective data from 147 elite athletes who underwent a primary lateral ligament repair for acute grade III injuries with clinical ankle instability from 2015 to 2019 with a minimum of 2-year follow-up were reviewed. Pertinent details such as characteristics of injury, time taken to RTS, impact of associated injuries on RTS and complications were recorded and analysed. RESULTS The average age was 24.4 years (S.D = 4.9) with 89.1% males. Approximately two-thirds of the elite athletes were football players (66.0%) and 21.1% were rugby players. Isolated lateral ligament complex injuries were sustained by 122 (83%) patients, while 25 (17%) had associated injuries (osteochondral lesions of the talus/deltoid injury/syndesmosis injury). All 147 athletes returned to their preinjury level of sports with a median time of 69 days (range 58-132 days). There was no significant difference found in time to RTS between gender, age, and types of sports. However, there was a statistically significant difference noted in the time taken to RTS earlier in patients with isolated lateral ligament injuries when compared to those with associated injuries (68.6 vs. 82.8 days; p = 0.004). Multiple conditional linear regression yielded three independent predictors of longer time taken to RTS which were associated deltoid injury (7.5 days longer; 95% CI 2.9-12.3; p = 0.002), associated syndesmosis injury (6.7 days longer; 95% CI 0.5-12.8; p = 0.034) and associated OLT (30.3 days longer; 95% CI 25.1-35.5; p = 0.000). CONCLUSION Early surgical repair for acute grade III lateral ligament injuries in elite athletes yielded excellent rate of RTS at 9-10 weeks and a re-injury rate of 2%. Concomitant injuries will delay RTS after surgical intervention. These findings serve as important guide to managing elite athletes following acute rupture of the lateral ligament complex. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK.
- Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore, 119228, Singapore.
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Troiani Z, Harrington M, Anoushiravani A, Tallapaneni J, Salgado A, Rosenbaum A. Isolated Anterior Talofibular Ligament (ATFL) vs Combined ATFL and Calcaneofibular Ligament Suture Tape Augmentation for the Treatment of Lateral Ankle Instability: Are Outcomes Equivalent? FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231185071. [PMID: 37484536 PMCID: PMC10357052 DOI: 10.1177/24730114231185071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Background The Broström procedure with suture tape augmentation has become commonplace for surgical treatment of chronic lateral ankle instability. However, there is no consensus among surgeons whether internal bracing of the ATFL alone or a combined ATFL and calcaneofibular ligament (CFL) internal brace produces superior clinical outcomes. This retrospective study aims to investigate whether isolated internal bracing of the ATFL has comparable outcomes to combined ATFL and CFL brace. Methods There were 85 patients from a single tertiary medical center's electronic medical record identified who underwent an ATFL or ATFL and CFL reconstruction between January 2017 and December 2020. Postoperative outcomes including patient satisfaction, ankle instability, ankle pain, and the need for revision surgery at 1-year follow-up were evaluated. Results Forty-eight patients underwent isolated ATFL reconstruction, and 37 underwent combined ATFL and CFL reconstruction. The choice was made between the 2 options based on surgeon preference. At 1-year follow-up, postoperative outcomes were statistically indistinguishable between the 2 treatment groups. Conclusion The modified Broström reconstruction with ATFL and CFL reconstruction with an internal brace did not produce superior functional outcomes measured at 1 year compared to isolated ATFL reconstruction. Further investigation of long-term functional outcomes is needed to evaluate the long-term efficacy of combined or single-ligament reconstruction.Level of Evidence: Level III, retrospective study.
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Affiliation(s)
- Zachary Troiani
- Division of Orthopaedics, Albany Medical College, Albany, NY, USA
| | | | | | | | - Andrew Salgado
- Division of Orthopaedics, Albany Medical College, Albany, NY, USA
| | - Andrew Rosenbaum
- Division of Orthopaedics, Albany Medical College, Albany, NY, USA
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Hong CC, Calder J. The Burden of the "Simple Ankle Sprains": A Review of the Epidemiology and Long-Term Impact. Foot Ankle Clin 2023; 28:187-200. [PMID: 37137618 DOI: 10.1016/j.fcl.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Lateral ankle sprain (LAS) is not as simple as it was believed to be as it has substantial negative impacts on the active sporting population. The negative impact on physical function, quality of life (QoL) and economic burden is significant with increased risk of reinjury, development of chronic lateral ankle instability and posttraumatic ankle osteoarthritis resulting in functional deficits, decreased QoL and chronic disabilities. Economic burden from a societal perspective demonstrated notably higher indirect costs from productivity loss. Preventative interventions with early surgery for a selective cohort of active sporting population may be considered to mitigate morbidities associated with LAS.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore 119228, Singapore.
| | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK; Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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Thompson AA, Hwang NM, Mayfield CK, Petrigliano FA, Liu JN, Peterson AB. Evaluation of Spin in the Clinical Literature of Suture Tape Augmentation for Ankle Instability. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231179218. [PMID: 37325695 PMCID: PMC10262628 DOI: 10.1177/24730114231179218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background Spin is defined as the use of specific reporting strategies to highlight the beneficial effect of a treatment despite nonsignificant results. The presence of spin in peer-reviewed literature can negatively impact clinical and research practices. The purpose of this study was to identify the quantity and types of spin present in primary studies and systematic reviews using suture tape augmentation for ankle instability as a model. Methods This study was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Each abstract was assessed for the presence of the 15 most common types of spin. Extracted data included study title, authors, publication year, journal, level of evidence, study design, funding, reported adherence to PRISMA guidelines, and PROSPERO registration. Full texts of systematic reviews were used in the assessment of study quality per A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2). Results Nineteen studies were included in the final sample. At least 1 type of spin was identified in each study except one (18 of 19, 94.7%). The most common type of spin observed was type 3 ("selective reporting or overemphasis on efficacy outcomes or analysis favoring the beneficial effect of the experimental intervention") (6 of 19, 31.6%), The second most reported category of spin was type 4 ("the conclusion claims safety based on non-statistically significant results with a wide confidence interval") (4 of 19, 21.1%). Among systematic reviews, we identified type 5 ("the conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies") in 4 out of 6 (66.7%) of the articles that were included. No significant associations were found between study characteristics and type of spin. Conclusion In this exploration of the introduction of a new technology, we identified spin to be highly present in the abstracts of primary studies and systematic reviews concerning suture tape augmentation for ankle instability. Steps should be taken by scientific journals to ensure that spin is minimized in the abstract to accurately reflect the quality of the intervention.
