Ultrasound Analysis of Lateral Ankle Ligaments in Functional Ankle Instability

The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor placement, suture technique, or both. In this research study, we propose placing a bone screw anchor into the lateral shoulder of the talus rather than the typical placement at the lateral malleolus for anatomic reconstruction of the lateral ankle ligaments. (J Am Podiatr Med Assoc 98(6): 473–476, 2008)

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Arthrogenic Muscle Inhibition in the Leg Muscles of Subjects Exhibiting Functional Ankle Instability

Foot & Ankle International ◽

10.1177/107110070502601210 ◽

2005 ◽

Vol 26 (12) ◽

pp. 1055-1061 ◽

Cited By ~ 97

Author(s):

Eric D. McVey ◽

Riann M. Palmieri ◽

Carrie L. Docherty ◽

Steven M. Zinder ◽

Christopher D. Ingersoll

Keyword(s):

Tibialis Anterior ◽

Ankle Instability ◽

H Reflex ◽

Functional Ankle Instability ◽

Injured Limb ◽

Lateral Ankle ◽

M Wave ◽

Muscle Inhibition ◽

Lateral Ankle Ligaments ◽

Arthrogenic Muscle Inhibition

Background: Functional ankle instability or a subjective report of “giving way” at the ankle may be present in up to 40% of patients after a lateral ankle sprain. Damage to mechanoreceptors within the lateral ankle ligaments after injury is hypothesized to interrupt neurologic feedback mechanisms resulting in functional ankle instability. The altered input can lead to weakness of muscles surrounding a joint, or arthrogenic muscle inhibition. Arthrogenic muscle inhibition may be the underlying cause of functional ankle instability. Establishing the involvement of arthrogenic muscle inhibition in functional ankle instability is critical to understanding the underlying mechanisms or chronic ankle instability. The purpose of this investigation was to determine if arthrogenic muscle inhibition is present in the ankle joint musculature of patients exhibiting unilateral functional ankle instability. Methods: Twenty-nine subjects, 15 with unilateral functional ankle instability and 14 healthy control subjects, consented to participate. Bilateral soleus, peroneal, and tibialis anterior H-reflex and M-wave recruitment curves were obtained. Maximal H-reflex and maximal M-wave values were identified and the H:M ratios were calculated for data analysis. Separate 1 × 2 ANOVA were done for both the functional ankle instability and control groups to evaluate differences between limbs on the H:M ratios. Bonferroni multiple comparison procedures were used for post hoc comparisons ( p ≤ 0.05). Results: The soleus and peroneal H:M ratios for subjects with functional ankle instability were smaller in the injured limb when compared with the uninjured limb (p < 0.05). No limb difference was detected for the tibialis anterior H:M ratio in the functional ankle instability group ( p = 0.904). No side-to-side differences were detected for the H:M ratios in patients reporting no history of ankle injury ( p > 0.05). Conclusions: Depressed H:M ratios in the injured limb suggest that arthrogenic muscle inhibition is present in the ankle musculature of patients exhibiting functional ankle instability. Establishing and using therapeutic techniques to reverse arthrogenic muscle inhibition may reduce the incidence of functional ankle instability.

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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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There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000362 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Ashish Shah ◽

Brent Cone ◽

Cesar de Cesar Netto ◽

Ibukunoluwa Araoye ◽

Parke Hudson ◽

...

Keyword(s):

Single Incision ◽

Ankle Instability ◽

Demographic Data ◽

Lateral Ligament ◽

Complication Rates ◽

Ligament Repair ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Significant Difference ◽

Lateral Ankle Ligaments

Category: Ankle Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair. Methods: This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test. Results: Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively. Conclusion: Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.

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The improvement of postural control in patients with mechanical ankle instability after lateral ankle ligaments reconstruction

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-015-3660-2 ◽

2015 ◽

Vol 24 (4) ◽

pp. 1081-1085 ◽

Cited By ~ 12

Author(s):

Hong-Yun Li ◽

Jie-Jiao Zheng ◽

Jian Zhang ◽

Ye-Hua Cai ◽

Ying-Hui Hua ◽

...

Keyword(s):

Postural Control ◽

Ankle Instability ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Lateral Ankle Ligaments

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Reconstruction of the Lateral Ankle Ligaments Using an Inferior Extensor Retinaculum Flap

Foot & Ankle International ◽

10.1177/107110079701801108 ◽

1997 ◽

Vol 18 (11) ◽

pp. 723-728 ◽

Cited By ~ 31

Author(s):

D. Saragaglia ◽

F. Fontanel ◽

E. Montbarbon ◽

Y. Tourné ◽

F. Picard ◽

...

Keyword(s):

Ankle Instability ◽

Chronic Ankle Instability ◽

X Rays ◽

Extensor Retinaculum ◽

Sports Activity ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Functional Instability ◽

Lateral Ankle Ligaments ◽

Inferior Extensor Retinaculum

The aim of this study was to assess the results of 32 cases of chronic ankle instability. These were treated by ligament shortening and reinforced with an inferior extensor retinaculum flap. All patients complained of persistent functional instability unrelieved with proprioceptive exercises. Results were assessed clinically (pain, instability, recovery of sports activity, mobility) and radiologically (correction of laxity on stress x-rays). This enabled us to draw up a revision score on a scale of 100 points. We obtained a mean score of 86.7 points (45–100 points), and subjective results showed that 88% of the patients were satisfied with the surgery.

