The Effect of Lateral Ankle Ligament Repair in Muscle Reaction Time in Patients with Mechanical Ankle Instability

Objectives: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,188) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,141) or lateral ankle ligament reconstruction (n=1,063). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=219), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=325), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Average cost per patient was higher for both arthroscopy groups: repair with arthroscopy ($6,207.78) versus repair without arthroscopy ($3,677.11; p < 0.0001); reconstruction with arthroscopy ($5,758.21) versus reconstruction without arthroscopy ($4,601.13; p = 0.0039). There was a significantly higher proportion of patients with complications in the reconstruction without arthroscopy group than in the reconstruction with arthroscopy group (7.59%, 4.31%; p = 0.0431), but the difference between repair groups was insignificant (p = 0.0626). The proportion of patients with newly diagnosed intra-articular defects was significantly higher in both arthroscopy groups: repair with arthroscopy (53.0%) versus repair without arthroscopy (35.6%; p < 0.0001); reconstruction with arthroscopy (56.0%) versus reconstruction without arthroscopy (39.8%; p < 0.0001). There was a significantly higher proportion of patients who underwent reoperation for intra-articular defects in the combined (repair plus reconstruction) arthroscopy group (7.18%) than in the combined non-arthroscopy groups (4.91%; p = 0.049). Most importantly, the average time until reoperation for intra-articular defects was significantly shorter in the combined arthroscopy group (271.923 days) than in the combined non-arthroscopy group (411.473 days; p = 0.024). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was nearly 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.

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Concurrent arthroscopic osteochondral lesion treatment and lateral ankle ligament repair has no substantial effect on the outcome of chronic lateral ankle instability

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4774-5 ◽

2017 ◽

Vol 26 (10) ◽

pp. 3129-3134 ◽

Cited By ~ 8

Author(s):

Dong Jiang ◽

Yin-fang Ao ◽

Chen Jiao ◽

Xing Xie ◽

Lin-xin Chen ◽

...

Keyword(s):

Ankle Instability ◽

Osteochondral Lesion ◽

Substantial Effect ◽

Ligament Repair ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Ankle Ligament ◽

Lateral Ankle Instability ◽

Lateral Ankle Ligament ◽

Lesion Treatment

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Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00441 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0044

Author(s):

Yoshiharu Shimozono ◽

Eoghan Hurley ◽

John Kennedy

Keyword(s):

Clinical Outcomes ◽

Complication Rate ◽

Comparative Studies ◽

Ankle Instability ◽

Ligament Repair ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Ankle Ligament ◽

Lateral Ankle Instability ◽

Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: There has a been recent increase in the use of the arthroscopic approach to lateral ankle ligament repair for chronic lateral ankle instability. However, the clinical outcomes of this technique are still unclear. The purpose of this systematic review was to evaluate the current studies on arthroscopic lateral ankle ligament repair for chronic lateral ankle instability. Our hypothesis was that arthroscopic lateral ligament repair would result in excellent outcomes with a low complication rate. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases, based on the PRISMA guidelines, was performed during August 2017 by 2 independent reviewers. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. The weighted mean preoperative AOFAS score improved from 59.6 to 95.0 at a mean follow-up of 14.8 months in 8 studies. Five studies utilized Karlsson-Peterson scores with mean postoperative score of 88.5 at a mean follow-up of 21.2 months. Three comparative studies were reported. The comparative studies showed similar clinical outcomes between arthroscopic and open procedures. The overall complication rate was 13.4% in the included studies. . Only 2 studies reported patients returning to sport and demonstrated that 100% of patients returned to sport at pre-injury level. Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair yields favorable clinical outcomes in the short-term. However, there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure, and there is no long-term data currently available for the arthroscopic procedure. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates for both open and arthroscopic techniques.

