scholarly journals Return to sport following lateral ankle ligament repair is under-reported: a systematic review

2017 ◽  
Vol 2 (5) ◽  
pp. 234-240 ◽  
Author(s):  
Kenneth J Hunt ◽  
Richard S Fuld ◽  
Brittan S Sutphin ◽  
Helder Pereira ◽  
Pieter D’Hooghe
Keyword(s):  
Systematic Review ◽  
Return To Sport ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

2020 ◽  
Vol 13 ◽  
pp. 152-159 ◽  
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Megan Bechtold ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Return To Sport ◽  
Full Weight Bearing ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Operative Care ◽  
Ankle Ligament ◽  
Rehabilitation Protocols ◽  
Lateral Ankle Ligament ◽  
Suture Tape

Introduction. Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study was to analyze and assess the variability across different rehabilitation protocols for patients undergoing either lateral ankle ligament repair, reconstruction, and suture tape augmentation. Methods. Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Inclusion criteria were protocols for post-operative care after an ankle ligament surgery (repair, reconstruction, or suture tape augmentation). Protocols for multi-ligament surgeries and non-operative care were excluded. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weight-bearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. Results. Twenty-six protocols were analyzed. There was variability across rehabilitation protocols for lateral ankle ligament operative patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. All (12/12) repair, internal brace, and unspecified protocols and 86% (12/14) of reconstruction protocols recommended no ROM immediately postoperatively. Eighty-six percent (6/7) of repair and 78% (11/14) of reconstruction protocols recommended no weight-bearing immediately after surgery, making post-operative ROM and weight-bearing status the most consistent aspects across protocols. Five protocols allowed post-operative weight-bearing in a cast to keep ROM restricted. Sixty-six percent (2/3) of suture tape augmentation protocols allowed full weight-bearing immediately post-operatively. Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker time-line with full weight-bearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3) protocols. RTS was consistent in repair protocols (100% at week 12-16) but varied more in reconstruction. Conclusion. There is significant variability in the post-operative protocols after surgery for ankle instability. ROM was highly variable across protocols and did not always match-up with supporting literature for early mobilization of the ankle. Return to sport was most likely to correlate between protocols and the literature. Weight-bearing was consistent between most protocols but requires further research to determine the best practice. Overall, the variability between programs demonstrated the need for standardization of rehabilitation protocols.

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

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.

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

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.

scholarly journals Early Versus Delayed Mobilization Postoperative Protocols for Lateral Ankle Ligament Repair: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092525 ◽  
Author(s):  
Matthew L. Vopat ◽  
Armin Tarakemeh ◽  
Brandon Morris ◽  
Maaz Hassan ◽  
Pat Garvin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Talar Tilt ◽  
Primary Lateral

Background: The majority of patients with an acute lateral ankle ligamentous injury are successfully treated nonoperatively with functional rehabilitation; however, a small proportion of these patients experience persistent chronic instability and may require surgical intervention. Delayed primary repair of the ruptured ligaments is most commonly indicated for these patients. Optimal rehabilitation after lateral ankle ligament repair remains unknown, as surgeons vary in how they balance protection of the surgical repair site with immobilization against the need for ankle joint mobilization to restore optimal postoperative ankle range of motion. Purpose: To compare early and delayed mobilization (EM and DM, respectively) postoperative protocols in patients undergoing primary lateral ankle ligament repair to determine optimal evidence-based rehabilitation recommendations. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a meta-analysis using the PubMed/Ovid MEDLINE database was performed (October 11, 1947 to October 16, 2017), searching for articles involving lateral ankle ligament repair. Postoperative protocols were reviewed and divided into 2 categories: EM (within 3 weeks of surgery) and DM (more than 3 weeks post surgery). Return to sport (RTS), outcome scores (American Orthopaedic Foot and Ankle Society [AOFAS] ankle-hindfoot scale and Karlsson score), radiographic outcomes (talar tilt and anterior drawer), and complications of both populations were recorded and statistically analyzed. Results: A total of 28 of 1574 studies met the criteria for the final analysis, comprising 1457 patients undergoing primary lateral ankle ligament repair. The postoperative AOFAS score was significantly greater in the EM versus DM group (98.8 vs 91.9, respectively; P < .001), as was the postoperative Karlsson score (92.2 vs 90.0, respectively; P < .001). However, the EM group had significantly greater postoperative laxity on both the anterior drawer test (6.3 vs 3.9 mm, respectively; P < .001) and talar tilt test (5.1° vs 4.5°, respectively; P < .001). Also, the DM group had significantly lower rates of overall complications (3.1% vs 11.4%, respectively; P < .001) and skin wound complications (1.3% vs 3.8%, respectively; P = .005). RTS was not significantly different between groups ( P = .100). Conclusion: Patients with EM postoperative protocols demonstrated improved functional outcomes; however, the EM group had increased objective laxity and a higher complication rate. Additional randomized studies are needed to definitively evaluate early versus delayed rehabilitation protocol timetables to optimize functional outcomes without compromising long-term stability.

Optimal suture anchor direction in arthroscopic lateral ankle ligament repair

2017 ◽  
Vol 26 (7) ◽  
pp. 2110-2115 ◽  
Author(s):  
Ichiro Yoshimura ◽  
Tomonobu Hagio ◽  
Masahiro Noda ◽  
Kazuki Kanazawa ◽  
So Minokawa ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

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

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
G. Matthew Heenan ◽  
Kisan B. Parikh ◽  
Armin Tarakemeh ◽  
Scott M. Mullen ◽  
John Paul Schroeppel ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Newly Diagnosed ◽  
Ligament Repair ◽  
Chronic Instability ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
The Difference ◽  
Articular Pathology

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.

scholarly journals Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Megan Bechtold ◽  
...  
Keyword(s):  
Return To Sport ◽  
Ankle Sprains ◽  
Inclusion Criteria ◽  
Lateral Ankle ◽  
Ankle Stability ◽  
Ankle Ligament ◽  
Rehabilitation Protocols ◽  
Lateral Ankle Ligament ◽  
Leg Exercise ◽  
Suture Tape

Category: Ankle; Sports Introduction/Purpose: Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study is to analyze the variability across rehabilitation for patients undergoing lateral ankle ligament repair, reconstruction, or suture tape augmentation. Methods: 26 protocols were found. Inclusion criteria was protocols for ankle ligament surgery. Protocols for nonoperative care were excluded. A rubric was created to analyze weightbearing, range of motion (ROM), immobilization, single leg exercises, return to running, and return to sport (RTS). Results: There was variability especially in recommendations for immobilizing brace, partial and full weigh bearing, specific ROM movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement. 100% (12/12) of repair and 86% (12/14) of reconstruction protocols recommended no ROM postoperatively, and 86% (6/7) repair and 78% (11/14) reconstruction recommended no weightbearing postoperatively, making postoperative ROM and weightbearing status the most consistent aspects across protocols. Suture tape augmentation protocols generally allowed rehabilitation on a quicker timeline with full weightbearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3). RTS was consistent in repair protocols (100% at week 12-16). Conclusion: ROM was variable across protocols and did not always match up with supporting literature. Return to sport was likely to correlate between protocols and the literature. Weightbearing was consistent between protocols. The variability between programs demonstrated the need for standardization of rehabilitation.

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