Generalized Ligamentous Laxity Is an Independent Predictor of Poor Outcomes After the Modified Broström Procedure for Chronic Lateral Ankle Instability

2016 ◽  
Vol 44 (11) ◽  
pp. 2975-2983 ◽  
Author(s):  
Kwang Hwan Park ◽  
Jin Woo Lee ◽  
Jae Wan Suh ◽  
Myung Ho Shin ◽  
Woo Jin Choi
Keyword(s):  
Independent Predictor ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ligamentous Laxity ◽  
Lateral Ankle Instability ◽  
Poor Outcomes ◽  
Modified Broström Procedure

scholarly journals A Retrospective Chart Review to Examine Failed Modified Brostrom Procedures for Chronic Lateral Ankle Instability

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Kaitlyn Rizzo ◽  
Greggory Brandle ◽  
Nicholas A. Cheney ◽  
Brian C. Clark
Keyword(s):  
Chart Review ◽  
Ankle Instability ◽  
Retrospective Chart Review ◽  
Tilt Test ◽  
Recurrent Instability ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Modified Broström Procedure

Category: Ankle; Other Introduction/Purpose: Recurrent ankle injuries can lead to chronic ankle instability requiring surgical stabilization. Since the anterior talofibular ligament (ATFL) is the weakest of the lateral ankle ligaments, repair is often required in cases of chronic lateral ankle instability. Damage to the calcaneofibular ligament (CFL) is less common than the ATFL, but additional repair of it in these cases may be necessary to avoid this recurrent instability. A modified Brostrom procedure has been a widely accepted surgical approach to chronic lateral ankle instability if conservative measures fail. However, cases of recurrent instability even after initial stabilization surgery can present. The purpose was to examine reasoning for and rate of revision surgeries attempting to fix chronic lateral ankle instability as it relates to the ATFL and CFL integrity. Methods: A retrospective chart review was conducted to assess outcomes of a modified Brostrom procedure to determine underlying reasoning of the need for revision surgery by utilizing results of the anterior drawer and varus tilt tests. The files of these patients were examined via electronic health records to determine the reasoning for surgery. The preoperative and postoperative results of the anterior drawer test (ADT) and varus tilt test were used to examine ATFL and CFL integrity, respectively, in addition to operative notes. Results: 172 patients met criteria having undergone a modified Brostrom dual ligament repair procedure for lateral ankle instability by a single orthopedic foot and ankle surgeon. With a 3.49% revision rate in the patient population, the only similarity found in all of the patients was the presence of a positive varus tilt test indicating the CFL was a major contributor of failed correction via the modified Brostrom procedure. One patient had a positive ADT, and one had a mildly positive ADT. These ADT and varus tests were performed at various time points in the care of the patients. The average length between surgeries was calculated to be 624.2 days. This revision rate is higher than past studies but was limited to a few years under examination. Conclusion: In conclusion, the anterior drawer and varus tilt tests are utilized to determine the integrity of the ATFL and CFL in the lateral ankle ligament complex. In failed modified Brostrom procedures examined, the positive result was consistently in the varus tilt test, indicating that the CFL is the ligament most affected in these patients requiring additional surgery. However, these physical exam tests are only one way to examine the ankle and do not take additional pathologies of the lateral ankle into account. Additional studies are needed to examine long-term outcomes of the modified Brostrom procedure and reasoning for failure.

scholarly journals Comparison of Clinical Outcomes in Patients with Generalized Ligamentous Laxity and without Generalized Laxity in the Arthroscopic Modified Broström Operation for Chronic Lateral Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
YoungKoo Lee ◽  
Jungwoo Yoo ◽  
Keon Hee Yun ◽  
Ji Yong Park
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Tilt Angle ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ligamentous Laxity ◽  
Lateral Ankle Instability ◽  
Talar Tilt

