Outcomes of ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large malleolar accessory ossicles

Abstract BackgroundAccessory malleolar ossicles are often found in patients with chronic ankle instability. For the large ossicles more than 10mm, there are still uncertainties about the suitable surgical option.This study was aimed at evaluating the clinical efficacy of ossicle resection and anatomic reconstruction of the lateral ligaments for chronic ankle instability with large accessory malleolar ossicles.MethodsSixteen chronic ankle instability patients with large accessory malleolar ossicles were treated with ossicle resection and anatomic reconstruction of lateral ligaments between December 2014 and February 2018. The clinical effects were evaluated with Visual Analogue Scale, Karlsson-Peterson ankle scoring system, and subjective satisfaction of patients. The varus talar tilt angle and anterior talar displacement between bony surfaces of the tibia and talus were included as radiographic parameters.ResultsThere were 11 males and 5 females in this study group. The average age at the time of surgery was 28.9 years old. The average final follow-up time was 26.9 months (range, 12 to 47). The average size of the ossicles was 11.7mm. The VAS score declined from 3.5 ± 1.6 preoperatively to 1.4 ± 1.0 at the final follow up (p < 0.01). The Karlsson-Peterson score was significantly improved from 52.7 ± 15.1 before surgery to 86.4 ± 8.2 at the last follow up (p < 0.01). Radiologically, the average varus talar tilt angle was decreased from 15.4 ± 2.0 degrees preoperatively to 6.2 ± 1.6 degrees at the final follow up (p < 0.01), and the average anterior talar displacement was decreased from 14.3 ± 2.1 mm preoperatively to 6.3 ± 1.4 mm at final follow up (p < 0.01). Fourteen patients (87.5%) were satisfied (‘excellent’ or ’good’) with treatment outcome.ConclusionsOssicle resection and anatomic reconstruction of the lateral ligaments provided good clinical outcomes for chronic ankle instability with large accessory malleolar ossicles. This method appears to be one of the reliable and effective procedures for the treatment of chronic ankle instability with large accessory malleolar ossicles.

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Anatomical reconstruction of the lateral ligaments using Gracillis tendon in chronic ankle instability; a new technique

Foot and Ankle Surgery ◽

10.1016/j.fas.2010.07.006 ◽

2011 ◽

Vol 17 (4) ◽

pp. 239-246 ◽

Cited By ~ 27

Author(s):

S.A. Ibrahim ◽

F. Hamido ◽

A.K. Al Misfer ◽

S.A. Ghafar ◽

A. Awad ◽

...

Keyword(s):

Ankle Instability ◽

Chronic Ankle Instability ◽

New Technique ◽

Anatomical Reconstruction ◽

Lateral Ligaments ◽

A New Technique

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Surgical Management of Lateral Ankle Instability in Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-348-18 ◽

2019 ◽

Vol 54 (6) ◽

pp. 639-649 ◽

Cited By ~ 4

Author(s):

Luis D. Camacho ◽

Zachary T. Roward ◽

Yu Deng ◽

L. Daniel Latt

Keyword(s):

Surgical Management ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

Anatomic Reconstruction ◽

Ankle Sprains ◽

Functional Rehabilitation ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Initial Surgery ◽

Lateral Ankle Ligaments

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.

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Anatomical repair of lateral ligaments in patients with chronic ankle instability

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-004-0562-0 ◽

2004 ◽

Vol 13 (3) ◽

pp. 231-237 ◽

Cited By ~ 25

Author(s):

R. Schmidt ◽

S. Benesch ◽

B. Friemert ◽

A. Herbst ◽

L. Claes ◽

...

Keyword(s):

Ankle Instability ◽

Chronic Ankle Instability ◽

Lateral Ligaments

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Treatment of Chronic Ankle Instability

Albanian Journal of Trauma and Emergency Surgery ◽

10.32391/ajtes.v3i2.52 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Edvin Selmani ◽

Agron Dogjani

Keyword(s):

Ankle Joint ◽

Ankle Instability ◽

Donor Site ◽

Donor Site Morbidity ◽

Chronic Ankle Instability ◽

Arthroscopic Repair ◽

Anatomic Reconstruction ◽

Direct Repair ◽

Lateral Ankle Instability ◽

Short And Long Term

Treatment of chronic ankle instability remains a challenge for orthopedic surgeon. Surgical procedures for this disorder include anatomic direct repair, anatomic reconstruction with an autograft or allograft, and arthroscopic repair. Open direct repair is commonly used for patients with sufficient ligament quality. Reconstruction incorporating either an autograft or an allograft is another promising option in the short term, although the longevity of this procedure remains unclear. Use of an allograft avoids donor site morbidity, but it comes with inherent risks. Arthroscopic repair of chronic lateral ankle instability can provide good to excellent short- and long-term clinical outcomes, but the evidence supporting this technique is limited. Deterioration of the ankle joint after surgery is also a concern. Studies are needed on not only treating ligament insufficiency but also on reducing the risk of ankle joint deterioration.

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Chronic Lateral Ankle Instability: Results of Anatomic Repair with Polyester Tape Augmentation

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0013.9781 ◽

2020 ◽

Vol 22 (1) ◽

pp. 27-33

Author(s):

Islam Sarhan ◽

Islam Mubark ◽

Ahmed Waly

Keyword(s):

Ankle Sprain ◽

Ankle Instability ◽

Chronic Ankle Instability ◽

High Rate ◽

Anatomic Reconstruction ◽

Foot And Ankle ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Anatomic Repair ◽

Lateral Ankle Instability

Background. Ankle sprains are one of the most common injuries in both athletes and the general population. A major problem accompanying ankle injury is the high rate of recurrence, with about 20% of acute ankle sprain patients developing chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability usually needs surgical intervention. Various anatomic reconstruction techniques using the ruptured ends of the ligaments to restore stability have gained popularity. The purpose of this study was to evaluate the functional results of the treatment of chronic lateral ankle instability with anatomic repair of the injured ligaments and reinforcement with polyester tape. Material and methods. A prospective study of 30 consecutive patients who underwent anatomic reconstruction of the lateral ligaments using transosseous suturing and augmentation using a polyester tape done at a single centre by a single surgeon from 2016 to 2017. All patients were assessed preoperatively and postoperatively at 6 weeks, 3, 6 and 12 months. The American Orthopaedic Foot and Ankle Score (AOFAS) and Free Online Foot and Ankle Ability Measure (FAAM) were recorded and used for results analysis. Results. At 12 months’ follow-up, the AOFAS had improved from mean 52.47 ± 2.06 to 91.0 ± 6.03 (p< 0.001) .The FAAM mean score had improved from mean 55.21± 1.9 to 90.43 ± 4.02 Conclusion. The ankle ligament reconstruction with additional polyester tape augmentation is an effective technique in treating chronic ankle instability with a satisfactory surgical outcome.

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