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Strain patterns in normal anterior talofibular and calcaneofibular ligaments and after anatomical reconstruction using gracilis tendon grafts: A cadaver study

10.21203/rs.3.rs-197087/v1 ◽

2021 ◽

Author(s):

Masato Takao ◽

Danielle Lowe ◽

Satoru Ozeki ◽

Xavier M Oliva ◽

Ryota Inokuchi ◽

...

Keyword(s):

Ankle Instability ◽

Plantar Flexion ◽

Three Dimensional ◽

Anatomical Reconstruction ◽

Axial Motion ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Strain Measurements ◽

Relative Strain ◽

Lateral Ankle Ligaments

Abstract BackgroundInversion sprains of the lateral ankle ligaments often result in symptomatic lateral ankle instability, and some patients need lateral reconstruction surgeries to reduce pain, improve function, and prevent subsequent injuries. Although anatomically reconstructed ligaments should behave in a biomechanically normal manner, previous studies have not measured the strain patterns of the anterior talofibular (ATFL) and calcaneofibular ligaments (CFL) after anatomical reconstruction. This study aimed to measure the strain patterns of normal and reconstructed ATFL and CFLs using a miniaturization ligament performance probe (MLPP) system.MethodsThe MLPP was sutured into the ligamentous bands of the ATFLs and CTLs of three fresh-frozen, lower extremity, cadaveric specimens. Each ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N m force was applied to the ankle and subtalar joint complex.ResultsThe normal and reconstructed ATFLs exhibited maximal strain (100) during supination in three-dimensional motion. Although the normal ATFLs were not strained during pronation, the reconstructed ATFLs demonstrated relative strain values of 16–36. During axial motion, the normal ATFLs began to gradually tense at 0° plantarflexion, with the strain increasing, as the plantarflexion angle increased, to a maximal value (100) at 30° plantarflexion; the reconstructed ATFLs showed similar strain patterns. The normal CFLs exhibited maximum strain (100) during plantarflexion-abduction and relative strain measurements of 30–52 during dorsiflexion in three-dimensional motion. The reconstructed CFLs exhibited the most strain during dorsiflexion-adduction and demonstrated relative strain measurements of 29–62 during plantarflexion-abduction. During axial motion, the normal CFLs began to gradually tense at 20° plantarflexion and 5° dorsiflexion.ConclusionOur results showed that the strain patterns of reconstructed ATFLs and CFLs are not exactly the same as those in the normal ligaments.

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Influence of Ankle Ligaments on Tibial Rotation: An In Vitro Study

Foot & Ankle International ◽

10.1177/107110079601700204 ◽

1996 ◽

Vol 17 (2) ◽

pp. 79-84 ◽

Cited By ~ 18

Author(s):

Christian Sommer ◽

Beat Hintermann ◽

Benno M. Nigg ◽

Anton J. van den Bogert

Keyword(s):

Degrees Of Freedom ◽

Ankle Instability ◽

In Vitro Study ◽

Tibial Rotation ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Vertical Loading ◽

6 Degrees Of Freedom ◽

Lateral Ankle Ligaments

The purpose of this study was to clarify the role of the ankle ligaments in controlling the tibial rotation for different foot positions. A 6 degrees of freedom device was constructed for in vitro simulation of this movement transfer during the support phase of gait. Tibia rotation angle was measured for different foot positions and vertical loads, while the ligament integrity was modified. Data were collected from eight legs of four different cadavers. The results showed that vertical loading is unimportant to influence tibial rotation, while the lateral ankle ligaments have significant influence, especially during eversion. It was concluded that chronic partial or total lateral ankle instability may contribute to knee and foot injuries through abnormal tibial rotation.

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Reconstruction of the Lateral Ankle Ligaments with Allograft in Patients with Chronic Ankle Instability

Foot and Ankle Clinics ◽

10.1016/j.fcl.2006.05.003 ◽

2006 ◽

Vol 11 (3) ◽

pp. 597-605 ◽

Cited By ~ 71

Author(s):

Alessandro Caprio ◽

Francesco Oliva ◽

Fabio Treia ◽

Nicola Maffulli

Keyword(s):

Ankle Instability ◽

Chronic Ankle Instability ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Lateral Ankle Ligaments

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Lateral Ankle Ligament Repair: Evolution of Technique from Open to Arthroscopy

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1015 ◽

2014 ◽

Vol 1 (2) ◽

pp. 65-68

Author(s):

Kushal Nag ◽

Ken Jin Tan

Keyword(s):

Ankle Instability ◽

Surgical Techniques ◽

Asia Pacific ◽

Lateral Ligament ◽

Ligament Repair ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Lateral Ankle Ligaments

ABSTRACT One of the most common injuries of the lower extremity is the lateral ankle sprain. In recent years, with greater emphasis on physical fitness, the chronically painful and unstable lateral ankle is an increasing common clinical finding presenting to the outpatient clinic. If residual instability and pain is still present after a course of physiotherapy, the patient should be presented with surgical options to restore ankle stability. Several surgical techniques have been described for the treatment of chronic ankle instability. Recently, some authors have developed arthroscopic suture anchor techniques to repair the lateral ankle ligaments with excellent results. The authors’ aim is to give an overview of the various techniques for repair or reconstruction of the lateral ligament complex with special emphasis on the arthroscopic lateral ligament reconstruction. How to cite this article Nag K, Tan KJ. Lateral Ankle Ligament Repair: Evolution of Technique from Open to Arthroscopy. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):65-68.

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