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Affiliation(s)
- Ashley A. Thompson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - N. Mina Hwang
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Cory K. Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Joseph N. Liu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander B. Peterson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Dallman J, Wolf MR, Campbell T, Herda T, White J, Tarakemeh A, Vopat BG. Current Definitions of Failure in Lateral Ankle Instability Surgery: A Systematic Review. Am J Sports Med 2023:3635465231153165. [PMID: 36917833 DOI: 10.1177/03635465231153165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND "Failure" is a term that is frequently used to describe an unfavorable outcome for patients who undergo surgical treatment for lateral ankle instability (LAI). A standard definition of failure for the surgical treatment of ankle instability has not been established by clinicians and researchers. PURPOSE To identify the definitions of ankle instability treatment failure that are currently in the literature and to work toward the standardization of the definition. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic search of MEDLINE, SPORTDiscus, CINAHL, Embase, and Web of Science was conducted to identify clinical studies that included patients who underwent surgical treatment for LAI and included information about surgical failure. Studies with level of evidence 1 to 4 were included in this review. Animal studies, biomechanical studies, cadaveric studies, review articles, and expert opinions were excluded. The included studies were then reviewed for definitions of failure of any surgical procedure that was performed to correct LAI. RESULTS Of the 1200 studies found, 3.5% (42/1200) published between 1984 and 2021 met the inclusion criteria and were analyzed. After reviewing the data, we found numerous definitions were reported in the literature for LAI surgical failure. The most common was recurrent instability (40% [17/42]), followed by rerupture (19% [8/42]). For the original surgical procedure, the anatomic Broström-Gould technique was used most frequently (57% [24/42]). The failure rate of the Broström-Gould technique ranged from 1.1% to 45.2% depending on the definition of failure. CONCLUSION There were multiple definitions of failure for the surgical treatment of LAI, which is one of the reasons why the rate of failure can vary greatly. The literature would benefit greatly from the standardization of the definition of ankle instability treatment failure. This definition should include specific, objective physical examination findings that eliminate the ambiguity surrounding failure.
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Affiliation(s)
| | - Megan R Wolf
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA.,Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Tanner Campbell
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Trent Herda
- Neuromechanics Laboratory, Department of Health, Sport & Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
| | - Jacob White
- Dykes Library, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan G Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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Rhyu HS, Hong SY, Rhi SY. EFEITOS DO EXERCÍCIO DE REABILITAÇÃO ACELERADA DEPOIS DE TBM SOBRE A FUNÇÃO E A FORÇA NA INSTABILIDADE DO TORNOZELO. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329022022_0117p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RESUMO Introdução: Os atletas de taekwondo com instabilidade lateral crônica do tornozelo (ILCT) podem apresentar dificuldades com propriocepção e força muscular do tornozelo. Depois da cirurgia, um programa de exercícios de reabilitação convencional pode ser ineficaz, porque a propriocepção ou a força muscular podem não se restaurar e, portanto, resultar em melhora mínima. Objetivos: Este estudo teve como objetivo avaliar os efeitos de um programa de ERA depois de TBM sobre a propriocepção, força isocinética e resistência do tornozelo. Métodos: Trinta atletas com diagnóstico de ILCT foram submetidos à TBM. Eles foram divididos em grupo ERA (n=15) e grupo controle CON (n = 15). O grupo ERA realizou exercícios ERA precoces seis vezes por semana durante 4 semanas. Os parâmetros aplicados para testar a força muscular do tornozelo foram velocidade angular de 30°/s e 180°/s (inversão: Inv e eversão: Eve, respectivamente). A propriocepção foi medida pela capacidade de sentir a posição articular de 15° de Inv e 5° de Eve Resultados: Foram observadas diferenças significativas entre os grupos ERA e CON na força do tornozelo 30°/s (Inv: p < 0,001, Eve: p < 0,001), 180°/s (Inv: p < 0,001, Eve: p < 0,001), e propriocepção a 15° (Inv: p < 0,001) e 5° (Eve: p < 0,001). Conclusões: Registramos efeitos de curto prazo significativos com ERA precoce em atletas de taekwondo com ILCT depois da TBM. Os resultados fornecem dados de referência para o reabilitador esportivo ou ATC (Certified athletic trainer) na avaliação da fase de reabilitação e informar os pacientes sobre as expectativas depois da TBM em termos de condições de desempenho e momento de retorno ao esporte. Nível de evidência III; Estudos terapêuticos – Investigação dos resultados do tratamento - Estudo de caso-controle.
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Rhyu HS, Hong SY, Rhi SY. EFFECTS OF ACCELERATED REHABILITATION EXERCISE AFTER MBO ON ANKLE FUNCTION AND STRENGTH IN ANKLE INSTABILITY. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329022022_0117i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
ABSTRACT Background: Taekwondo athletes with lateral chronic ankle instability (LCAI) may experience difficulties with proprioception and ankle muscle strength. After surgery, a conventional rehabilitation exercise program can be ineffective, as it may not restore proprioception or muscle strength and, thus, result in minimal improvement. Objective: This study aimed to assess the effects of an ARE program following MBO on the proprioception, isokinetic strength, and endurance of ankle. Methods: Thirty athletes diagnosed with LCAI underwent MBO. They were divided into the ARE group (n=15) and the control group (CON, n=15). The ARE group performed early ARE exercises six times per week for 4 weeks. The parameters applied to test ankle muscle strength were angular speed of 30°/sec and 180°/sec (inversion: Inv. and eversion: Eve., respectively). Proprioception was measured as being able to sense a joint position of 15° of Inv. and 5° of Eve. Results: Significant differences were observed between the ARE and CON groups in ankle strength 30°/sec (Inv.: p<0.001, Eve.: p<0.001), 180°/sec (Inv.: p<0.001, Eve.: p<0.001), and proprioception at 15° (Inv.: p<0.001) and 5° (Eve.: p<0.001). Conclusions: We recorded significant short-term effects from early ARE in Taekwondo athletes with LCAI after MBO. The results provide reference data for the sports rehabilitator or ATC in evaluating the rehabilitation phase and informing patients about expectations after MBO in terms of performance status and the timing of return to sports. Level of evidence III; Therapeutic studies–Investigation of treatment outcomes - Case-control Study.
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Arthroscopic Broström-Gould repair has comparable radiological and clinical outcomes compared to traditional open Broström-Gould repair in high-demand patients. Knee Surg Sports Traumatol Arthrosc 2022; 31:2208-2215. [PMID: 36562810 DOI: 10.1007/s00167-022-07289-5] [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: 08/17/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study sought to confirm whether traditional open Broström-Gould repair and arthroscopic Broström-Gould repair for chronic ankle instability (CAI) would produce comparable radiological and clinical outcomes in high-demand patients. METHODS This retrospective case-cohort study included high-demand patients, as determined by a pre-injury Tegner Activity Level ≥ 6, who underwent Broström-Gould repair and were followed up for ≥ 2 years. Patients were divided into the arthroscopic Broström-Gould repair group (AS Group) and the open Broström-Gould repair group (Open Group). Perioperative radiological assessments were performed. The Tegner Activity Levels, Foot and Ankle Outcome Scores (FAOSs), Karlsson and Peterson (K-P) scores, and American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores were evaluated clinically. RESULTS A total of 65 patients (31 from the AS Group and 34 from the Open Group) were included in the study. There were no differences in age, sex, body mass index, preoperative anterior talar translation, talar tilt, signal-to-noise ratio, FAOS, K-P score, or AOFAS score between the two groups (n.s.). The preinjury median Tegner Activity Level was 7 and unchanged at the final follow-up in both groups. Postoperative stress radiographs showed improvement; however, the groups did not differ significantly. The FAOS, K-P scores, and AOFAS scores improved in each group (P < 0.001). However, the clinical scores did not differ between the groups (all n.s.). CONCLUSIONS Traditional open and arthroscopic Broström-Gould repair for CAI in high-demand patients had comparable radiological and clinical outcomes. Clinically, arthroscopic Broström-Gould repair may represent a viable surgical alternative to open Broström-Gould repair in high-demand patients. LEVEL OF EVIDENCE Level III.
