Evaluation of the Talar Cartilage in Chronic Lateral Ankle Instability with Lateral Ligament Injury Using Biochemical T2* Mapping

Hindfoot malalignment and chronic lateral ankle instability may lead to degenerative ankle arthritis. We retrospectively analyzed 10 patients with 13 cavovarus feet. None of the patients had underlying neurologic disorders. All patients presented with a history consistent with chronic lateral ankle instability, clinically with cavovarus feet, and radiographically with varying degrees of varus talar tilt and ankle arthritis. Ankles with severe degenerative change were fused. The ankles with mild or moderate change underwent calcaneal osteotomy with lateral ligament reconstruction and/or dorsiflexion osteotomy of the first metatarsal. A quantitative radiographic Coleman block test was utilized to aid in the preoperative planning of the calcaneal and metatarsal osteotomies. All patients had correction of preoperative deformity and resolution of pain and instability. Recognition of the association between cavovarus and chronic ankle instability and degenerative ankle arthritis may be important in developing the appropriate treatment strategy in this patient population.

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Associated Injuries Found in Chronic Lateral Ankle Instability

Foot & Ankle International ◽

10.1177/107110070002101003 ◽

2000 ◽

Vol 21 (10) ◽

pp. 809-815 ◽

Cited By ~ 221

Author(s):

Benedict F. DiGiovanni ◽

Carlos J. Fraga ◽

Bruce E. Cohen ◽

Michael J. Shereff

Keyword(s):

Ligament Reconstruction ◽

Ankle Instability ◽

Osteochondral Lesion ◽

Lateral Ligament ◽

Peroneal Tendon ◽

Associated Injuries ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Anterolateral Impingement

Sixty-one patients underwent a primary ankle lateral ligament reconstruction for chronic instability between 1989 and 1996. In addition to the ligament reconstruction, all patients had evaluation of the peroneal retinaculum, peroneal tendon inspection by routine opening of the tendon sheath, and ankle joint inspection by arthrotomy. A retrospective review of the clinical history, physical exam, MRI examination, and intraoperative findings was conducted on these 61 patients. The purpose was to determine the type and frequency of associated injuries found at surgery and during the preoperative evaluation. At surgery no patients were found to have isolated lateral ligament injury. Fifteen different associated injuries were noted. The injuries found most often by direct inspection included: peroneal tenosynovitis, 47/61 patients (77%); anterolateral impingement lesion, 41/61 (67%); attenuated peroneal retinaculum, 33/61 (54%); and ankle synovitis, 30/61 (49%). Other less common but significant associated injuries included: intra-articular loose body, 16/61 (26%); peroneus brevis tear, 15/61 (25%); talus osteochondral lesion, 14/61 (23%); medial ankle tendon tenosynovitis, 3/61 (5%). The findings of this study indicate there is a high frequency of associated injuries in patients with chronic lateral ankle instability. Peroneal tendon and retinacular pathology, as well as anterolateral impingement lesions, occur most often. A high index of suspicion for possible associated injuries may result in more consistent outcomes with nonoperative and operative treatment of patients with chronic lateral ankle instability.

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Diagnosis of Lateral Ankle Ligament Injury in the Evaluation of Chronic Lateral Ankle Instability

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2021.0126 ◽

2021 ◽

Vol 82 (6) ◽

pp. 1402

Author(s):

Ji Young Jeon

Keyword(s):

Ankle Instability ◽

Ligament Injury ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Ankle Ligament ◽

Lateral Ankle Instability ◽

Lateral Ankle Ligament ◽

Ankle Ligament Injury

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Simultaneous bilateral arthroscopic lateral ligament repair for chronic lateral ankle instability

Foot and Ankle Surgery ◽

10.1016/j.fas.2017.07.274 ◽

2017 ◽

Vol 23 ◽

pp. 62-63

Author(s):

I. Yoshimura ◽

T. Hagio ◽

K. Kanazawa ◽

S. Minokawa ◽

M. Noda ◽

...

