Effect of Lateral Ligament Augmentation Using Suture-Tape on Functional Ankle Instability

2019 ◽  
Vol 40 (4) ◽  
pp. 447-456 ◽  
Author(s):  
Byung-Ki Cho ◽  
Seok-Hyun Hong ◽  
Jae-Hyeon Jeon
Keyword(s):  
Postural Control ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Peak Torque ◽  
Lateral Ligament ◽  
Functional Ankle Instability ◽  
Unaffected Side ◽  
Ligament Augmentation ◽  
Suture Tape

Background: Although lateral ligament augmentation using suture-tape has been effective for restoration of mechanical ankle stability, few data are available regarding changes of peroneal strength, proprioception, and postural control. The aim of this study was to determine effects of suture-tape augmentation on functional ankle instability (FAI). Methods: Twenty-four patients who underwent suture-tape augmentation were eligible and were followed more than 2 years postoperatively. Functional outcomes were evaluated with the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM). Changes of peroneal strength, proprioception and postural control were analyzed with an isokinetic dynamometer and a modified Romberg test. Results: CAIT and FAAM (average of daily and sports activity scores) significantly improved to average 27.2 points and 86.7 points, respectively, at final follow-up. Peak torque for eversion in 60 degrees/s angular velocity significantly improved to 10.6 Nm at final follow-up. Deficit ratio of peak torque for eversion significantly improved from mean 39.5% to 20.9%, and significant side-to-side difference was revealed ( P < .001). There were no significant differences in joint position sense. A significant improvement in balance retention time was revealed at final follow-up, and the relative deficit ratio compared to the unaffected side was 30.9%. Conclusions: Patient-reported functional outcomes significantly improved after lateral ligament augmentation using suture-tape. Although this procedure demonstrated significant effects on FAI based on improvement of isokinetic peroneal strength and postural control, recovery rates compared to the unaffected side were not significant at the intermediate-term follow-up. In addition, there was no positive effect on proprioception of the ankle. Level of Evidence: Level IV, prospective case series.

scholarly journals The Effects of Lateral Ligaments Augmentation Using Suture-tape on Functional Ankle Instability

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0014
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Postural Control ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Peak Torque ◽  
Functional Ankle Instability ◽  
Unaffected Side ◽  
Lateral Ligaments ◽  
Patient Reported ◽  
Final Followup ◽  
Suture Tape

Category: Sports Introduction/Purpose: Although lateral ligaments augmentation using suture-tape has been effective for restoration of mechanical ankle stability, few data are available regarding changes of peroneal strength, proprioception and postural control. The aim of this study was to determine effects of suture-tape augmentation on functional ankle instability (FAI). Methods: Twenty-four patients that underwent suture-tape augmentation were eligible and were followed more than two years postoperatively. Functional outcomes were evaluated with the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM). Changes of peroneal strength, proprioception and postural control were analyzed with an isokinetic dynamometer and a modified Romberg test. Results: CAIT and FAAM significantly improved to average 27.2 points, 86.7 points at final followup. Peak torque for eversion in 60º/sec angular velocity significantly improved to 10.6 Nm at final followup. Deficit ratio of peak torque for eversion significantly improved from mean 39.5% to 20.9%, and significant side to side difference was revealed (P < .001). There were no significant differences in joint position sense. A significant improvement in balance retention time was revealed at final followup and relative deficit ratio compared to unaffected side was 30.9%. Conclusion: Patient-reported functional outcomes significantly improved after lateral ligaments augmentation using suture-tape. Although this procedure demonstrated significant effects on FAI based on improvement of isokinetic peroneal strength and postural control, recovery rates compared to the unaffected side were insufficient at the intermediate-term followup. In addition, there was no significantly positive effect on proprioception of the ankle.

Relationship Between Functional Ankle Instability and Postural Control

2008 ◽  
Vol 38 (12) ◽  
pp. 782-789 ◽  
Author(s):  
Marcos De Noronha ◽  
Kathryn M. Refshauge ◽  
Jack Crosbie ◽  
Sharon L. Kilbreath
Keyword(s):  
Postural Control ◽  
Ankle Instability ◽  
Functional Ankle Instability

scholarly journals Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110074
Author(s):  
Jakob Ackermann ◽  
Fabio A. Casari ◽  
Christoph Germann ◽  
Lizzy Weigelt ◽  
Stephan H. Wirth ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Clinical Outcomes ◽  
Cartilage Repair ◽  
Ankle Instability ◽  
Lesion Size ◽  
Lateral Ligament ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Radiographic Outcomes