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Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review and Meta-Analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00388 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0038

Author(s):

Yoshiharu Shimozono ◽

Alexandra J Brown ◽

Eoghan T Hurley ◽

John G Kennedy

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Ankle Instability ◽

Arthroscopic Repair ◽

Ligament Repair ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Ankle Ligament ◽

Lateral Ankle Instability ◽

Lateral Ankle Ligament

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Open modified Broström-Gould procedure is generally accepted as the gold-standard treatment for chronic lateral ankle instability. Recently an arthroscopic lateral ankle ligament repair technique has become increasingly popular in an effort to reduce post-operative pain and facilitate early recovery. The purpose of the current systematic review was to evaluate the current evidence on arthroscopic lateral ankle ligament repair techniques and to compare the clinical outcomes of arthroscopic and open techniques for chronic lateral ankle instability with meta-analysis. Methods: A systematic search of MEDLINE and EMBASE databases was performed during August 2017. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Variable reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Comparative studies were compared using RevMan version 5.3, and a p-value of < 0.05 was considered statistically significant. Results: Twelve studies for a total of 421 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. There were three comparative studies of open and arthroscopic repair procedures, with two Level III studies and one Level I study. There was a significant difference in favor of arthroscopic repair at final follow-up for the Karlsson- Peterson score (MD; 2.59, 95%CI, -0.19 to 2.36, I2=0%, p=0.10) and the AOFAS score (MD; 1.50, 95%CI, 0.41 to 2.59, I2=0%, p=0.007) in the comparative studies. The overall complication rate was 13.4% in the included studies but in the comparative studies there was no statistically significant difference between open and arthroscopic repair (12.1% vs 11.4%, p=0.90). Conclusion: The current systematic review demonstrated that arthroscopic lateral ankle ligament repair may yield favorable clinical outcomes and may be superior to open procedure in the short-term, but there is no clinical evidence to support the advantages of the arthroscopic procedure over the open procedure in the mid- long-term follow-up. There was a relatively high complication rate associated with the arthroscopic procedures, with a 13.4% complication rate, although recent comparative studies demonstrated similar complication rates.

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Early versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Repair: A Systematic Review and Meta-analysis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00077 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0007

Author(s):

Matthew L. Vopat ◽

Armin Tarakemeh ◽

Brandon Morris ◽

Maaz Hassan ◽

Pat Garvin ◽

...

Keyword(s):

Ankle Instability ◽

Meta Analysis ◽

Return To Sport ◽

Early Mobilization ◽

Lateral Ligament ◽

Ligament Repair ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Primary Lateral

Category: Ankle, Sports, Post-op protocol Introduction/Purpose: Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. Some patients, however, experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization which can include primary lateral ligament repair to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament repairs remains unknown, as surgeon vary in how they balance protection of surgical repair with immobilization with the need for ankle joint mobilization to restore range of motion. The aim of this review is to provide insight into early and delayed mobilization post- operative protocols in patients undergoing primary lateral ankle ligament repairs to determine if an optimal evidence-based post- operative rehabilitation protocol exists in the literature. Methods: Following PRIMSA criteria, a meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947- 10/16/2017). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical and non-English language were excluded. Protocols were reviewed and divided into two categories; early mobilization (within 3 weeks of surgery) and delayed mobilization (after 4 weeks of surgery). Return to sport, outcome scores (AOFAS, Karlsson scores) and complications of both populations were recorded and statistically analyzed. Results: 31 out of 1,844 studies met the criteria for the final analysis, representing 1,608 patients undergoing primary lateral ligament repair. There was no statistical difference in pre-operative AOFAS scores with delayed mobilization having a score of 67.3 and early mobilization having a score of 67.6 (p<0.639). There was statistical significance in the post-operative AOFAS score comparing delayed mobilization group versus early mobilization group with 91.8 versus 98.8, respectively (p<0.001) and post- operative Karlsson scores with values of 90.0 vs. 92.2 in delayed versus early respectively (p<0.001). Return to sport in the delayed group was 11.8 weeks versus 10.9 in early (p<0.044). No significant difference was found in complication rates between groups with delayed having a rate of 3.7% and early 4.8% (p<0.389). Conclusion: Patients may benefit from early mobilization protocols after lateral ankle ligament repair. The early mobilization protocols group had improved functional outcomes and decreased time until return to sport without a difference in complications. More studies are needed to definitively evaluate early versus delayed rehabilitation protocols due to heterogeneity of the studies.

