All-inside arthroscopic repair of the anterior talofibular ligament: a case series

2022 ◽  
Author(s):  
Gustavo Araujo Nunes ◽  
Gabriel Ferraz Ferreira ◽  
Rafael Medeiros Caetano ◽  
Tania Szejnfeld Mann ◽  
Matteo Guelfi
Keyword(s):  
Case Series ◽  
Arthroscopic Repair ◽  
Anterior Talofibular Ligament

Arthroscopic Findings in Patients with Chronic Ankle Instability

2002 ◽  
Vol 30 (3) ◽  
pp. 402-409 ◽  
Author(s):  
Beat Hintermann ◽  
Andreas Boss ◽  
Dirk Schäfer
Keyword(s):  
Structural Changes ◽  
Ankle Instability ◽  
Cartilage Damage ◽  
Case Series ◽  
Chronic Ankle Instability ◽  
Ankle Arthroscopy ◽  
Lateral Ligament ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries

Background There are little objective data on structural changes of the chronically unstable ankle. Such knowledge could help with preoperative planning. Hypothesis Preoperative ankle arthroscopy provides important insights into the causes and mechanisms of ankle instability and the resulting disability. Study Design Case series. Methods From 1993 to 1999, arthroscopic examination was performed in the ankles of 148 patients with symptomatic chronic ankle instability that had lasted 6 months or more. All structural changes were recorded and compared with the clinical diagnosis. Results A rupture or elongation of the anterior talofibular ligament was noted in 86% of ankles, of the calcaneofibular ligament in 64%, and of the deltoid ligament in 40%. Cartilage damage was noted in 66% of ankles with lateral ligament injuries, whereas 98% of the ankles with deltoid ligament injuries had cartilage damage. Although lateral instability could be verified arthroscopically in 127 patients, medial instability was presumed clinically in 38 patients but was actually detected in 54 patients arthroscopically. Conclusion Preoperative ankle arthroscopy revealed an essential amount of information that would otherwise have been undetected. For instance, the ligaments showed typical abnormalities corresponding to different entities of ankle instability and different intra-articular pathologic conditions.

scholarly journals Arthroscopic Fixation of Avulsion Fractures of the Lesser Tuberosity of the Humerus: Clinical Outcomes With a Mean 3.5-Year Follow-up

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110298
Author(s):  
Lin Lin ◽  
Jian Xiao ◽  
Guoqing Cui ◽  
Hui Yan
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Full Range ◽  
Case Series ◽  
Arthroscopic Repair ◽  
Suture Anchors ◽  
Avulsion Fractures ◽  
Lesser Tuberosity ◽  
Arthroscopic Fixation

Background: Avulsion fracture of the lesser tuberosity (AFLT) of the humerus has traditionally been treated with open reduction internal fixation using screw fixation. The clinical outcomes of arthroscopic repair with suture anchors remains unknown. Hypothesis: It was hypothesized that arthroscopic fixation with suture anchors would result in good clinical outcomes for the treatment of AFLT. Study Design: Case series; Level of evidence, 4. Methods: This study included 15 patients who underwent arthroscopic repair of AFLT of the humerus between January 2014 and October 2017. All patients had 3-dimensional computed tomography scans and magnetic resonance imaging to evaluate the avulsed fracture and concomitant injuries before surgery. The arthroscopic double-row and suture-bridge techniques were used based on the morphology of the avulsion fractures. Functional outcomes were assessed with range of motion, the visual analog scale (VAS) for pain, the Subjective Shoulder Value (SSV), the American Shoulder and Elbow Surgeons (ASES) score, and the University of California, Los Angeles (UCLA) shoulder score. The bear-hug test, liftoff test, and internal rotation resistance test at 90° abduction and external rotation (IRRT 90°) were used to evaluate subscapularis tendon integrity. Results: The mean follow-up time was 3.5 years (range, 3-5 years). Comminuted fractures with 1 large part and ≥1 small pieces were seen in 12 cases, partial tear of the supraspinatus in 2 cases, Bankart lesion in 2 cases, and superior labrum anterior to posterior injury in 2 cases. There was a statistically significant improvement from the baseline to the final follow-up in the VAS (from 6.9 ± 1.5 to 1.1 ± 1), SSV (from 30.7 ± 5.1 to 90.5 ± 11.6), ASES (from 28.5 ± 7.7 to 92.3 ± 4.5), and UCLA (from 29.5 ± 6.3 to 94.2 ± 8.3) scores ( P < .001 for all). All patients showed full range of shoulder motion and bilateral symmetric strength on physical examination with the bear-hug test, liftoff test, and IRRT 90° test. Conclusion: The arthroscopic repair of AFLT resulted in excellent reduction and healing of the displaced fragment. At the final follow-up, clinical and functional results were good. Associated injuries occurred in 40% of patients but did not affect outcomes.