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Liu Z, Li J, Chen G, Gao S, Feng E, Su H, Chen H, Jiang T. Crochet Hook Technique for Arthroscopic Anterior Talofibular Ligament Repair: Technique Note. J Clin Med 2022; 11:jcm11236922. [PMID: 36498499 PMCID: PMC9740159 DOI: 10.3390/jcm11236922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Ankle sprains can lead to chronic lateral ankle instability caused by an injured anterior talofibular ligament (ATFL), and surgery is often required when conservative treatments fail. BROSTROM surgery is considered the gold standard and has a definite curative effect. Advancements in arthroscopic surgery and improvements in implanted anchors have led to an increase in ATFL repairs using arthroscopic surgery. Arthroscopic AFTL repair is less invasive, and patients could experience faster recovery compared to open AFTL repair. To simplify the complicated suture-passing processes in arthroscopic AFTL repair, we developed a crochet hook and loop wire technique, which is described in this paper.
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Affiliation(s)
- Zitao Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510261, China; (Z.L.); (G.C.); (E.F.); (H.S.)
| | - Jing Li
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510006, China; (J.L.); (S.G.)
| | - Gengxin Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510261, China; (Z.L.); (G.C.); (E.F.); (H.S.)
| | - Shihua Gao
- The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510006, China; (J.L.); (S.G.)
| | - Enhui Feng
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510261, China; (Z.L.); (G.C.); (E.F.); (H.S.)
| | - Haitao Su
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510261, China; (Z.L.); (G.C.); (E.F.); (H.S.)
| | - Haiyun Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510261, China; (Z.L.); (G.C.); (E.F.); (H.S.)
- Correspondence: (H.C.); (T.J.)
| | - Tao Jiang
- Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510261, China; (Z.L.); (G.C.); (E.F.); (H.S.)
- Correspondence: (H.C.); (T.J.)
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Characteristics of Synovial Fistula of the Ankle Joint: A Case Series. J Clin Med 2022; 11:jcm11206215. [PMID: 36294537 PMCID: PMC9605358 DOI: 10.3390/jcm11206215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Little is known about the etiology, clinical features, diagnosis methods, treatments, and the prognosis of synovial fistula of the ankle joint. The purpose of this study is to investigate the clinical features of synovial fistula of the ankle joint. (2) Methods: Between March 2003 and December 2018, 40 cysts associated with synovial fistula of the ankle joint were treated consecutively by two surgeons. Case histories, clinical manifestations, intraoperative findings, surgical treatment methods, and treatment outcomes were evaluated to characterize fistula-associated cysts. The clinical results were assessed using the visual analog scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional scores, preoperatively and at the last follow-up. (3) Results: The main complaints were ankle instability and pain (15 patients), pain only (15 patients), instability (seven patients), and cosmetic problems (three patients). Eleven patients had a cyst with an open skin wound, and eight of these patients had undergone surgery under a misdiagnosis of bursitis. Cysts were located anterior to the lateral malleolus in 22 cases, next to the lateral malleolus in 13 cases, posterior to the lateral malleolus in three cases, and across the entire lateral malleolus in two cases. Mean VAS and AOFAS scores improved from 5.2 (range, from 1 to 7) and 72.3 (range, from 65 to 87) preoperatively to 1.1 (range, from 0 to 3) and 93.6 (range, from 85 to 100), respectively, at final follow-up visits. (4) Conclusions: Cyst occurrence due to a synovial fistula should be considered when treating a cyst around the lateral malleolus. Fistula repair and reinforcement with fibular periosteum provides a good treatment option for cysts attributed to synovial fistula of the ankle that fail to respond to conservative treatment.
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The ALR-RSI score is a valid and reproducible scale to assess psychological readiness before returning to sport after modified Broström-Gould procedure. Knee Surg Sports Traumatol Arthrosc 2022; 30:2470-2475. [PMID: 35079843 PMCID: PMC9206630 DOI: 10.1007/s00167-022-06895-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 10/26/2022]
Abstract
PURPOSE Psychological readiness scores have been developed to optimize the return to play in many sports-related injuries. The purpose of this study was to statistically validate the ankle ligament reconstruction-return to sport injury (ALR-RSI) scale after modified Broström-Gould (MBG) procedure. METHODS A similar version of the ACL-RSI scale with 12 items was adapted to quantify the psychological readiness to RTS after MBG and to describe construct validity, discriminant validity, feasibility, reliability and internal consistency of the scale, according to the COSMIN methodology. The term "knee" was replaced by "ankle". The AOFAS and Karlsson scores were used as references patient-related outcome measurements (PROMs). RESULTS A total of 71 patients were included. The ALR-RSI score after MBG procedure was highly (r > 0.5) correlated to the AOFAS and Karlsson scores, with a Pearson coefficient r = 0.69 [0.54-0.80] and 0.72 [0.53-0.82], respectively. The mean ALR-RSI score was significantly greater in the subgroup of 55 patients who resumed sports activity compared to those that no longer practiced sport: 61.9 (43.8-79.6) vs 43.4 (25.0-55.6), (p = 0.01). The test-retest showed an "excellent" reproducibility with a ρ intraclass correlation coefficient of 0.93 [0.86-0.96]. The Cronbach's alpha statistic was 0.95, attesting an "excellent" internal consistency between the 12 ALR-RSI items. CONCLUSION The ALR-RSI score is a valid and reproducible tool for the assessment of psychological readiness to RTS after an MBG procedure for the management of CLAI, in a young and active population. The ALR-RSI score may help to identify and counsel athletes on their ability to return to sport. LEVEL OF EVIDENCE III.
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Mercer NP, Kanakamedala AC, Azam MT, Hurley ET, Samsonov AP, Walls RJ, Kennedy JG. Clinical Outcomes After Suture Tape Augmentation for Ankle Instability: A Systematic Review. Orthop J Sports Med 2022; 10:23259671221095791. [PMID: 35647213 PMCID: PMC9134450 DOI: 10.1177/23259671221095791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background: There is minimal literature on the use of suture tape augmentation in the
treatment of chronic lateral ankle instability (CLAI), prompting an
investigation on its use and effect during surgery of the lateral ankle. Purpose: To evaluate the evidence for the use of suture tape augmentation in the
treatment of CLAI and the outcomes after this procedure. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using the PRISMA (Preferred Reporting Items
for Systematic Reviews and Meta-Analyses) guidelines. Studies were included
if they evaluated the use of suture tape for CLAI. Outcome measures included
the Foot and Ankle Ability Measure, American Orthopaedic Foot and Ankle
Society (AOFAS) score, return to play, and radiological improvement in
anterior talar translation and talar tilt angle. Quantitative and
qualitative analyses were performed. Results: There were 11 studies (2 with level 2 evidence, 1 with level 3, and 8 with
level 4) including 334 patients (334 ankles) that underwent suture-tape
augmentation. The mean age was 27.3 years, 67.3% were women, and the mean
follow-up was 27.6 months (range, 11.5-38.5 months). The mean weighted
postoperative AOFAS score was 95, and 87.7% were able to return to sports.