Keyword(s):

Ankle Instability ◽

Lateral Ligament ◽

Ligament Repair ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

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454 Brace Brace: Modified Brsotrom-Gould Procedure with and Without Internal Brace for the Treatment of Chronic Lateral Ankle Instability

British Journal of Surgery ◽

10.1093/bjs/znab134.282 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J McGuigan ◽

A Pillai ◽

A Hall

Keyword(s):

Clinical Outcomes ◽

Ligament Reconstruction ◽

Ankle Instability ◽

Nonoperative Treatment ◽

Lateral Ligament ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Significant Difference ◽

Internal Brace

Abstract Introduction The most common ankle injury is a sprain. Surgical management is only indicated when nonoperative treatment fails. Modified Broström-Gould (MBG) is the gold standard surgical technique. MBG technique may be augmented with an internal brace. This study aims to compare the clinical outcomes of MBG with and without internal brace for the treatment of chronic lateral ankle instability using validated patient recorded outcome measures. Method Retrospective analysis of patients that underwent lateral ankle ligament reconstruction between January 2012 and June 2019 were reviewed at and asked to complete the Manchester oxford foot and ankle questionnaire (MOXFQ). 29 patients (30 ankles) underwent lateral ligament reconstruction between these dates and completed the questionnaire, 20 patients (21 ankles) without internal brace and 9 patients with internal brace. Results The group with internal brace displayed significantly better results in the MOXFQ summary index score (20.49 ± 13.15 vs 43.53 ± 34.72, P = 0.014) and standing/walking subscale (15.48 ± 13.00 vs 45.92 ± 36.60, P = 0.023) compared to group without internal brace. There was no significant difference between Pain and Social interactions subscales. Conclusions Our results show that the addition of an internal brace to the MBG procedure for the management of chronic lateral ankle instability improves clinical outcomes.

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Ankle Arthroscopy, Lateral Ligament Repair and Peroneal Tendon Reefing for Chronic Lateral Ankle Instability: The Triad vs Arthroscopy with Ligament Repair

Surgical Science ◽

10.4236/ss.2015.69058 ◽

2015 ◽

Vol 06 (09) ◽

pp. 403-411

Author(s):

John J. Anderson ◽

Loren K. Spencer ◽

Zflan Fowler

Keyword(s):

Ankle Instability ◽

Ankle Arthroscopy ◽

Lateral Ligament ◽

Peroneal Tendon ◽

Ligament Repair ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

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All-inside arthroscopic modified Broström-Gould procedure for chronic lateral ankle instability with and without anterior talofibular ligament remnant repair produced similar functional results

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-020-06361-2 ◽

2020 ◽

Author(s):

Shi-Ming Feng ◽

Nicola Maffulli ◽

Chao Ma ◽

Francesco Oliva

Keyword(s):

Ankle Instability ◽

Rate Of Return ◽

Lateral Ligament ◽

Functional Score ◽

Anterior Talofibular Ligament ◽

Return To Sports ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Functional Scores

Abstract Purpose The Broström-Gould procedure, with the repair of the anterior talofibular ligament (ATFL) combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI). Lateral ligament reconstruction is considered if the ATFL remnant quality is poor or the ATFL has been damaged beyond the ability to suture it. It remains unclear whether not repairing the ATFL remnant produces comparable functional outcomes to the classical Broström-Gould procedure. Methods This retrospective cohort study included 84 patients with CLAI undergoing either repair or non-repair of the ATFL remnant using an all-inside arthroscopic Broström-Gould procedure from 2015 to 2018. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results All the functional scores (VAS, AOFAS, KAFS, ATT, AJPS) significantly improved in both groups at 1 and 2 years after surgery. At all the follow-up time points, the VAS, AOFAS, KAFS, ATT, AJPS, and the rate of return to sport scores were comparable between the repair and non-repair group. Conclusion There are no statistically significant differences in postoperative outcomes between ATFL remnant repair and non-repair for the management of CLAI using the all-inside arthroscopic Broström-Gould procedure. From the clinical viewpoint, the present study shows that the potential differences in clinical outcomes between ATFL remnant repair and non-repair are likely not relevant when performing an all-inside arthroscopic Broström-Gould procedure for CLAI. Level of evidence III.

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