Extensor Retinaculum Flap and Fibular Periosteum Ligamentoplasty After Failed Surgery for Chronic Lateral Ankle Instability

2020 ◽  
Vol 41 (12) ◽  
pp. 1546-1552
Author(s):  
Ernesto Pintore ◽  
Lucio Cipollaro ◽  
Raffaele Pintore ◽  
Francesco Oliva ◽  
Nicola Maffulli
Keyword(s):  
Ankle Instability ◽  
Case Series ◽  
High Rate ◽  
Anterior Talofibular Ligament ◽  
Low Grade ◽  
Reconstructive Procedures ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability

Background: The anterior talofibular ligament and the calcaneofibular ligament are 2 of the most frequently injured structures in sports, being damaged in 30% to 45% of all sports injuries. Most reconstructive procedures are successful but can deteriorate with time and can lead to low-grade radiographic degeneration. Methods: We operated on 26 consecutive patients from 2001 to 2008 who had failed previous surgical procedures for the lateral ligamentous complex of the ankle, with an average of 104 (range, 75-140) months. Results: The overall functional rating was excellent in 14 ankles, good in 10, fair in 1, and poor in 1. Twenty-four patients (92.3%) were satisfied with the procedure and 15 (57.7%) were able to return to their preinjury level of activity. Local complications were detected in 2 patients who presented with skin necrosis; 1 patient developed severe reflex sympathetic dystrophy. Conclusion: Revision surgery for the management of failure after surgical treatment of chronic lateral ankle instability is under debate, and the literature is devoid of clinical studies with long-term follow-up. The technique described offers a high rate of long-term excellent and good results, with a low rate of complications and a good rate of return to preinjury level. Level of Evidence: Level IV, retrospective case series.

scholarly journals Recurrent Shoulder Instability in a Young, Active, Military Population and Its Professional Implications

2017 ◽  
Vol 10 (1) ◽  
pp. 54-59 ◽  
Author(s):  
James H. Flint ◽  
Adam Pickett ◽  
Brett D. Owens ◽  
Steven J. Svoboda ◽  
Karen Y. Peck ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Surgical Repair ◽  
Case Series ◽  
Arthroscopic Repair ◽  
Naval Academy ◽  
Recurrent Instability ◽  
Recurrent Shoulder Instability ◽  
Treatment Indications ◽  
The Us ◽  
The Impact

Background: Shoulder instability is a topic of significant interest within the sports medicine literature, particularly regarding recurrence rates and the ideal treatment indications and techniques. Little has been published specifically addressing the occupational implications of symptomatic recurrent shoulder instability. Hypothesis: Previous arthroscopic repair will continue to be a significant predisposing factor for recurrent instability in a young, active population, and that recurrent instability may have a negative effect on college graduation and postgraduate occupational selection. Study Design: Case series. Level of Evidence: Level 4. Methods: We conducted a retrospective review of approved medical waivers for surgical treatment of anterior shoulder dislocation or instability prior to matriculation at the US Military Academy or the US Naval Academy for the graduating classes of 2010 to 2013. Statistical analysis was performed to determine the incidence and risk factors for recurrence and to determine the impact on graduation rate and occupation selection. Results: Fifty-nine patients were evaluated; 34% developed recurrent anterior instability. Patients with previous arthroscopic repair had a significantly higher incidence of recurrence (38%, P = 0.044). Recurrent shoulder instability did not significantly affect graduation rates or self-selected occupation ( P ≥ 0.05). Conclusion: There is a significant rate of recurrent shoulder instability after primary surgical repair, particularly among young, active individuals. In addition, arthroscopic repair resulted in a significantly higher recurrence rate compared with open repair in our population. Surgical repair for shoulder instability should not necessarily preclude young individuals from pursuing (or being considered for) occupations that may place them at greater risk of recurrence. Clinical Relevance: The risk of recurrent instability is greater than the rate typically described, which may suggest that some subpopulations are at greater risk than others. A unique data point regarding instability is the effect on occupation selection.

scholarly journals Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096732
Author(s):  
Soichi Hattori ◽  
Kentaro Onishi ◽  
Yuji Yano ◽  
Yuki Kato ◽  
Hiroshi Ohuchi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Open Repair ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Arthroscopic Repair ◽  
Anterior Talofibular Ligament ◽  
Lower Margin ◽  
Level Of Evidence ◽  
The Mean ◽  
Noninferiority Margin

Background: Arthroscopic repair is a widely accepted surgical treatment for chronic ankle instability; however, recent studies have shown that arthroscopic repair is nonanatomic in its anchor placement and resultant biomechanics. Ultrasound may improve the accuracy of the anchor placement. Hypothesis: Our hypothesis was that the accuracy of anchor placement in sonographically guided anterior talofibular ligament (ATFL) repair will be comparable with that in open ATFL repair. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 26 patients who received surgical treatment between April 2012 and October 2019 for chronic ankle instability. Fifteen patients underwent open modified Broström repair and 11 underwent sonographically guided ATFL repair. The distance between the anchor hole and the fibular obscure tubercle was measured using 3-dimensional computed tomography and was compared between the operative procedures. For comparison, a noninferiority trial was employed, with open modified Broström repair as the reference surgery. The noninferiority margin was defined as 5 mm. Results: The mean ± SD distance between the anchor and fibular obscure tubercle was 6.0 ± 2.7 mm in open repair and 5.6 ± 3.3 mm in sonographically guided repair. The mean difference in distance between the techniques ( open repair – sonographically guided repair) was 0.37 mm (95% CI, –2.1 to 2.9 mm). The lower margin of the confidence interval was within the noninferiority margin (–5 to 5 mm). Conclusion: Anchor placement under sonographically guided ATFL repair was equivalent to that of open ATFL repair and can be considered anatomic and accurate.