Category: Sports Introduction/Purpose: The arthroscopic modified Broström operation (MBO) has been developed and frequently used to treat chronic lateral ankle instability (CLAI). Clinical outcome of arthroscopic MBO was reported as good or excellent. But there were no report about comparison of clinical outcomes between patients with generalized ligamentous laxity (laxity) and without generalized ligamentous laxity (no laxity). The purpose of this study is to compare the clinical outcomes of the group with generalized ligamentous laxity and without generalized ligamentous laxity in chronic lateral ankle instability. Methods: From January 2013 to November 2015, Arthroscopic MBO was performed in 99 patients for CLAI. We retrospectively analyzed 99 consecutive patients were included in terms of inclusion criteria. All patients had giving way, persistent pain and an inability to resume one’s preinjury activity level for more than 6 months. Patients were divided into 2 groups: laxity group (24 ankles) and no laxity group (75 ankles). Evaluation was performed preoperatively and at a final follow-up a minimum of 12 months postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score, pain Visual Analogue Scale (VAS)(0~100), and talar tilt angle. Results: In terms of radiological outcomes, the preoperatively talar tilt angle was greater in patients in laxity group than in no laxity group (p < .001). The last follow-up talar tilt angle was the same between in patients in laxity group and in no laxity group (p=0.413). But preoperative-last follow up difference was found between two groups (p=0.03). The variation from preoperative to last follow up talar tilt angle showed significant greater value in laxity group (-6.9 ± 5.2) than in no laxity group (-4.2 ± 4.2)(p=0.03). In terms of clinical outcome, last follow up AOFAS and VAS in all groups were improved than preoperative scores (27.5 ± 23.7, 24.1 ± 18.4, respectively). But preoperative-last follow up differences were not found between two groups (P=0.52). Conclusion: In terms of radiologic outcomes, there was difference outcome variation between two groups, in terms of clinical outcomes, there were no difference outcome variations between two groups. All groups achieved successful clinical and radiological last follow up outcomes even though there was difference outcome variation in talar tilt. Arthroscopic MBO should be considered as a reasonable method in patients who have chronic lateral ankle instability regardless of generalized ligamentous laxity.

Chronic lateral ankle instability: Results of two-staged approach, correlation with magnetic resonance imaging findings, and incidence of associated pathologies – A 4-year follow-up study

2020 ◽  
Vol 0 ◽  
pp. 1-8
Author(s):  
Shaival Dalal ◽  
Geralt Morgan
Keyword(s):  
Ankle Instability ◽  
Treatment Protocol ◽  
Ankle Arthroscopy ◽  
Resonance Imaging ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Staged Treatment ◽  
Modified Broström Procedure

Objectives: About 20% of ankle sprains have persistent symptoms even after 6 weeks–3 months of conservative treatment of physiotherapy and bracing. We followed a two-staged operative treatment protocol for the management of patients with persistent chronic lateral ankle instability. This study aims to analyze the outcomes of this two-staged treatment protocol and also to compare the magnetic resonance imaging (MRI) and arthroscopic findings in such patients and note the presence of associated pathologies. Materials and Methods: This is a retrospective study of 87 patients operated for chronic lateral ankle instability in two stages: (1) Diagnostic examination under anesthesia and ankle arthroscopy and (2) modified Brostrom procedure. Results: With a mean follow-up of 4 years, 31% of the patients had a complete resolution of their symptoms 4 months after the first procedure. Mean American Orthopaedic Foot and Ankle Score (AOFAS) and visual analog scale (VAS) scores show a significant improvement in functional outcomes in both the groups (P < 0.05). Moreover, the MRI findings were equivocal or false negative in 60% of the patients. We also observed associated pathologies such as synovitis, osteochondral defect of talus, and anterolateral impingement in 40% of the patients. Conclusion: The two-staged treatment of ankle arthroscopy and modified Brostrom procedure is highly effective in resolution of the symptoms of patients with chronic lateral ankle instability. As MRI is not very sensitive and because of the associated intra-articular lesions found in this spectrum of patients, a primary ankle arthroscopy followed by a staged Brostrom procedure has shown to improve outcomes significantly with optimal intervention.

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