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Du MZ, Su T, Jiang YF, Jiao C, Guo QW, Hu YL, Jiang D. Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3–11-Year Follow-up. Front Surg 2022; 9:816669. [PMID: 35615649 PMCID: PMC9124844 DOI: 10.3389/fsurg.2022.816669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeThis study aims to evaluate the mid- to long-term outcome of concurrent arthroscopic treatment of osteochondral lesion (OCL) and open anatomical repair of lateral ankle ligaments for severe acute ankle sprain patients and compare them to the outcome of those without OCL.MethodsA total of 166 patients with grade III acute lateral ankle ligament injuries underwent concurrent ankle arthroscopy and open anatomic ligament repair. Forty-three patients (group A) with OCL underwent arthroscopic treatment followed by open ligament repair. A total of 105 patients (group B) without OCL were followed up as the control. The evaluation parameters included sports recovery, postoperative visual analog scale (VAS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner score, sprain recurrence, satisfaction, and range of motion. Patients in group A were then subgroup-analyzed according to age, sex, body mass index, injury side, OCL location, and stage (Ferkel and Cheng’s staging system).ResultsThe postoperative exercise level of the two groups recovered to more than 90% of the normal level (91.2% ± 11.2% in group A and 90.9% ± 13.3% in group B, n.s.). The average time of group A and group B to return to preinjury sports activity was respectively 4.4 ± 1.0 months and 4.4 ± 1.2 months with no significant difference (p = 0.716). No significant differences were found in the preoperation VAS pain score, AOFAS score, and Tegner score between the two groups. The postoperative VAS pain score in group A was significantly higher than that in group B (0.8 ± 1.7 vs. 0.3 ± 0.8, p = 0.027), but the difference was not clinically important. The postoperative VAS pain score of patients with stage D–F lesions was significantly higher than that of patients with stage B–C lesions (1.3 ± 2.1 vs. 0.3 ± 0.9, p = 0.038).ConclusionsFor the severe acute ankle sprain combined with OCL, the simultaneous arthroscopic treatment and open lateral ankle ligament repair achieved good mid- to long-term outcomes. Except that the pain was more pronounced than in the control group, there were no differences in other outcomes. Postoperative pain was positively correlated with the grade of OCL.
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Affiliation(s)
- Ming-Ze Du
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China
- Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
- Correspondence: Dong Jiang
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Feng SM, Chen J, Ma C, Migliorini F, Oliva F, Maffulli N. Limited medial osteochondral lesions of the talus associated with chronic ankle instability do not impact the results of endoscopic modified Broström ligament repair. J Orthop Surg Res 2022; 17:69. [PMID: 35115041 PMCID: PMC8811990 DOI: 10.1186/s13018-022-02968-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients. Methods This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups. Conclusion In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome. Level of Evidence Level III, a retrospective comparative study.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China.
| | - Jie Chen
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Chao Ma
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno, Italy.,Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, Staffordshire, ST4 7QB, England.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
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