Concurrent arthroscopic osteochondral lesion treatment and lateral ankle ligament repair has no substantial effect on the outcome of chronic lateral ankle instability

2017 ◽  
Vol 26 (10) ◽  
pp. 3129-3134 ◽  
Author(s):  
Dong Jiang ◽  
Yin-fang Ao ◽  
Chen Jiao ◽  
Xing Xie ◽  
Lin-xin Chen ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Substantial Effect ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligament ◽  
Lesion Treatment

scholarly journals Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0044
Author(s):  
Yoshiharu Shimozono ◽  
Eoghan Hurley ◽  
John Kennedy
Keyword(s):  
Clinical Outcomes ◽  
Complication Rate ◽  
Comparative Studies ◽  
Ankle Instability ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: There has a been recent increase in the use of the arthroscopic approach to lateral ankle ligament repair for chronic lateral ankle instability. However, the clinical outcomes of this technique are still unclear. The purpose of this systematic review was to evaluate the current studies on arthroscopic lateral ankle ligament repair for chronic lateral ankle instability. Our hypothesis was that arthroscopic lateral ligament repair would result in excellent outcomes with a low complication rate. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases, based on the PRISMA guidelines, was performed during August 2017 by 2 independent reviewers. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. The weighted mean preoperative AOFAS score improved from 59.6 to 95.0 at a mean follow-up of 14.8 months in 8 studies. Five studies utilized Karlsson-Peterson scores with mean postoperative score of 88.5 at a mean follow-up of 21.2 months. Three comparative studies were reported. The comparative studies showed similar clinical outcomes between arthroscopic and open procedures. The overall complication rate was 13.4% in the included studies. . Only 2 studies reported patients returning to sport and demonstrated that 100% of patients returned to sport at pre-injury level. Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair yields favorable clinical outcomes in the short-term. However, there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure, and there is no long-term data currently available for the arthroscopic procedure. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates for both open and arthroscopic techniques.

scholarly journals Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0038
Author(s):  
Yoshiharu Shimozono ◽  
Alexandra J Brown ◽  
Eoghan T Hurley ◽  
John G Kennedy
Keyword(s):  
Systematic Review ◽  
Comparative Studies ◽  
Ankle Instability ◽  
Arthroscopic Repair ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligament

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Open modified Broström-Gould procedure is generally accepted as the gold-standard treatment for chronic lateral ankle instability. Recently an arthroscopic lateral ankle ligament repair technique has become increasingly popular in an effort to reduce post-operative pain and facilitate early recovery. The purpose of the current systematic review was to evaluate the current evidence on arthroscopic lateral ankle ligament repair techniques and to compare the clinical outcomes of arthroscopic and open techniques for chronic lateral ankle instability with meta-analysis. Methods: A systematic search of MEDLINE and EMBASE databases was performed during August 2017. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Comparative studies were compared using RevMan version 5.3, and a p-value of < 0.05 was considered statistically significant. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. There were three comparative studies of open and arthroscopic repair procedures, with two Level III studies and one Level I study. There was a significant difference in favor of arthroscopic repair at final follow-up for the Karlsson- Peterson score (MD; 2.59, 95%CI, -0.19 to 2.36, I2=0%, p=0.10) and the AOFAS score (MD; 1.50, 95%CI, 0.41 to 2.59, I2=0%, p=0.007) in the comparative studies. The overall complication rate was 13.4% in the included studies but in the comparative studies there was no statistically significant difference between open and arthroscopic repair (12.1% vs 11.4%, p=0.90). Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair may yield favorable clinical outcomes and may be superior to open procedure in the short-term, but there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure in the mid- long-term follow-up. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates.

Chronic Lateral Ankle Instability

Foot & Ankle ◽  
1991 ◽  
Vol 12 (3) ◽  
pp. 182-191 ◽  
Author(s):  
J. Wesley Peters ◽  
Saul G. Trevino ◽  
Per A. Renstrom
Keyword(s):  
Operative Treatment ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Management Options ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Anatomical Point ◽  
Lateral Ankle Ligament

Chronic lateral ankle instability may be present in as many as 10% to 30% of people suffering from acute lateral ankle ligament injuries. Ankle instability has been referred to as either functional instability or mechanical instability. Management options consist of either nonoperative or operative treatment, with the majority of the literature emphasizing operative management for chronic instability. Long-term studies assessing the different types of available operative repairs have now been published. This review article discusses chronic lateral ankle ligament instability from a functional, anatomical point of view. The indications for treatment, nonoperative and operative treatment, as well as the biomechanical information available regarding these methods of treatment are considered. The major emphasis of this review is discussion and analysis of the many different surgical treatment options. Following this review, we presently recommend anatomical repair to the bone of both the anterior talofibular ligament and the calcaneofibular ligament, together with imbrication of the ligaments. In patients with hypermobility, long-standing instability, or arthritis, reconstruction using the Chrisman-Snook technique is recommended.