Overall, 9 recurrent instability events (4.1%) were reported. In 3 studies
that compared Broström repair and suture tape augmentation, there were no
significant differences between the procedures in recurrent instability
(mean difference [MD], 0.81 [95% CI, 0.19 to 3.50]; I2 = 0%; P = .78), Foot and Ankle Ability Measure
(MD, 1.24 [95% CI, –3.73 to 6.21]; I2 = 66%; P = .63), talar tilt angle improvement
(MD, –0.07 [95% CI, –0.68 to 0.54]; I2 = 0%; P = .42), or anterior talar translation
improvement (MD, –0.06 [95% CI, –0.69 to 0.56]; I2 = 0%; P = .77). Conclusion: Suture tape augmentation did not significantly improve clinical or
radiological outcomes in the setting of modified Broström repair for CLAI.
There is currently insufficient evidence to recommend suture tape
augmentation for all patients at this time.
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Affiliation(s)
- Nathaniel P. Mercer
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
| | | | - Mohammad T. Azam
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
| | - Eoghan T. Hurley
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alan P. Samsonov
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
| | - Raymond J. Walls
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
| | - John G. Kennedy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, New York, USA
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Mercer NP, Azam MT, Davalos N, Kaplan DJ, Colasanti CA, Chen JS, Kanakamedala AC, Dankert JF, Stone JW, Kennedy JG. Anterior Talofibular Ligament Augmentation With Internal Brace in the Office Setting. Arthrosc Tech 2022; 11:e545-e550. [PMID: 35493039 PMCID: PMC9051666 DOI: 10.1016/j.eats.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023] Open
Abstract
The anterior talofibular ligament (ATFL) is the most frequently injured lateral ligament of the ankle, and up to 20% of patients with ankle sprains may require surgical intervention to correct chronic lateral ankle instability. There has been increased interest in arthroscopic lateral ankle ligament repair techniques to minimize postoperative pain and expedite recovery. Additionally, the use of suture-tape augmentation may allow for improved recovery in those with ATFL reconstruction. The goal of this Technical Note is to describe the steps to performing in-office needle arthroscopy using suture tape as an internal brace for an ATFL deficient ankle. We also include an accompanying discussion on indications and opportunities afforded by an in-office procedure over the traditional operating room suite.
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Affiliation(s)
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Nicholas Davalos
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Daniel J. Kaplan
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | | | - Jeffrey S. Chen
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | | | - John F. Dankert
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York,Address correspondence to John G. Kennedy, M.D., NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY 10002.
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Le T, Liu H, Jenkins SM, Rayos del Sol S, Gardner BB, McGahan P, Chen J. Single Knotless Suture Anchor Repair of Anterior Talofibular Ligament Following Distal Fibula Nonunion Excision. Arthrosc Tech 2022; 11:e449-e455. [PMID: 35256990 PMCID: PMC8897637 DOI: 10.1016/j.eats.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023] Open
Abstract
Anterior talofibular ligament (ATFL) tear is the most common ankle ligament injury. This can lead to recurrent ankle instability, which is detrimental to ankle function and the patient's quality of life. Currently, several techniques have shown successful outcomes for ATFL repair. In this technical note, we describe an open ATFL repair using a single knotless suture anchor at the distal fibula location. This approach is rapid, equipment-efficient, and reproducible, while promising excellent results and high patient satisfaction by restoring ATFL anatomy.
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Affiliation(s)
| | | | - Sarah M. Jenkins
- Address correspondence to Sarah M. Jenkins, M.D., AO Sports, Advanced Orthopaedics and Sports Medicine, 450 Sutter St., San Francisco, CA 94108, U.S.A.
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May NR, Driscoll M, Nguyen S, Ferkel RD. Analysis of Return to Play After Modified Broström Lateral Ankle Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671211068541. [PMID: 35127960 PMCID: PMC8814985 DOI: 10.1177/23259671211068541] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Despite marked improvements in stability after lateral ankle ligament repair, many patients do not return to their preinjury activity level. There are few studies addressing athletes’ assessment of their ability to return to play after lateral ankle ligament reconstruction for recurrent instability. Purpose: To determine the rate of return to the preinjury activity level among physically active patients after the modified Broström procedure (MBP) for recurrent lateral ankle instability. Study Design: Case series; Level of evidence, 4. Methods: Included were patients who had undergone a primary MBP by a single surgeon over a 6-year period and had a minimum 24 months of follow-up. A telephone questionnaire was conducted to ascertain the patient’s ability to return to sport and/or work activity at final follow-up. Activity levels were evaluated utilizing the Tegner activity score. Outcome scores and other measured variables were compared between patients who returned to their preinjury level and those who did not. The reasons for failing to return were also documented. Results: Of the 59 patients who met the inclusion criteria, 41 (69%; 20 men and 21 women) participated in the telephone interview. Results indicated that 22 (54%) returned to their prior level of activity (returners). The mean age of returners was 27.2 years; for nonreturners, the mean age was 27.1 years. Most patients (36/41; 88%) were satisfied with surgery and the overall outcome. Of the 19 nonreturners, 7 (37%) noted ankle-related reasons for not returning (pain: 57%; residual instability: 29%; decreased range of motion: 14%), and 12 (63%) cited non–ankle-related reasons. The mean preinjury and postoperative Tegner score for returners was 6.8. Moreover, 7 of 14 (50%) high-level athletes with preinjury Tegner scores ≥8 returned to their preinjury activity level. For high-level athletes who did not return to their previous level, the mean postoperative Tegner score was 6.6, and only 1 (7%) cited an ankle-related reason for not returning. Conclusion: A high patient satisfaction rate was reported after the MBP for recurrent lateral ankle instability. The majority of patients who did not return to their preinjury level cited a non–ankle-related factor as the reason for not returning to sport. This was especially true for the higher level athletes.
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Affiliation(s)
- Nolan R. May
- New West Sports Medicine, Kearney, Nebraska, USA
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Moradi R, Cengiz B. Modified arthroscopic Broström procedure using a soft anchor for chronic lateral ankle instability: Short-term follow-up results. Jt Dis Relat Surg 2021; 32:744-751. [PMID: 34842108 PMCID: PMC8650643 DOI: 10.52312/jdrs.2021.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/15/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives
This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Broström technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports. Patients and methods
A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months. Results
The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine (64.3%) patients returned to sports activities after surgery at a mean period of 9±2.1 months. Conclusion
In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique.
