Is Internal brace augmentation a gold standard treatment compared to Isolated Modified Brostrom Gould repair for Chronic Lateral ligament Ankle Instability: Effect on functional outcome and Return to preinjury activity. A Retrospective analysis

The Foot ◽  
2021 ◽  
pp. 101865
Author(s):  
Nimesh P. Jain ◽  
Brijesh Ayyaswamy ◽  
Alexandra Griffiths ◽  
Elizabeth Alderton ◽  
Milosz Kostusiak ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Retrospective Analysis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Ankle Instability ◽  
Lateral Ligament ◽  
Instability Effect ◽  
Internal Brace

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

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.

scholarly journals Arthroscopic Internal Brace Augmentation With Arthroscopic Modified Broström Operation for Chronic Ankle Instability

2021 ◽  
Author(s):  
Akinobu Nishimura ◽  
Shigeto Nakazora ◽  
Yoshiyuki Senga ◽  
Yukie Kitaura ◽  
Aki Fukuda ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Internal Brace

Time to abandon the old dictum of delayed laparoscopic cholecystectomy after acute cholecystitis has settled in Caribbean practice

2021 ◽  
pp. 004947552110100
Author(s):  
Shamir O Cawich ◽  
Avidesh H Mahabir ◽  
Sahle Griffith ◽  
Patrick FaSiOen ◽  
Vijay Naraynsingh
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Gold Standard ◽  
Standard Treatment ◽  
Gallstone Disease ◽  
Acute Attack ◽  
Early Laparoscopic Cholecystectomy ◽  
Delayed Surgery ◽  
Delayed Cholecystectomy ◽  
Delayed Laparoscopic Cholecystectomy

Although laparoscopic cholecystectomy is the gold standard treatment for acute cholecystitis, many Caribbean surgeons are reluctant to operate during the acute attack. We collected data for all consecutive patients who underwent laparoscopic cholecystectomy for acute cholecystitis from January 1 to 31 December 2018. Delayed cholecystectomy was done >6 weeks after acute cholecystitis settled. We compared data between early and delayed groups. Delayed laparoscopic cholecystectomy was performed in 54 patients, and 42 had early laparoscopic cholecystectomy. Delayed surgery resulted in significantly more complications requiring readmission (39% vs 0), longer operations (2.27 vs 0.94 h) and lengthier post-operative hospitalisation (1.84 vs 1.1 days). Caribbean hospitals should abandon the practice of delayed surgery after cholecystitis has settled. Early laparoscopic cholecystectomy would be financially advantageous for our institutions, and it would save patients recurrent attacks of gallstone disease.

scholarly journals Delayed unilateral pneumocephalus after bilateral endoscopic dacryocystorhinostomy in an elderly patient

2021 ◽  
Vol 14 (5) ◽  
pp. e241540
Author(s):  
Jaekyoung Lee ◽  
Dong Cheol Lee
Keyword(s):  
Elderly Patient ◽  
Cerebrospinal Fluid ◽  
Gold Standard ◽  
Standard Treatment ◽  
Nasolacrimal Duct ◽  
Intravenous Antibiotic ◽  
Duct Obstruction ◽  
Orbital Wall ◽  
Silicone Intubation ◽  
Endoscopic Dcr

Dacryocystorhinostomy (DCR) is the ‘gold standard’ treatment for nasolacrimal duct obstruction (NLDO). However, despite its recent technical advancements, complications are possible. Herein, to the best of our knowledge, we present the first reported case of delayed unilateral pneumocephalus after bilateral endoscopic DCR. An 85-year-old man with bilateral NLDO underwent endoscopic DCR with silicone intubation. After 1 month, he became lethargic and was admitted to emergency room. Brain CT demonstrated left pneumocephalus and a suspected microfistula in left orbital wall. Intravenous antibiotic therapy was started, and cerebrospinal fluid studies showed no evidence of meningitis. After 13 days of antibiotic treatment, his mental state recovered with no signs of pneumocephalus. Although DCR has high success rate and is relatively safe, surgeons should be aware of the risk, although low, of pneumocephalus, especially in elderly patients who are vulnerable to fractures and who exhibit headache or mental status changes after endoscopic DCR.

scholarly journals Local Chemotherapy as an Adjuvant Treatment in Unresectable Squamous Cell Carcinoma: What Do We Know So Far?

