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.

scholarly journals Outcomes Following a Modified Broström Procedure and Arthroscopic Debridement of Medial Gutter Osteoarthritis Combined With Chronic Lateral Ankle Instability

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0014
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Operative Treatment ◽  
Ankle Instability ◽  
Joint Space ◽  
Arthroscopic Debridement ◽  
Limited Information ◽  
Aged Patients ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Modified Broström Procedure

Category: Ankle Arthritis Introduction/Purpose: 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 lateral ankle instability. Methods: Twenty-four 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 3.1 points (P < .001), 5 patients (20.8%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.2%) with recurrent ankle instability, while 6 patients (25%) showed a progression of arthritis stage. Conclusion: 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.

scholarly journals Prognosis of Medial Gutter Osteoarthritis Combined with Chronic Ankle Instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Ankle Sprains ◽  
Arthroscopic Debridement ◽  
Foot And Ankle ◽  
Middle Aged ◽  
Ankle Pain ◽  
Aged Patients ◽  
Modified Broström Procedure ◽  
Arthritic Changes

Category: Ankle Arthritis Introduction/Purpose: Although the frequent intraarticular pathologies associated with recurrent ankle sprains are well known, informations regarding treatment method for arthritic changes in the medial gutter are still insufficient. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following modified Broström procedure and arthroscopic debridement in the middle-aged patients. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after surgical treatment. All patients showed medial joint space narrowing of Takakura stage 2. The clinical evaluation consisted of the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue 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 followup, 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 discomfort at gait with considerable pain ≥ 4 points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression in arthritis stage. Conclusion: Modified Broström procedure concomitant with arthroscopic debridement for medial gutter osteoarthritis secondary to chronic ankle instability is not effective enough to treat the medial ankle pain and functional impairment. Alternative treatment strategies for middle-aged cohort with arthritic changes are needed to improve the clinical outcomes and to prevent a progressive osteoarthritis.

Role of Arthroscopic Debridement of Hemophilic Ankles

2018 ◽  
Vol 39 (10) ◽  
pp. 1199-1204 ◽  
Author(s):  
Elcil Kaya Bicer ◽  
Kemal Kayaokay ◽  
Andac Alsina ◽  
Huseyin Gunay ◽  
Kaan Kavakli ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Case Series ◽  
Patient Reported Outcome ◽  
Arthroscopic Debridement ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Foot Function ◽  
Bleeding Episodes ◽  
American Orthopaedic

Background: Arthroscopic debridement has been used in the treatment of early stages of hemophilic ankle arthropathy. The aim of this procedure is to alleviate pain, improve function, and diminish bleeding episodes. Evaluation of patient-reported outcomes of arthroscopic debridement for hemophilic ankle arthropathies was evaluated in this study. Methods: Fifteen patients with hemophilia who had undergone arthroscopic debridement between 2008 and 2017 were included in this study. Preoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Foot Function Index (FFI) with its subscales were obtained. Patient-reported outcome was measured using FFI at the latest follow-up. Radiologic severity of hemophilic arthropathy was assessed with the Pettersson score. Preoperative and postoperative intraarticular bleeding frequencies of the hemophilic patients were compared. Results: Patients experienced statistically significant improvements of FFI and its subscales. Median preoperative FFI scores dropped from 42.2% to 22.2% postoperatively. Median value for the Pettersson score was 3. Annual median bleeding frequency of the study group was 18 preoperatively and 1.5 postoperatively ( P = .002). Conclusion: By assessing patient-reported outcomes, pain and functional restrictions associated with hemophilic ankle arthropathy were improved following arthroscopic debridement. By means of subjective measures, this procedure was effective. Level of Evidence: Level IV, retrospective case series.

Is Knee Arthroscopy Beneficial in Treating Traumatic Meniscal Tears on Patients Older Than 60 Years?

2017 ◽  
Vol 31 (07) ◽  
pp. 635-641 ◽  
Author(s):  
Ke Li ◽  
Etienne Cavaignac ◽  
Hong Chen ◽  
Wei Xu ◽  
Cheng Chen ◽  
...  
Keyword(s):  
Meniscal Tear ◽  
Arthroscopic Surgery ◽  
Case Series ◽  
Functional Score ◽  
Meniscal Tears ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Aged Patients ◽  
Traumatic History ◽  
History Of