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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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Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00206 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0020

Author(s):

G. Matthew Heenan ◽

Kisan Parikh ◽

Armin Tarakemeh ◽

J. Paul Schroeppel ◽

Scott Mullen ◽

...

Keyword(s):

Ankle Sprain ◽

Ankle Instability ◽

Newly Diagnosed ◽

Ligament Repair ◽

Chronic Instability ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Articular Pathology ◽

Lateral Ankle Ligament Reconstruction

Category: Ankle, Arthroscopy Introduction/Purpose: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,428) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,236) or lateral ankle ligament reconstruction (n=1,211). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=314), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=473), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Cost was higher for arthroscopy groups: repair with arthroscopy ($5,991.32) versus repair without arthroscopy ($3,677.11; p<0.001); reconstruction with arthroscopy ($5,744.83) versus reconstruction without arthroscopy ($4,601.13; p=0.001). Proportionately more patients had complications in the repair without arthroscopy group than in the repair with arthroscopy group (9.87%, 5.41%; p=0.013). Proportionately more patients had newly-diagnosed intra-articular defects in arthroscopy groups: repair with arthroscopy (57.0%) versus repair without arthroscopy (35.6%; p<0.001); reconstruction with arthroscopy (63.0%) versus reconstruction without arthroscopy (39.8%; p<0.001). Proportionately more patients underwent reoperation for intra-articular defects in the combined arthroscopy group (6.89%) than in the combined non-arthroscopy group (4.18%; p=0.006). The average time until reoperation for intra-articular defects was shorter in the combined arthroscopy group (302.536 days) than in the combined non-arthroscopy group (473.886 days; p=0.045). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was over 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.

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Sex-Specific Differences Following Lateral Ankle Ligament Repair

Foot & Ankle International ◽

10.1177/10711007211004191 ◽

2021 ◽

pp. 107110072110041

Author(s):

Ezra Goodrich ◽

Matthew L. Vopat ◽

Jordan Baker ◽

Armin Tarakemeh ◽

Kimberly Templeton ◽

...

Keyword(s):

Success Rate ◽

Ankle Instability ◽

Postoperative Outcomes ◽

Lateral Ligament ◽

Ligament Repair ◽

Lateral Ankle ◽

Ankle Ligament ◽

Lateral Ankle Ligament ◽

Males And Females ◽

Primary Lateral

Background: Chronic ankle instability is a common condition that can be treated with lateral ankle ligament repair. These procedures have a reported success rate greater than 85% in the literature, but little has been reported about the differences in postoperative outcomes between males and females. The purpose of this study was to evaluate sex-specific outcomes following lateral ankle ligament repair. Methods: In this systematic review and meta-analysis, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria to search for articles on electronic databases and included studies in which study participants underwent primary lateral ligament repair and sex-specific outcomes were evaluated. Functional postoperative outcomes for males and females were recorded and statistically analyzed. Results: Out of 2768 studies, 7 (0.25%) met inclusion criteria and were analyzed in this review. These studies included 618 patients (402 males [65%] and 216 females [35%]) who underwent primary lateral ligament repair for ankle instability. Karlsson score ( P = .1582) and American Orthopaedic Foot & Ankle Society (AOFAS) score ( P = .1586) analyses found no statistically significant difference between males and females. Postoperative success rate—defined as a “good” or “excellent” Karlsson score (>81)—was not found to be significantly different between males and females ( P = .9374). Conclusion: There was no difference in postoperative mean Karlsson scores, AOFAS scores, or success rates between males and females who underwent primary lateral ankle ligament repair. Level of Evidence: Level IV, therapeutic.

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