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Affiliation(s)
- Ramin Moradi
- Özel Sincan Koru Hastanesi Ortopedi ve Travmatoloji Bölümü, 06934 Sincan, Ankara, Türkiye.
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Park YH, Cho HW, Choi JW, Kim HJ. Validation and cross-cultural adaptation of the Korean translation of the Achilles tendon Total Rupture Score. BMC Musculoskelet Disord 2021; 22:876. [PMID: 34649549 PMCID: PMC8518316 DOI: 10.1186/s12891-021-04765-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background The Achilles tendon Total Rupture Score (ATRS) is a widely used patient-reported outcome measure to assess clinical outcomes of Achilles tendon rupture, but it has not been validated in Korean yet. The purpose of this study was to translate the ATRS into Korean and evaluate its reliability and validity in a Korean population. Methods The ATRS was translated into Korean according to recommended guidelines for forward-backward translation. Thirty-eight patients who underwent surgical treatment for Achilles tendon rupture from 2017 to 2019 were enrolled. Reliability was evaluated by the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC). Construct validity was assessed with Spearman rank correlations with the Korean version of the Foot and Ankle Outcome Score (FAOS) and Numeric Rating Scale (NRS) for pain in daily activity. Results The Korean translation of the ATRS had excellent test-retest reliability (ICC = 0.84) and acceptable internal consistency (Cronbach’s alpha = 0.84). The SEM was 6.61, and the MDC was 18.32 at the individual level and 2.97 at the group level. The Korean translation of the ATRS was strongly correlated with the FASO (r = 0.88). Correlation with the NRS in daily activity (r = − 0.66) was moderate. Conclusion The Korean translation of the ATRS showed sufficient reliability and validity for use in the Korean population. Level of evidence II. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04765-w.
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Affiliation(s)
- Young Hwan Park
- Department of Orthopaedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hyun Woo Cho
- Department of Orthopaedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Jung Woo Choi
- Department of Orthopaedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Medical Center, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
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Goru P, Talha S, Majeed H. Outcomes and Return to Sports Following the Ankle Lateral Ligament Reconstruction in Professional Athletes: A Systematic Review of the Literature. Indian J Orthop 2021; 56:208-215. [PMID: 35140851 PMCID: PMC8789970 DOI: 10.1007/s43465-021-00532-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The literature on the early reconstruction of severe acute lateral ligament injuries in professional athletes suggests earlier rehabilitation and reduced incidence of recurrent instability. Predicted time to return to training and sports is important to both the athlete and the club and has not previously been reported. AIMS AND OBJECTIVES The primary aim was to establish the best treatment options available for lateral ligament injury in professional athletes and assess the average time to return to physical training and return to play (RTP). Secondary aims were to find out the rate of return to the pre-injury level of competitive sports and the reasons for delayed recovery. MATERIALS AND METHODS We performed a systematic review according to PRISMA guidelines to evaluate the demographics, clinical profile, management, and treatment outcomes. Electronic searches of the MEDLINE, EMBASE, and Cochrane databases were performed. Studies conducted between Jan 2000 and Dec 2020 with articles reporting the ankle lateral ligament reconstruction in professional athletes were included. MAIN RESULTS After initial screening, 982 articles were identified, of which, 10 articles evaluating 343 athletes met the criteria and were included for final review. The combined mean age was 23 years with an average follow-up of 58.4 months. After surgery 308 (89%) returned to their pre-injury level of sports, 7 (2%) patients returned to a lower-level sport while the remaining 28 (9%) never returned to play. CONCLUSION Our results provide a guide to predict the expected time to return to play (RTP) after surgical repair of lateral ligament injuries along with associated injuries leading to delayed rehabilitation. Lateral ligament reconstruction is a safe and effective treatment for severe ruptures providing a stable ankle with a mean time of 16 weeks to return to sports. The available studies vary considerably in their metrics used for measuring patient-reported outcomes. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00532-0.
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Affiliation(s)
- Poornanand Goru
- Trauma and Orthopaedics, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK ,Warrington, UK
| | - Samir Talha
- Trauma and Orthopaedics, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
| | - Haroon Majeed
- Trauma and Orthopaedics, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL UK
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Lan R, Piatt ET, Bolia IK, Haratian A, Hasan L, Peterson AB, Howard M, Korber S, Weber AE, Petrigliano FA, Tan EW. Suture Tape Augmentation in Lateral Ankle Ligament Surgery: Current Concepts Review. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211045978. [PMID: 35097476 PMCID: PMC8532228 DOI: 10.1177/24730114211045978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Chronic lateral ankle instability (CLAI) is a condition that is characterized by persistent disability and recurrent ankle sprains while encompassing both functional and mechanical (laxity) instability. Failure of conservative treatment for CLAI often necessitates operative intervention to restore the stability of the ankle joint. The traditional or modified Broström techniques have been the gold standard operative approaches to address CLAI with satisfactory results; however, patients with generalized ligament laxity (GLL), prior unsuccessful repair, high body mass index, or high-demand athletes may experience suboptimal outcomes. Synthetic ligament constructs have been tested as an adjunct to orthopedic procedures to reinforce repaired or reconstructed ligaments or tendons with the hope of early mobilization, faster rehabilitation, and long-term prevention of instability. Suture tape augmentation is useful to address CLAI. Multiple operative techniques have been described. Because of the heterogeneity among the reported techniques and variability in postoperative rehabilitation protocols, it is difficult to evaluate whether the use of suture tape augmentation provides true clinical benefit in patients with CLAI. This review aims to provide a comprehensive outline of all the current techniques using suture tape augmentation for treatment of CLAI as well as present recent research aimed at guiding evidence-based protocols.
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Affiliation(s)
- Rae Lan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Eric T. Piatt
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K. Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Laith Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander B. Peterson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Mark Howard
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Shane Korber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E. Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Eric W. Tan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Goodrich E, Vopat ML, Baker J, Tarakemeh A, Templeton K, Mulcahey MK, Schroeppel JP, Mullen S, Vopat BG. Sex-Specific Differences Following Lateral Ankle Ligament Repair. Foot Ankle Int 2021; 42:1311-1318. [PMID: 34024152 DOI: 10.1177/10711007211004191] [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] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic ankle instability is a common condition that can be treated with lateral ankle ligament repair. These procedures have a reported success rate greater than 85% in the literature, but little has been reported about the differences in postoperative outcomes between males and females. The purpose of this study was to evaluate sex-specific outcomes following lateral ankle ligament repair. METHODS In this systematic review and meta-analysis, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to search for articles on electronic databases and included studies in which study participants underwent primary lateral ligament repair and sex-specific outcomes were evaluated. Functional postoperative outcomes for males and females were recorded and statistically analyzed. RESULTS Out of 2768 studies, 7 (0.25%) met inclusion criteria and were analyzed in this review. These studies included 618 patients (402 males [65%] and 216 females [35%]) who underwent primary lateral ligament repair for ankle instability. Karlsson score (P = .1582) and American Orthopaedic Foot & Ankle Society (AOFAS) score (P = .1586) analyses found no statistically significant difference between males and females. Postoperative success rate-defined as a "good" or "excellent" Karlsson score (>81)-was not found to be significantly different between males and females (P = .9374). CONCLUSION There was no difference in postoperative mean Karlsson scores, AOFAS scores, or success rates between males and females who underwent primary lateral ankle ligament repair. LEVEL OF EVIDENCE Level IV, therapeutic.