2021 ◽  
Vol 28 (4) ◽  
pp. 2317-2325
Author(s):  
Luigi Bennardo ◽  
Francesco Bennardo ◽  
Amerigo Giudice ◽  
Maria Passante ◽  
Stefano Dastoli ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Gold Standard ◽  
Systemic Chemotherapy ◽  
Standard Treatment ◽  
Case Reports ◽  
Case Series ◽  
Surgical Removal ◽  
Local Chemotherapy

Background: Squamous cell carcinoma (SCC) is one of the most common cancers involving skin and oral mucosa. Although this condition’s gold-standard treatment is the surgical removal of the lesions, the physician must propose alternative treatments in some cases due to the patient’s ineligibility for surgery. Among the available alternative therapies, local chemotherapy may represent an initial treatment in combination with radiotherapy or systemic chemotherapy due to the low frequency of side-effects and the lack of necessity for expensive devices. Methods: In this paper, we review all available literature in various databases (PubMed, Scopus-Embase, Web of Science), proposing local chemotherapy as a treatment for cutaneous and oral SCC. Exclusion criteria included ocular lesions (where topical treatments are common), non-English language, and non-human studies. Results: We included 14 studies in this review. The majority were case reports and case series describing the treatment of non-resectable localized SCC with either imiquimod or 5-fluorouracil. We also analyzed small studies proposing combination treatments. Almost all studies reported an excellent clinical outcome, with a low risk of relapses in time. Conclusions: Resection of the lesion remains the gold-standard treatment for SCC. When this approach is not feasible, local chemotherapy may represent a treatment alternative, and it may also be associated with radiotherapy or systemic chemotherapy.

Treatment of vertigo and postural instability using visual illusions

2014 ◽  
Vol 128 (11) ◽  
pp. 1005-1007 ◽  
Author(s):  
G van Kerckhoven ◽  
A Mert ◽  
J A De Ru
Keyword(s):  
Gold Standard ◽  
Prosthetic Valve ◽  
Standard Treatment ◽  
Vestibular Function ◽  
Prosthetic Valve Endocarditis ◽  
Postural Instability ◽  
Risk Of Falling ◽  
Important Advance ◽  
Dizziness Handicap Inventory ◽  
Increased Risk

AbstractBackground:Ototoxicity caused by medication can lead to debilitating symptoms such as dizziness, vertigo and postural instability. There is no current ‘gold standard’ treatment available.Case report:A 79-year-old male, with bilateral loss of vestibular function caused by gentamicin toxicity after surgery for prosthetic valve endocarditis, complained of dizziness, difficulty in walking and an increased risk of falling. Physical examination showed a positive head thrust test suggesting bilateral loss of vestibular function.Results:The patient underwent a specific motion-based virtual reality enhanced protocol for peripheral vestibular disease. He showed a great improvement, with a 50 per cent reduction in his Dizziness Handicap Inventory score.Conclusion:Computer-aided rehabilitation programmes might represent an important advance in gait and posture training.

scholarly journals Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Jakob Ackermann ◽  
Fabio A. Casari ◽  
Christoph Germann ◽  
Lizzy Weigelt ◽  
Stephan H. Wirth ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Ankle Instability ◽  
Lesion Size ◽  
Lateral Ligament ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

scholarly journals Early Outcomes of Arthroscopic Modified Brostrom Operation for Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Dong-Woo Shim ◽  
Yeokgu Hwang ◽  
Yoo Jung Park ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcomes ◽  
Gold Standard ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Vas Score ◽  
Lateral Ankle Instability ◽  
Talar Tilt ◽  
Outcome Evaluations ◽  
Modified Broström Procedure

Category: Ankle, Arthroscopy Introduction/Purpose: The gold standard for the surgical treatment of chronic lateral ankle instability is the modified Brostrom procedure. Surgery aims to re-establish ankle stability and function, without compromising ankle motion. Recently introduced all inside arthroscopic modified Brostrom procedure coincide with the goal on that aspect. The purpose of this study was to investigate the early outcomes of all inside arthroscopic modified Brostrom operation for chronic ankle instability. Methods: From January 2015 to August 2016, 30 patients were included. The visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, Foot and Ankle Outcome Score (FAOS), and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Clinical outcome evaluations were performed preoperatively, at 3 months and 6 months postoperatively, and at a final follow-up using the VAS score, the AOFAS ankle-hindfoot score, FAOS, and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: Thirty patients (19 males and 11 females) were followed up for a mean of 11.0 (range 4 – 23) months. The VAS, AOFAS, 1 FAOS subscale (Quality-of-life) and the Karlsson scores were improved significantly at the each follow-up period of 3 month, 6 month and 1 year postoperatively. Other 4 subscales of FAOS showed no significant outcomes (Table 1). The mean anterior talar translation and talar tilt showed significant improvements from 5.8 mm (SD = 0.4) and 7.9° (SD = 1.0) to 5.3 mm (SD = 0.3) and 5.7° (SD = 0.6) at the final follow-up each (p = 0.034, p=0.034). Conclusion: The arthroscopic modified Brostrom technique could be a viable alternative to the gold-standard open modified Brostrom procedure for anatomic repair of chronic lateral ankle instability. It can yield outstanding functional and clinical outcomes without adverse effects in terms of pain.

Sign in / Sign up

Export Citation Format

Share Document