Background: Autologous matrix-induced chondrogenesis (AMIC) has been shown to result in favorable clinical outcomes in patients with osteochondral lesions of the talus (OLTs). Though, the influence of ankle instability on cartilage repair of the ankle has yet to be determined. Purpose/Hypothesis: To compare the clinical and radiographic outcomes in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. It was hypothesized that the outcomes would be comparable between these patient groups. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty-six patients (13 with and 13 without concomitant ankle instability) who underwent AMIC with a mean follow-up of 4.2 ± 1.5 years were enrolled in this study. Patients were matched 1:1 according to age, body mass index (BMI), lesion size, and follow-up. Postoperative magnetic resonance imaging and Tegner, American Orthopaedic Foot & Ankle Society (AOFAS), and Cumberland Ankle Instability Tool (CAIT) scores were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART (magnetic resonance observation of cartilage repair tissue) 1 and MOCART 2.0 scores. Results: The patients’ mean age was 33.4 ± 12.7 years, with a mean BMI of 26.2 ± 3.7. Patients with concomitant LLS showed worse clinical outcome measured by the AOFAS (85.1 ± 14.4 vs 96.3 ± 5.8; P = .034) and Tegner (3.8 ± 1.1 vs 4.4 ± 2.3; P = .012) scores. Postoperative CAIT and AOFAS scores were significantly correlated in patients with concomitant LLS ( r = 0.766; P = .002). A CAIT score >24 (no functional ankle instability) resulted in AOFAS scores comparable with scores in patients with isolated AMIC (90.1 ± 11.6 vs 95.3 ± 6.6; P = .442). No difference was seen between groups regarding MOCART 1 and 2.0 scores ( P = .714 and P = .371, respectively). Conclusion: Concurrently performed AMIC and LLS in patients with OLT and ankle instability resulted in clinical outcomes comparable with isolated AMIC if postoperative ankle stability was achieved. However, residual ankle instability was associated with worse postoperative outcomes, highlighting the need for adequate stabilization of ankle instability in patients with OLT.

Lower Signal Intensity of the Anterior Talofibular Ligament is Associated with a Higher Rate of Return to Sport After ATFL Repair for Chronic Lateral Ankle Instability

2019 ◽  
Vol 47 (10) ◽  
pp. 2380-2385 ◽  
Author(s):  
Hong Li ◽  
Yinghui Hua ◽  
Sijia Feng ◽  
Hongyun Li ◽  
Shiyi Chen
Keyword(s):  
Signal Intensity ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Return To Sport ◽  
Rate Of Return ◽  
Anterior Talofibular Ligament ◽  
Aofas Score ◽  
Significant Difference ◽  
The Mean

Background: The treatment strategy for anterior talofibular ligament (ATFL) injury is usually determined by the ATFL remnant condition during surgery. Preoperative magnetic resonance imaging (MRI)–based signal intensity of the ATFL remnant, represented by the signal/noise ratio (SNR) value, can reveal the ATFL remnant condition. Thus far, there is a lack of evidence regarding the relationship between the ATFL remnant condition and functional outcomes. Purpose/Hypothesis: The purpose was to quantitatively evaluate whether the MRI-based ATFL ligament SNR value is related to functional outcomes after ATFL repair for ankles with chronic lateral ankle instability. The hypothesis was that a lower preoperative SNR is related to a better clinical outcome, particularly a higher rate of return to sport. Study Design: Cohort study; Level of evidence, 3. Methods: First, a preliminary study was performed to measure the ATFL SNR in preoperative MRI, the results of which suggested that a preoperative SNR >10.4 was indicative of a poor ATFL condition. Then, a cohort study was retrospectively performed with consecutive patients who underwent open repair of ATFL injuries between January 2009 and August 2014. Accordingly, the patients were divided into 2 groups: high SNR (HSNR; ≥10.4) and low SNR (LSNR; <10.4). Functional outcomes based on the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner Activity Scale were then compared between the HSNR group and the LSNR group. Results: Ultimately, 70 patients were available for the final follow-up: 37 in the HSNR group and 33 in the LSNR group. No significant difference was detected between the HSNR group and the LSNR group in terms of the AOFAS score, KAFS, or Tegner Activity Scale ( P > .05 for all) preoperatively. At the final follow-up, the mean ± SD AOFAS score in the LSNR group (92 ± 6) was higher than that in the HSNR group (87 ± 12), although no significant difference was detected postoperatively ( P = .16). The mean KAFS in the LSNR group (94 ± 7) was significantly higher than that in the HSNR group (88 ± 11) postoperatively ( P = .03). At follow-up, the mean Tegner score in the LSNR group (6; range, 3-7) was significantly higher than that in the HSNR group (5; range, 1-8) postoperatively ( P = .03). Patients in the LSNR group had a significantly higher percentage of sports participation than those in the HSNR group (91% vs 65%, P = .02) postoperatively. Conclusion: A lower signal intensity in the ATFL ligament based on preoperative MRI is associated with a better clinical outcome, particularly a higher rate of return to sport.