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Affiliation(s)
- Ezra Goodrich
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Matthew L Vopat
- University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Jordan Baker
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Armin Tarakemeh
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | | | | | - Scott Mullen
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bryan G Vopat
- University of Kansas Medical Center, Kansas City, Kansas, USA
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26
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Smith JD, Hazratwala K, Matthews B, Faruque R, Doma K. Modified Broström-Gould With Gracilis Autograft Augmentation Surgery and Accelerated Noncasted Rehabilitation in High Demand Patients With Lateral Ankle Instability. J Foot Ankle Surg 2021; 60:512-519. [PMID: 33551228 DOI: 10.1053/j.jfas.2020.04.020] [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: 12/04/2019] [Revised: 04/13/2020] [Accepted: 04/20/2020] [Indexed: 02/03/2023]
Abstract
Lateral ankle instability that has failed conservative management can be physically debilitating. Good outcomes are obtained from Broström-Gould augmented repair techniques, however there are few studies evaluating the use of a gracilis autograft augmentation coupled with an accelerated rehabilitation program in high functional demand patients. We believe that the modified Broström-Gould technique utilizing a Gracilis autograft will provide significant improvements in stability while maintaining normal ankle biomechanics in young, high demand patients. The prospective cohort study involved 19 patients (20 ankles) who underwent surgery for chronic lateral ankle instability by a single surgeon, at a single institution between October 2014 and April 2016. Patients were followed for 33.8 ± 11.7 (range 12-48) months. Patients were assessed both pre- and postoperatively for talar tilt angle radiographically and with both American Orthopaedic Foot and Ankle Society Ankle and Hindfoot scores and Karlsson-Peterson scores. A Tegner activity score was taken at the last follow-up. The mean American Orthopaedic Foot and Ankle Society score increased from 68.85 ± 10.57 to 91.56 ± 5.31 points (p < .01) and mean Karlsson-Peterson score increased from 50.9 ± 15.53 to 88.11 ± 8.64 points (p value <.01) when compared preoperatively to mean postoperative follow-up of 33.8 months. Tegner activity score was 7.05 ± 0.89 at last follow-up. The technique was found to be effective in treating chronic lateral ankle instability and in combination with an accelerated rehabilitation protocol, patients returned to their premorbid level of activity with improved stability and no significant effect on donor graft site morbidity.
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Affiliation(s)
- Jason Daniel Smith
- Associate Registrar, Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia.
| | - Kaushik Hazratwala
- Senior Surgeon, Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Brent Matthews
- Associate Registrar, Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Ryan Faruque
- Associate Registrar, Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
| | - Kenji Doma
- Statistician, Orthopaedic Research Institute of Queensland, Townsville, Queensland, Australia
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Yeo ED, Park SB, Lee SW, Cho WJ, Kim HK, Cheon SH, Lee YK. Knotless All-Inside Arthroscopic Modified Broström Procedure for Lateral Ankle Instability. J Foot Ankle Surg 2021; 60:541-547. [PMID: 33549425 DOI: 10.1053/j.jfas.2020.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/07/2020] [Accepted: 11/30/2020] [Indexed: 02/03/2023]
Abstract
One reported complication of the arthroscopic modified Broström operation is pain caused by the suture anchoring knot. We hypothesized that a knotless technique could reduce such pain. Therefore, in this study we evaluated the clinical and radiological outcomes after knotless all-inside arthroscopic modified Broström operation for lateral ankle instability. From July 2017 to November 2017, 28 patients were treated. Clinical and radiological features were evaluated preoperatively and 3, 6, and 12 months postoperatively using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale score, visual analogue scale score for pain, anterior talar drawer test, and talar tilt angle. The mean age of the 28 patients (14 men, 14 women) was 41.71 ± 17.19 years. Three (10.7%) complications, but no knot-associated pain, occurred. The clinical and radiological outcomes were significantly improved 12 months postoperatively compared with preoperative outcomes (all p < .05). Knotless all-inside arthroscopic modified Broström operation for lateral ankle instability avoided knot-associated pain and improved not only patient satisfaction but also clinical and radiological outcomes.
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Affiliation(s)
- Eui Dong Yeo
- Department of Orthopedic Surgery, VHS medical center, South Korea
| | - Sung Bum Park
- Department of Orthopaedic Surgery, Lee Chun Tek Hospital, South Korea
| | - Sang Woo Lee
- Department of Orthopaedic Surgery, Yonsei The Bareun Hospital, South Korea
| | - Whi Je Cho
- Departments of Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, South Korea
| | - Hyun Kwon Kim
- Departments of Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, South Korea
| | - Seung Hee Cheon
- Department of Orthopedic Surgery, VHS medical center, South Korea
| | - Young Koo Lee
- Departments of Orthopedic Surgery, Soonchunhyang University, Bucheon Hospital, South Korea.
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28
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Ahn J, Choi JG, Jeong BO. The signal intensity of preoperative magnetic resonance imaging has predictive value for determining the arthroscopic reparability of the anterior talofibular ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:1535-1543. [PMID: 32770383 DOI: 10.1007/s00167-020-06208-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Arthroscopic all-inside anterior talofibular ligament (ATFL) repair is a common surgical technique for chronic ankle instability (CAI), and the condition of the ATFL remnants is associated with its reparability. ATFL reparability can affect the clinical course, but the relationship between magnetic resonance imaging (MRI) findings and the intraoperative ATFL reparability is still unclear. The purpose of this study was to investigate the relationship between ATFL signal intensities according to MRI and intraoperative ATFL reparability. METHODS This study included 55 cases of CAI (n = 37) and osteochondral lesion of the talus (n = 18) that underwent MRI followed by subsequent arthroscopy. MRI signal intensity was measured preoperatively to calculate the signal to noise ratio (SNR). During arthroscopy, the presence of an ATFL tear was checked and the ATFL tension was classified as taut, mild laxity, or laxity; ATFL quality was classified as excellent (normal), moderate (abnormal but reparable), or poor (irreparable). It was then analyzed whether there was a relationship between the intraoperative findings and the SNR. RESULTS The mean SNR was 23.4 ± 21.6. The SNR was significantly different according to the presence of an ATFL tear and ATFL tension and quality (all P = 0.001). The SNR was better correlated with ATFL quality (r = 0.708) than the presence of a tear (r = 0.545) or degree of tension (r = 0.653). The diagnostic SNR cutoff point to distinguish a normal ATFL from an abnormal but reparable ATFL was 11.2, and that to distinguish between an irreparable and reparable ATFL, was 32.3. CONCLUSION The SNR, representing MRI signal intensities, is highly correlated with the intraoperative measures of the ATFL. Therefore, the SNR had predictive value for determining the arthroscopic reparability of the ATFL. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jungtae Ahn
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Jung Gyu Choi
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Bi O Jeong
- Department of Orthopedic Surgery, College of Medicine, Kyung Hee University, 23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, South Korea.
