Modified Broström Procedure for Chronic Ankle Instability With Generalized Joint Hypermobility

2016 ◽  
Vol 44 (4) ◽  
pp. 1011-1016 ◽  
Author(s):  
Bingzhe Huang ◽  
Yong Tae Kim ◽  
Jung Uk Kim ◽  
Jung Hoon Shin ◽  
Yong Wook Park ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Joint Hypermobility ◽  
Generalized Joint Hypermobility ◽  
Modified Broström Procedure

scholarly journals The Effect of Peroneal Muscle Strength on Functional Outcomes After the Modified Broström Procedure for Chronic Ankle Instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Muscle Strength ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Peak Torque ◽  
Chronic Ankle Instability ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Patient Reported ◽  
Functional Outcome Measures ◽  
Modified Broström Procedure

Category: Sports Introduction/Purpose: Although the peroneal muscle is known to be a major dynamic lateral stabilizer of the ankle, few informations are available regarding the changes of muscle strength and relationship with the outcomes after lateral ligaments repair surgery. The purpose of this study was to identify the effects of peroneal strength on the validated functional outcome measures after the modified Broström procedure(MBP) for chronic ankle instability. Methods: Forty-one patients (41 ankles) underwent MBP using suture anchors were eligible and followed up to 2 years postoperatively. Functional evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM). The changes of peroneal strength were evaluated using isokinetic dynamometer. Differences in the functional outcomes between the 3 groups divided according to recovery rate of peroneal strength were analysed. Results: Peak torque and total work for eversion in 60º/sec angular velocity significantly improved from a mean 8.1 Nm, 5.2 Nm preoperatively to 11.4 Nm, 6.9 Nm at postoperative 2 years, respectively (P < .001, P = .038). Deficit ratio of peak torque for eversion significantly improved from a mean 38.6% to 17.4%, and a significant side to side difference was found (P = .011). There were no significant differences in FAOS, FAAM, and measurements of stress radiograph between the 3 groups. Conclusion: Although restoration of peroneal strength postoperatively was about 82.6% of unaffected ankle, patient-reported function in daily and sport activities were satisfactorily improved. Postoperative isokinetic strength of the peroneus demonstrated no statistically significant effects on the functional outcomes after MBP.

scholarly journals Evaluation of the Anterior Talofibular Ligament by Stress Ultrasound for Assessing Generalized Joint Hypermobility

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0045
Author(s):  
Jaehwang Song ◽  
Chan Kang ◽  
Je Hyung Jeon ◽  
Chang Uk Ham
Keyword(s):  
Ankle Joint ◽  
Ankle Instability ◽  
Plantar Flexion ◽  
Joint Hypermobility ◽  
Anterior Talofibular Ligament ◽  
Specific Method ◽  
Ultrasound Images ◽  
Beighton Score ◽  
Generalized Joint Hypermobility ◽  
Ultrasound Parameters

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Chronic ankle instability with generalized joint hypermobility (GJH) is considered a relative contraindication for the modified Bröstrom procedure. Most clinicians use the Beighton score to assess GJH. However, the Beighton score itself does not involve investigation of the ankle joint. In our experience, resting, longitudinal ultrasound images of the uninjured, intact ATFL frequently show a loose, wavy pattern in patients with high Beighton scores. We evaluated anterior talofibular ligament (ATFL) status according to Beighton score and the manual anterior drawer test (ADT). It was hypothesized that the value of ultrasound for ATFL would be significantly different between participants with GJH (Beighton score >= 5) and without GJH and show a correlation with participant’s Beighton scores and manual ADT grades. Methods: Forty-four healthy young patients (44 ankles) aged 20 to 40 years and without a history of ankle trauma or disease were included in the study. To assess GJH and ankle instability, Beighton scores and manual ADT grades were evaluated, respectively. For the investigation of ATFL, resting and stress ultrasonography were performed to assess its length, height, and thickness. Ultrasound images were taken in resting position and during maximal plantar-flexion and inversion (Figure: Ultrasound images of the ATFL in (a) the resting position and (b) stress position in a 21-year-old woman with Beighton score of 9. Dotted red line: Length, Yellow line: Height, Green double-headed arrow: Thickness). Beighton scores, manual ADT grades, and ultrasound parameters of participants with and without GJH were compared and the correlation coefficients among Beighton scores, manual ADT grades, and the length, height, and thickness of resting and stress ATFLs were analyzed. Results: The participants were divided into two groups, those without GJH (24 ankles) and with GJH (20 ankles). Mean Beighton scores and manual ADT grades were significantly different between the two groups (P < .05). The mean length, height of resting, stress ATFL and mean difference in height between resting and stress ATFL were significantly different between the two groups (P < .05). The resting and stress ATFL length, height, and difference in height between resting and stress ATFL showed a moderately positive linear relationship with Beighton scores and manual ADT grades (P < .05). Among the ATFL parameters, resting ATFL height showed the strongest relationship with the Beighton score (r = 0.763, P < .001) and ADT grade (r = 0.763, P < .001). Conclusion: The ATFL stress ultrasound parameters showed significant differences between participants with high and low Beighton scores and were correlated with Beighton scores and manual ADT grades. We believe that this ankle joint specific method might provide significant, quantitative parameters for assessing GJH in addition to the Beighton score.

