Simultaneous ossicle resection and lateral ligament repair give excellent clinical results with an early return to physical activity in pediatric and adolescent patients with chronic lateral ankle instability and os subfibulare

Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Although the initial treatment is conservative, some patients may develop chronic instability requiring surgical repair. Arthroscopy is often performed prior to ligament reconstruction to evaluate concomitant intraarticular and cartilage injuries. Arthroscopic treatment may be performed immediately prior to ligament repair (single stage), or it may be scheduled days/weeks prior to ligament repair (double stage). Concerns of single stage arthroscopic treatment are related to the increased difficulty in dealing with ligaments and soft-tissue injuries hindered by fluid extravasation. Our study compares outcomes between single and double stage arthroscopy in patients undergoing lateral ligament repair surgery. Methods: In this retrospective study we reviewed charts of patients with chronic lateral ankle instability who underwent ankle arthroscopy followed by lateral ligament repair from 2011 to through 2015. A total of 102 patients were included in the study, 65 patients in the single stage group, and 37 in the double stage group. Surgical failure was defined as recurrence of ankle instability at any point in the follow up period after the procedure. Demographic data and recurrence rate of instability were compared between the groups using chi-squared test. Results: Women comprised 72% (73/102) percent of the total patient population. No significant differences in demographic data were found between the two groups. There was no difference in the recurrence rate of lateral ankle instability between patients who underwent 1-stage versus 2-stage arthroscopic treatment. The rate was similar between the groups: 10.8% (7/65) of patients with the single stage technique and 8.1% (3/37) of patients in the double stage group (p=0.6208). Conclusion: In the treatment of chronic lateral ankle instability, the use of single-stage arthroscopy and lateral ligament repair showed similar rates of surgical failure when compared to the double-stage procedure. A single stage approach may be a more efficient use of time and hospital resources, and avoids the need to place the patient under anesthesia multiple times. Arthroscopy may be performed immediately prior to lateral ligament repair without concern for increased risk of recurrence of instability.

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

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4774-5 ◽

2017 ◽

Vol 26 (10) ◽

pp. 3129-3134 ◽

Cited By ~ 8

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

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Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00441 ◽

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.

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Percutaneous Lateral Ligament Reconstruction with Allograft for Chronic Lateral Ankle Instability

Foot & Ankle International ◽

10.3113/fai.2012.0099 ◽

2012 ◽

Vol 33 (2) ◽

pp. 99-104 ◽

Cited By ~ 41

Author(s):

Hyunkook Youn ◽

Yong Sang Kim ◽

Jongseok Lee ◽

Woo Jin Choi ◽

Jin Woo Lee

Keyword(s):

Ligament Reconstruction ◽

Ankle Instability ◽

Lateral Ligament ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00388 ◽

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.

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