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29
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Park JM, Kim HJ, Kong SH. Changes of Functional Recovery of Ankle Joint with Application of Rehabilitation Exercise Program after Arthroscopic Modified Brostrom Operation: A Pilot Study. THE ASIAN JOURNAL OF KINESIOLOGY 2021. [DOI: 10.15758/ajk.2021.23.2.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to demonstrate its effectiveness by applying a systematic rehabilitation exercise program to patients after arthroscopic modified Brostrom operation.METHODS The research subjects were 13 patients who had arthroscopic modified Brostrom operation, the 60-minute rehabilitation exercise program was applied twice a week for six weeks, and then, subjective evaluation of ankle joint, and its dynamic stability and isokinetic muscle strength were measured.RESULTS After application of the rehabilitation exercise program, subjective evaluation of the ankle joint(p<.001), its dynamic stability(p<.001) and strengths of the involved side for isokinetic muscle strength peak torque inversion(p<.001), eversion(p<.01), total work inversion(p<.001), eversion(p<.01) uninvolved side peak torque inversion(p<.001), eversion(p<.01), total work(p<.01), muscle endurance of the involved side peak torque inversion(p<.001), eversion(p<.01), total work inversion(p<.001), eversion(p<.01), uninvolved side peak torque inversion(p<.01), total work inversion(p<.01) were significantly increased.CONCLUSIONS It was confirmed that application of rehabilitation exercise program after arthroscopic modified Brostrom operation was effective for positive possibilities of its settlement as regular rehabilitation exercise program.
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30
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Triantafyllopoulos IK, Economopoulos DG, Panagopoulos A, van Niekerk L. Chronic Lateral Ankle Instability in Highly Active Patients: A Treatment Algorithm Based on the Arthroscopic Assessment of the Calcaneofibular Ligament. Cureus 2021; 13:e14310. [PMID: 33968520 PMCID: PMC8099009 DOI: 10.7759/cureus.14310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Ankle sprains are common injuries that may recur as chronic conditions. We aim to describe a treatment algorithm for chronic lateral ankle instability based on the arthroscopic findings of the calcaneofibular ligament (CFL). Methods We assessed 67 highly active patients with chronic lateral ankle instability. They were recreational athletes or active military personnel. After clinical examination, they were all investigated further with MRI scans and stress views. Diagnostic arthroscopy followed, where the integrity of the CFL was assessed. Patients with an intact CFL were placed in group A while those with CFL tears in group B. Concomitant intra-articular pathologies, if present, were treated arthroscopically. CFL tears mandated that modified Broström-Gould reconstruction would follow. The American Orthopaedic Foot and Ankle Society (AOFAS) and Tegner scores were noted post-injury and during the 24-month follow-up. Results A total of 37 patients were put in group A and 30 in group B. The posterior talofibular ligament was intact in both groups. Synovitis and scar tissue were more common in group A (p = 0.01) compared to group B. Overall, no postoperative ankle instability or relapsing ankle sprain was documented. Both groups demonstrated significant improvement in their Tegner (p = 0.009) and AOFAS scores (p = 0.001) during their 24 months follow-up. Inter-rater reliability for CFL tears was moderate on clinical examination (k = 0.514) and fair on MRI, in conjunction with ankle arthroscopy (k = 0.357). Conclusion Our proposed algorithm offered a reliable pathway for accurate evaluation and successful treatment of chronic lateral ankle instability in high-demand groups.
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Affiliation(s)
| | | | | | - Louw van Niekerk
- Orthopaedics and Trauma Department, Ministry of Defence Hospital Unit (MDHU) Northallerton, Northallerton, GBR
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31
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Joyner PW. CORR Insights®: Do Mid-term Outcomes of Lateral Ankle Stabilization Procedures Differ Between Military and Civilian Populations? Clin Orthop Relat Res 2021; 479:724-725. [PMID: 33229898 PMCID: PMC8083834 DOI: 10.1097/corr.0000000000001552] [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] [Received: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Patrick W Joyner
- P. W. Joyner, Orthocollier, Division of Neuroscience and Spine Associates, Naples, FL, USA
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32
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Evolution in Surgical Management of Ankle Instability in Athletes. J Am Acad Orthop Surg 2021; 29:e5-e13. [PMID: 33306560 DOI: 10.5435/jaaos-d-20-00176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 09/10/2020] [Indexed: 02/01/2023] Open
Abstract
Recent concepts are changing the management of ankle instability. These include concurrent medial and lateral instabilities, use of ankle arthroscopy, use of suture anchors, all-arthroscopic stabilization, synthetic augmentation, and early postoperative rehabilitation. Medial sided injuries occur in up to 72% of the lateral ankle sprains, and concomitant repair may provide greater stability. Suture anchors are equally as strong as transosseous tunnels, and the technique is simple, reproducible, and may decrease complications, but anchors do increase costs. Synthetic augmentation demonstrates greater strength than Broström alone in cadaver-based biomechanical testing. Although clinical studies of synthetic augmentation have demonstrated equivocal stability and pain compared with Broström alone, synthetic augmentation may expedite rehabilitation. All-arthroscopic ankle stabilization is gaining popularity with increasing publications. Early findings demonstrate comparable biomechanical and clinical data compared with open techniques. Early postoperative weight-bearing within 2 weeks seems to be safe and may shorten time to return to play. Surgeons may consider using these novel techniques in the management of lateral ankle instability.
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Abstract
PURPOSE OF REVIEW Lateral ankle ligament sprains are one of the most commonly reported injuries in high-level athletes and the general population. Unfortunately, up to 40% of these can go on to develop chronic lateral ankle instability which in the right circumstances requires surgical intervention. The purpose of this review is to present the gold standard surgical treatment for chronic lateral instability with anatomic ligament repair and to highlight the techniques, outcomes, and importance of anatomy when considering surgical treatment. RECENT FINDINGS Recent and remote literature agrees that the initial treatment for chronic ankle instability is non-operative rehabilitation. In the cases where this fails, the gold standard of surgical treatment is open anatomic repair using the Brostrom-Gould technique which stands out as having very good results over the course of time. Recent studies have shown equally good outcomes with arthroscopy as well as with internal brace devices, and both techniques show potential for earlier rehabilitation. In those with contraindications for anatomic repair including innate soft tissue laxity, high BMI, and in the revision setting, anatomic ligament reconstruction is an appropriate surgical option. Open modified Brostrom lateral ligament repair continues to be the preferred method of surgical treatment for chronic lateral ligament instability. In the setting of new modifications and techniques, long-term outcome studies are necessary to identify both their usefulness in long term and to compare them to the open surgery outcomes. It would be useful to standardize rehabilitation protocols as well as return to sport metrics in order to better evaluate outcomes moving forward.