The Effect of Peroneal Muscle Strength on Functional Outcomes After the Modified Broström Procedure for Chronic Ankle Instability

2017 ◽  
Vol 39 (1) ◽  
pp. 105-112 ◽  
Author(s):  
Byung-Ki Cho ◽  
Ji-Kang Park ◽  
Seung-Myung Choi ◽  
Nelson F. SooHoo
Keyword(s):  
Muscle Strength ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Case Series ◽  
Peak Torque ◽  
Chronic Ankle Instability ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Patient Reported ◽  
Modified Broström Procedure

Background: Although the peroneal muscles are known to be the major dynamic lateral stabilizers of the ankle, little information is available regarding the change in muscle strength and relation with the outcomes after lateral ligament repair surgery. The purpose of this study was to identify the effects of peroneal strength on the validated functional outcome measures after the modified Broström procedure (MBP) for chronic ankle instability. Methods: Forty-one patients (41 ankles) who underwent MBP using suture anchors were eligible and followed up to 2 years postoperatively. Functional evaluation consisted of the Foot and Ankle Outcome Score (FAOS), and Foot and Ankle Ability Measure (FAAM). The changes of peroneal strength were evaluated using an isokinetic dynamometer. Differences in the functional outcomes between the 3 groups divided according to the recovery rate of peroneal strength were analyzed. Results: Peak torque and total work for eversion in 60 degrees/s angular velocity significantly improved from a mean 8.1 and 5.2 Nm preoperatively to 11.4 and 6.9 Nm at postoperative 2 years, respectively ( P < .001, P = .038). The deficit ratio of peak torque for eversion significantly improved from a mean 38.6% to 17.4%, and a significant side-to-side difference was found ( P = .011). There were no significant differences in FAOS, FAAM, and measurements of stress radiograph between the 3 groups. Conclusions: Although restoration of peroneal strength postoperatively was about 82.6% of the unaffected ankle, patient-reported function in daily and sport activities were satisfactorily improved. Postoperative isokinetic strength of the peroneals demonstrated no statistically significant effects on the functional outcomes after MBP. Level of Evidence: Level III, prospective comparative case series.

Outcome Following a Modified Broström Procedure and Arthroscopic Debridement of Medial Gutter Osteoarthritis Combined With Chronic Ankle Instability

2018 ◽  
Vol 39 (12) ◽  
pp. 1473-1480 ◽  
Author(s):  
Byung-Ki Cho ◽  
Young-Duck Shin ◽  
Hyun-Woo Park
Keyword(s):  
Operative Treatment ◽  
Ankle Instability ◽  
Case Series ◽  
Chronic Ankle Instability ◽  
Arthroscopic Debridement ◽  
Limited Information ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Aged Patients ◽  
Modified Broström Procedure

Background: There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic ankle instability. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively ( P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.5 points ( P < .001), 8 patients (36.4%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression of arthritis stage. Conclusions: Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability. Level of Evidence: Level IV, retrospective case series.

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