Chronic Lateral Ankle Instability and Associated Conditions: A Rationale for Treatment

2007 ◽  
Vol 28 (10) ◽  
pp. 1041-1044 ◽  
Author(s):  
Joseph E. Strauss ◽  
Jonathan Agner Forsberg ◽  
Frederick G. Lippert
Keyword(s):  
Ankle Instability ◽  
Initial Time ◽  
Associated Injuries ◽  
Varus Alignment ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ankle Ligament ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligament ◽  
Associated Conditions

Background: Ankle sprains have a high incidence of associated injuries and conditions that may be unrecognized at the initial time of injury. Failure to treat these conditions at the index surgery may compromise outcomes and delay recovery. The purpose of this study was to determine the type and frequency of associated injuries and conditions in military patients with chronic lateral ankle instability. Methods: Between 1996 and 2002, 160 patients had 180 modified Broström-Gould lateral ankle ligament reconstructions for chronic ankle instability. A retrospective review of the clinical history, physical examination, radiographs, and intraoperative findings was conducted. Results: The overall incidence of associated extra-articular conditions and injuries found in this study was 64%; 115 conditions were identified in 180 ankles. Peroneal tendon injuries occurred with the highest frequency (28%), followed by os trigonum lesions (13%), lateral gutter ossicles (10%), hindfoot varus alignment (8%), anterior tibial spurs (3%), and tarsal coalitions (2%). Twenty revision lateral ankle ligament reconstructions were required for either persistent pain or recurrent instability. The most common associated conditions were undiagnosed hindfoot varus alignment abnormalities (28%) followed by untreated peroneal injuries (25%). Conclusions: This study confirms the frequency of conditions associated with lateral ankle instability and emphasizes several conditions that have received little attention in the literature. Identifying these associated conditions before surgery enables the surgeon to treat all conditions at one operation, returning the patient to full activity sooner. Guidelines are presented to assist clinicians in screening patients for these associated conditions.

scholarly journals Demographic Predictors of Concomitant Osteochondral Lesion of the Talus in Patients With Chronic Lateral Ankle Instability

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110133
Author(s):  
Yong Sang Kim ◽  
Tae Yong Kim ◽  
Yong Gon Koh
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Case Series ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Female Patients ◽  
Lateral Ankle Instability ◽  
Talar Tilt

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle ( P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.

scholarly journals Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
G. Matthew Heenan ◽  
Kisan B. Parikh ◽  
Armin Tarakemeh ◽  
Scott M. Mullen ◽  
John Paul Schroeppel ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Newly Diagnosed ◽  
Ligament Repair ◽  
Chronic Instability ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
The Difference ◽  
Articular Pathology

Objectives: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,188) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,141) or lateral ankle ligament reconstruction (n=1,063). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=219), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=325), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Average cost per patient was higher for both arthroscopy groups: repair with arthroscopy ($6,207.78) versus repair without arthroscopy ($3,677.11; p < 0.0001); reconstruction with arthroscopy ($5,758.21) versus reconstruction without arthroscopy ($4,601.13; p = 0.0039). There was a significantly higher proportion of patients with complications in the reconstruction without arthroscopy group than in the reconstruction with arthroscopy group (7.59%, 4.31%; p = 0.0431), but the difference between repair groups was insignificant (p = 0.0626). The proportion of patients with newly diagnosed intra-articular defects was significantly higher in both arthroscopy groups: repair with arthroscopy (53.0%) versus repair without arthroscopy (35.6%; p < 0.0001); reconstruction with arthroscopy (56.0%) versus reconstruction without arthroscopy (39.8%; p < 0.0001). There was a significantly higher proportion of patients who underwent reoperation for intra-articular defects in the combined (repair plus reconstruction) arthroscopy group (7.18%) than in the combined non-arthroscopy groups (4.91%; p = 0.049). Most importantly, the average time until reoperation for intra-articular defects was significantly shorter in the combined arthroscopy group (271.923 days) than in the combined non-arthroscopy group (411.473 days; p = 0.024). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was nearly 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.

Sign in / Sign up

Export Citation Format

Share Document