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Abstract
Surgical management for chronic lateral ankle ligament instability is useful when patients have failed nonoperative modalities. Open anatomic reconstruction is an effective method of stabilization. Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. An anatomic approach provides full range of motion, stability, and return to sport and activity. Allograft or suture tape augmentation can be useful for patients with generalized ligamentous laxity, patients with high body mass index, and elite athletes. Allograft reconstruction may be especially useful in revision procedures. Arthroscopic approach to lateral ankle ligament stabilization may provide good outcomes, with long-term data still limited.
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Affiliation(s)
- Eric Ferkel
- Southern California Orthopedic Institute, 6815 Noble Avenue, Suite 200, Van Nuys, CA 91405, USA.
| | - Shawn Nguyen
- Southern California Orthopedic Institute, 6815 Noble Avenue, Suite 200, Van Nuys, CA 91405, USA
| | - Cory Kwong
- Southern California Orthopedic Institute, 6815 Noble Avenue, Suite 200, Van Nuys, CA 91405, USA
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35
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Shim DW, Suh JW, Park KH, Lee JW, Byun J, Han SH. Diagnosis and Operation Results for Chronic Lateral Ankle Instability with Subtle Cavovarus Deformity and a Peek-A-Boo Heel Sign. Yonsei Med J 2020; 61:635-639. [PMID: 32608208 PMCID: PMC7329740 DOI: 10.3349/ymj.2020.61.7.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/27/2022] Open
Abstract
Cavovarus deformity is considered an anatomical risk factor for chronic lateral ankle instability (CLAI). However, subtle deformity can be difficult to detect, and its correction is controversial. The current study aimed to evaluate clinical and radiographic outcomes of a modified Broström procedure (MBP) with additional procedures for CLAI with subtle cavovarus deformity and a positive peek-a-boo heel sign. We reviewed the records of 15 patients who underwent MBP with additional procedures for CLAI with a positive peek-a-boo heel sign between August 2009 and April 2015. Consecutive physical and radiographic examinations were performed. The visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, and the Karlsson-Peterson (KP) ankle score were applied to assess clinical outcomes. Weight bearing radiographs, hindfoot alignment view, and ankle stress radiographs were also examined. The mean follow-up period was 58.5 months. Calcaneal lateral closing wedge osteotomy was performed in seven patients to correct fixed hindfoot varus, and first metatarsal dorsiflexion osteotomy was performed in 11 patients to correct plantarflexion of the first ray. Three patients underwent both procedures. Mean VAS, AOFAS, and KP ankle scores improved significantly (p=0.001), and instability did not recur. Radiographically, all stress parameters improved significantly (p=0.007). Simultaneous correction of a positive peek-a-boo heel sign and cavovarus deformity with MBP for CLAI improves clinical outcomes and prevents recurrent instability. A comprehensive evaluation and cautious approach for subtle cavovarus deformity should be followed when treating patients with CLAI. This trial is registered on Clinical Research Information Service (CRiS, KCT0003287).
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Affiliation(s)
- Dong Woo Shim
- Department of Orthopedic Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jae Wan Suh
- Department of Orthopedic Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Kwang Hwan Park
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Woo Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Junwoo Byun
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hwan Han
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
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36
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Hermanns C, Coda R, Cheema S, Vopat ML, Bechtold M, Tarakemeh A, Mullen S, Schroeppel JP, Vopat BG. Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery. Kans J Med 2020; 13:152-159. [PMID: 32612748 PMCID: PMC7324062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/15/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study was to analyze and assess the variability across different rehabilitation protocols for patients undergoing either lateral ankle ligament repair, reconstruction, and suture tape augmentation. METHODS Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Inclusion criteria were protocols for post-operative care after an ankle ligament surgery (repair, reconstruction, or suture tape augmentation). Protocols for multi-ligament surgeries and non-operative care were excluded. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weight-bearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. RESULTS Twenty-six protocols were analyzed. There was variability across rehabilitation protocols for lateral ankle ligament operative patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. All (12/12) repair, internal brace, and unspecified protocols and 86% (12/14) of reconstruction protocols recommended no ROM immediately postoperatively. Eighty-six percent (6/7) of repair and 78% (11/14) of reconstruction protocols recommended no weight-bearing immediately after surgery, making post-operative ROM and weight-bearing status the most consistent aspects across protocols. Five protocols allowed post-operative weight-bearing in a cast to keep ROM restricted. Sixty-six percent (2/3) of suture tape augmentation protocols allowed full weight-bearing immediately post-operatively. Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker time-line with full weight-bearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3) protocols. RTS was consistent in repair protocols (100% at week 12-16) but varied more in reconstruction. CONCLUSION There is significant variability in the post-operative protocols after surgery for ankle instability. ROM was highly variable across protocols and did not always match-up with supporting literature for early mobilization of the ankle. Return to sport was most likely to correlate between protocols and the literature. Weight-bearing was consistent between most protocols but requires further research to determine the best practice. Overall, the variability between programs demonstrated the need for standardization of rehabilitation protocols.
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Affiliation(s)
| | - Reed Coda
- University of Kansas School of Medicine, Kansas City, KS
| | - Sana Cheema
- University of Kansas School of Medicine, Kansas City, KS
| | - Matthew L. Vopat
- University of Kansas School of Medicine-Wichita, Department of Orthopaedics, Wichita, KS
| | - Megan Bechtold
- University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, KS
| | - Armin Tarakemeh
- University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, KS
| | - Scott Mullen
- University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, KS
| | - John Paul Schroeppel
- University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, KS
| | - Bryan G. Vopat
- University of Kansas School of Medicine, Kansas City, KS,University of Kansas Medical Center, Department of Orthopedic Surgery and Sports Medicine, Kansas City, KS
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Feng SM, Sun QQ, Wang AG, Chang BQ, Cheng J. Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium- and Long-Term Functional Follow-Up. Orthop Surg 2020; 12:505-514. [PMID: 32124530 PMCID: PMC7189041 DOI: 10.1111/os.12651] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium‐ and long‐term follow‐up. Methods From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles, 25 right ankles) aged between 21 and 56 years, with an average age of 32.17 ± 6.35 years, presenting with CLAI, was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07 ± 13.29 months. All patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair of ATFL, with the fixation of one to two anchors. Pre‐ and post‐operative visual analogue scales (VAS), the American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation. Results The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average of 51.25 ± 11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve, blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77 ± 1.36 days. All patients were followed for 24 to 45 months, averaging 33.16 ± 10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow‐up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12 ± 0.13, the AOFAS score increased to 92.53 ± 4.87, and the KAFS score increased to 93.36 ± 6.15. All the follow‐up indexes were significantly different from those before surgery. Conclusion Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable medium‐ and long‐term effect.
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Affiliation(s)
- Shi-Ming Feng
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China.,Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Qing-Qing Sun
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China
| | - Ai-Guo Wang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China.,Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, China
| | - Bu-Qing Chang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China
| | - Jian Cheng
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou, China
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