Sports Activity after Arthroscopic Superior Labral Repair using Suture Anchors in Overhead-Throwing Athletes

2005 ◽  
Vol 33 (4) ◽  
pp. 507-514 ◽  
Author(s):  
Junji Ide ◽  
Satoshi Maeda ◽  
Katsumasa Takagi
Keyword(s):  
Case Series ◽  
Arthroscopic Repair ◽  
Labral Repair ◽  
Suture Anchors ◽  
Level Of Evidence ◽  
Sports Activity ◽  
Baseball Players ◽  
Overhead Athletes ◽  
Trauma Group

Purpose To evaluate the results of arthroscopic repair of type II superior labral anterior posterior lesions of the shoulder in overhead athletes. Hypothesis Such repair is useful for overhead athletes in terms of postoperative sports activity. Study Design Case series; Level of evidence, 4. Methods The study group was composed of 40 patients with a mean age of 24 years (range, 15-38 years); mean follow-up was 41 months (range, 24-58 months). They were divided into an overuse (n = 22) and a trauma group (n = 18). The authors used 2 suture anchors loaded with a nonabsorbable suture at the 11-o'clock and 1-o'clock positions through the anterosuperior and lateral trans-rotator cuff portal. A modified Rowe score and postoperative athletic activities were evaluated. Results After arthroscopic repair, mean modified Rowe scores improved from 27.5 to 92.1 points (P <. 0001). Rated on this scale, the results were excellent in 30 (75%), good in 6 (15%), and fair in 4 (10%) athletes; there were no poor results. Satisfactory outcomes were achieved in 36 (90%) of these patients; 30 (75%) experienced a return to the preinjury level. The complete return rate of baseball players in the overuse group was lower than that of other overhead athletes in the trauma group. Conclusion Arthroscopic superior labral repair is a safe and reliable procedure in overhead athletes.

Long-term Results After Arthroscopic Repair of Isolated Subscapularis Tears

2016 ◽  
Vol 45 (4) ◽  
pp. 759-766 ◽  
Author(s):  
Gernot Seppel ◽  
Johannes E. Plath ◽  
Christopher Völk ◽  
Wolfgang Seiberl ◽  
Stefan Buchmann ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Structural Integrity ◽  
Constant Score ◽  
Case Series ◽  
Arthroscopic Repair ◽  
Long Term Results ◽  
Clinical Test ◽  
The Mean

Background: Although some reports have presented short- to midterm results after arthroscopic repair of isolated subscapularis (SSC) tendon tears, long-term evaluation is still lacking. Hypothesis: Long-term results after arthroscopic repair of isolated SSC tears are comparable with the functional and radiological short- to midterm outcomes described in the literature. Study Design: Case series, Level of evidence, 4. Methods: This study assessed 17 patients (5 females and 12 males; mean age, 45.6 years) with isolated SSC tears (Fox and Romeo classification types 2-4) who underwent all-arthroscopic suture anchor repair. The mean interval from symptom onset to the time of surgery was 5.3 months in 16 patients (94.1%). One patient (5.9%) was symptomatic for a prolonged period (104 months) before surgery. All patients were assessed with a clinical examination preoperatively. SSC function was investigated using specific clinical tests and common scoring systems, including Constant, American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH), and Simple Shoulder Test (SST) scores. At follow-up, muscular strength was evaluated using an electronic force-measuring plate. Structural integrity of the repair was assessed using magnetic resonance imaging (MRI). Results: At a mean follow-up of 98.4 ± 19.9 months, the mean Constant score improved from 47.8 preoperatively to 74.2 postoperatively ( P = .001). Higher Constant ( P = .010) and ASES ( P = .001) scores were significantly associated with a shorter time from symptom onset to surgery. The size of the SSC lesion did not correlate with any clinical score outcome ( P = .476, .449, .985, and .823 for Constant, ASES, DASH, and SST scores, respectively). Three patients (17.6%) had persistent positive clinical test results (belly-press/lift-off). Compared with the uninjured contralateral side, SSC strength was significantly reduced in the belly-press position ( P = .031), although active internal ( P = .085) and external ( P = .093) rotation was not affected. In 1 patient, a rerupture was detected by MRI. Six patients had cranial SSC atrophy. Overall, 88.2% of patients were “very satisfied” or “satisfied” with their results. Conclusion: Arthroscopic repair of isolated SSC tears results in significant clinical improvements and enduring tendon integrity, although SSC strength remains reduced in the long term. Early surgical treatment seems to be a relevant factor allowing good shoulder function.

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