AbstractKnee arthroscopic surgery is usually performed on young or middle-aged patients with meniscal tears. However, we have noted an amount of active elderly patients who suffered from traumatic meniscal tear without significant degenerative changes. Outcome data were prospectively collected and retrospectively reviewed in patients older than 60 years who underwent partial arthroscopic meniscectomy between April 2008 and July 2013. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, Kellgren–Lawrence (K–L) grade, Knee Society Score (KSS), and pain scores were collected, and conversion to total knee arthroplasty (TKA) was recorded. Subgroups comparing the clinical outcome of different level of K–L grade and Outerbridge's score were conducted. At an average of 31 months of follow-up (standard deviation [SD]: 8.9; range, 24–63 months) for 96 patients with a mean age of 65.8 years (SD: 5.7; range, 60–83 years), 12 patients underwent conversion to TKA at an average of 2.1 years. Patients with a clear traumatic history of the knee have better improvement in visual analog scale (p < 0.001), KSS functional score (p = 0.005), and WOMAC score (p < 0.001), patients with K–L grade greater than III were 3.1 times more likely to undergo conversion to TKA than patients with K–L grade less than III. The findings indicate that patients older than 60 years with mild osteoarthritis and clear traumatic history of the meniscus are a good indication for arthroscopic partial meniscectomy. The level of evidence is level IV (a retrospective case series).

scholarly journals Absence of ATFL Remnant Does not Affect the Clinical Outcomes of the Modified Broström Operation for Chronic Ankle Instability

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Sunghoon Park ◽  
Taehun Kim ◽  
Younguk Park
Keyword(s):  
Clinical Outcomes ◽  
Ankle Instability ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Clinical Results ◽  
Multiple Linear Regression Analysis ◽  
Chronic Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Retrospective Case ◽  
Normal Thickness

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The modified Broström operation (MBO) for chronic ankle instability (CAI) has demonstrated good clinical results. Absence of ligamentous tissue was known as a risk factor for recurrence of ankle instability after the sugery. The aim of this study was to evaluate the effect of quality of ligament tissue (anterior talofibular ligament, ATFL) on prognosis in a cohort of patients with CAI after the MBO. Methods: This study was a retrospective case series. A total of 60 patients underwent the MBO for CAI with a mean follow-up of 30.1 months (range, 24-47 months). Presence of ATFL remnant was assessed on ultrasound (US), magnetic resonance imaging (MRI), and arthroscopy in all patients. The foot and ankle outcome score (FAOS) was used to evaluate functional outcomes. Clinical outcomes were compared according to the condition of the ligament remnant. Association with other risk factors was evaluated using multiple linear regression analysis. Results: ATFL was visible in 51/60 cases on US. Thirty patients had thin or absent ATFL on MRI; 22 patients, normal thickness ATFL; and 8 patients, thick ATFL. ATFL was visible in 15 patients on arthroscopy and nonvisible or not clear in 45 cases. Significant differences in FAOS were not noted according to the presence of ATFL remnant on US, arthroscopy, and the grade of ATFL thickness on MRI. No correlation was found between FAOS and the thickness of ATFL. Conclusion: The results suggest that the MBO for patients with CAI had good results, regardless of the presence or absence of ATFL remnant.

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.

Radiographic Study of Pes Planovarus

2017 ◽  
Vol 38 (5) ◽  
pp. 526-531 ◽  
Author(s):  
Janic Aebi ◽  
Monika Horisberger ◽  
Arno Frigg
Keyword(s):  
Ankle Instability ◽  
Treatment Strategies ◽  
Case Series ◽  
Congenital Disease ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Correct Treatment ◽  
Hindfoot Alignment ◽  
Standard Values ◽  
The Mean

Background: Depending on the direction of the subtalar joint, a foot deformity generally tends towards pronation (pes planovalgus) or supination (pes cavovarus). However, the combination of hindfoot varus and flat midfoot/forefoot (pes planovarus) is an exception to this rule. Pes planovarus has so far only been referred to in connection with Müller-Weiss disease and congenital disease. We diagnosed pes planovarus in otherwise healthy patients without these diseases. Methods: Forty patients with 54 symptomatic feet who were treated between August 2012 and July 2016 were included (mean age, 44.1 ± 15.7 years; 15 male/25 female). They were selected from 1064 consecutive cases (3.8%). Inclusion criteria were hindfoot varus and flat midfoot/forefoot. Their symptoms, radiographs, and therapies within the first 3 months were retrospectively analyzed. The position in the hindfoot alignment view (HAV), talometatarsal-1 angle lateral (TMT1lat) and dorsoplantar (TMT1dp), talocalcaneal angle lateral (TCAlat) and dorsoplantar (TCAdp), and calcaneal pitch angle (CPA) were measured on a DICOM/PACS system. Results: The mean radiological results (standard values from the literature in brackets) were as follows: the hindfoot was significantly in varus in the HAV (−6.9 ± 3.6 mm [−1.6 ± 7.2 mm]; P < .001), the TMT1lat was significantly flatter (−6.7 ± 5.8 degrees [8.4 ± 5.9 degrees]; P < .001), the TMT1dp was significantly less in abduction (1.5 ± 7.9 degrees [7.7 ± 8.2 degrees]; P = .005), the TCAdp showed no difference (25.9 ± 7.9 degrees [24.1 ± 5.7 degrees]; P = .118), the TCAlat was significantly larger (47.5 ± 6.1 degrees [43.4 ± 7.1 degrees]; P < .001), and the CPA was significantly flatter (17.6 ± 3.9 degrees [24.5 ± 3.0 degrees]; P < .001). The most frequent symptoms were stress-induced foot pain (n = 33), hallux valgus (n = 20), chronic ankle instability (n = 17), metatarsalgia (n = 15), chronic midfoot pain (n = 13), heel pain (n = 12), and lesser toe deformities (n = 8). Thirty-one feet were treated conservatively and 23 operatively. Conclusion: This study showed the existence of pes planovarus without Müller-Weiss disease or congenital disease. This unusual foot form leads to difficulties if standard treatment strategies are applied, which raises the issue of the correct treatment for such patients. Level of Evidence: Level IV, retrospective case series.

Fully Intra-articular Lasso-Loop Stitch Technique for Arthroscopic Anterior Talofibular Ligament Repair

2021 ◽  
pp. 107110072110444
Author(s):  
Jiajun Qin ◽  
Qiang Fu ◽  
Qing Zhou ◽  
Helin Wu ◽  
Xiaosong Zhi ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Case Series ◽  
Anterior Talofibular Ligament ◽  
Nerve Injuries ◽  
Accidental Injury ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lateral Ankle Instability ◽  
Vas Scores

Background: Arthroscopic techniques have gradually become popular for anterior talofibular ligament (ATFL) repair. However, the reliability of the repair and the risk of nerve injuries are of concern. The aim of this study was to evaluate the fully intra-articular lasso-loop stitch technique for arthroscopic ATFL repair. Methods: From October 2018 to December 2019, 43 cases with chronic lateral ankle instability were treated with this fully intra-articular lasso-loop stitch technique using the Arthro-Pierce instrument. The Karlsson-Peterson score, Cumberland Ankle Instability Tool (CAIT) score, visual analog scale (VAS) score, anterior drawer and talar tilt stress fluoroscopy were evaluated at the preoperative and final follow-up appointments, respectively. All surgical complications were also recorded. Results: A total of 39 cases were followed up for a mean of 28.23 ± 3.64 months (range, 23-34 months). At the final follow-up, the averages of the Karlsson-Peterson, CAIT and VAS scores were 90.26 ± 6.58, 88.56 ± 7.21 and 0.79 ± 1.06, respectively. During surgery, 2 cases were modified with augmentation of the inferior extensor retinaculum. No nerve injuries were encountered. Only 1 female complained about mild knot irritation. A 25-year-old solider required revision surgery due to an accidental injury. Conclusion: We found the fully intra-articular lasso-loop stitch technique for ATFL repair using the Arthro-Pierce instrument to be reliable and safe with a sufficient and good-quality ligament remnant. Level of Evidence: Level IV, retrospective case series.

Effect of Modified Broström Procedure With Periosteal Flap Augmentation After Subfibular Ossicle Excision on Ankle Stability

2019 ◽  
Vol 40 (6) ◽  
pp. 656-660 ◽  
Author(s):  
Chul Hyun Park ◽  
JeongJin Park
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Case Series ◽  
Level Of Evidence ◽  
Periosteal Flap ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Talar Tilt ◽  
Modified Broström Procedure

Background: The study evaluated the clinical and radiographic outcomes of the modified Broström procedure (MBP) with periosteal flap augmentation after large subfibular ossicle excision for chronic lateral ankle instability (CLAI). Methods: Twenty-two CLAI cases with a large ossicle (≥10 mm) were treated consecutively using the MBP with periosteal flap augmentation after ossicle excision. The mean follow-up duration was 20 months (12-33). For clinical assessment, the visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Karlsson-Peterson score were evaluated preoperatively and at the last follow-up. For radiographic assessment, the size of the ossicle was measured by magnetic resonance imaging, and the talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. Results: The VAS, AOFAS, and Karlsson-Peterson scores improved from 6.3, 68.7, and 56.9 preoperatively to 1.6, 94.5, and 92.4 at the last follow-up, respectively. The mean size of the ossicles was 14.8 mm (11-21 mm). The talar tilt angle and anterior talar displacement improved from 11.2 degrees and 8.3 mm preoperatively to 4.4 degrees and 3.9 mm at the last follow-up, respectively. Conclusion: MBP combined with periosteal flap augmentation after ossicle excision provided good clinical and radiographic outcomes in CLAI with a large ossicle. Level of Evidence: Level IV, case series.

Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

2021 ◽  
pp. 107110072199707
Author(s):  
Yasunari Ikuta ◽  
Tomoyuki Nakasa ◽  
Junichi Sumii ◽  
Akinori Nekomoto ◽  
Nobuo Adachi
Keyword(s):  
Ankle Instability ◽  
Ct Images ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Mri Findings ◽  
Calcaneofibular Ligament ◽  
Level Of Evidence ◽  
Strong Negative Correlation

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

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