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 Functional outcomes and return-to-sports rate after modified Brostrom repair for lateral ankle instability with absorbable sutures and immediate postoperative weightbearing

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000 ◽  
Author(s):  
Somen Agrawal ◽  
Greg Keene ◽  
James Clayton
Keyword(s):  
Functional Outcomes ◽  
Ankle Instability ◽  
Weight Bearing ◽  
Return To Sport ◽  
Cost Effective ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Absorbable Sutures ◽  
Lateral Ankle Instability

Category: Sports Introduction/Purpose: The ankle is commonly injured in sporting activities occurring in up to 1 in 10,000 people a day. About 80% of ankle sprains recover with nonoperative management, with the remaining 20% of patients developing symptomatic instability requiring surgery. There are various surgical options being used, including anatomic repair (Brostrom technique and modifications), anatomic recon- struction with autograft or allograft, and nonanatomic reconstructions such as the Watson-Jones, Evans, and Chrisman-Snook procedures. The outcome of the direct anatomic repair is likely dependent on tissue quality, ability to tension the ligaments, and the security of the fixation. Secure fixation is critical to enable an early rehabilitation without compromising clinical outcome. We hypothesized that using absorbable suture for anatomic reconstruction is not only cost effective but also allows early rehabilitation with immediate postoperative weightbearing with good functional outcomes. Methods: The study included 71 patients presenting with chronic lateral ankle instability (who failed non-operative management) who underwent modified Brostrom repair by a single surgeon between Jan 2012 and Feb 2014.The anterior talofibular ligament and calcaneo- fibular ligament were anatomically repaired , and the repair was augmented with inferior extensor retinaculum proximal advancement, both with 1 vicryl suture. Full weight bearing in normal shoe was allowed from the day of surgery. Physiotherapy commenced prior to discharge from day surgery with gentle active range of motion, calf strength, and static peroneii exercises. From 3 to 4 weeks proprioceptive, theraband, and dynamic peroneal exercises were started. No boots, braces, or casts were used at any stage in the post-operative period. Patients were assessed preoperatively and at a minimum 2-year follow-up using the Foot and Ankle Outcome Score (FAOS). Complication, failure (recurrent instability), and return-to-sport rates were also recorded. Results: There were 41 were males and 30 females with mean age at surgery of 27 years (range 16 - 47 years), mean duration of symptoms of 2 years (range, 6 months to 8 years)and a mean follow-up duration of 34 months (range 24- 49 months). Significant improvement was seen in the FAOS from preoperatively to postoperatively (from 37 to 79): the pain subscale , the symptom subscale, the function subscale, the function in sports and recreation subscale, and the foot and ankle–related quality of life subscale improved from 38 to 79, 42 to 81, 43 to 82 , 31 to 79 and 32 to 77 respectively. All these findings were statistically significant. The failure rate was 4%, with 3 patients reporting instability after subsequent traumatic re-rupture. Two case of temporary neuropraxia of the superficial peroneal nerve was observed. Fifty four out of 71 patients were involved in sports prior to injury and forty seven (87%) returned to sport after reconstruction. Conclusion: This study demonstrates that lateral ligament reconstruction using absorbable sutures is an effective procedure for the treatment of chronic lateral ankle instability and allows immediate weight bearing. This allows a cost-effective approach to management with minimal impact on a patient’s activities of daily living in the post-operative period. The procedure also has high return-to-sport rate.

scholarly journals Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability

2017 ◽  
Vol 11 (1) ◽  
pp. 617-632 ◽  
Author(s):  
Jorge Pablo Batista ◽  
Jorge Javier del Vecchio ◽  
Luciano Patthauer ◽  
Manuel Ocampo
Keyword(s):  
Ankle Instability ◽  
Medical Condition ◽  
Surgical Techniques ◽  
Clinical Success Rate ◽  
Chronic Ankle Instability ◽  
Tilt Test ◽  
Lateral Ligament ◽  
Return To Sports ◽  
Ligament Repair

Objectives:Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury.Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela.Several open and arthroscopic surgical techniques have been described to treat this medical condition.Material and Methods:Of the 22 patients who were treated; 18 males and 4 females, and aged from 17-42 years (mean 28 years).All patients presented a history of more than three ankle sprains in the last two years and presented positive anterior drawer and talar tilt test of the ankle in the physical examination.We perform an anterior arthroscopy of the ankle in order to treat asociated disease and then we performed“All inside¨lateral ligament repair through two portals (anteromedial and anterolateral) using an anchor knotless suture.Results:Clinical outcome evaluations were performed at a mean follow up of 25 months. (R: 17-31).Overall results has been shown by means of the American Orthopaedic Foot and Ankle Society (AOFAS). Mean AOFAS scores improved from 63 points (range 52–77) preoperatively to 90 points (range 73–100) at final follow up.No recurrences of ankle instability were found in the cases presented.Conclusion:Several surgical procedures have been described during the last years in order to treat chronic ankle instability.¨All inside¨lateral ligament reconstruction presents lower local morbidity than open procedures with few complications. Moreover, it is a reproductible technique, with high clinical success rate, few complications and relatively quick return to sports activities. A high knowledge of the anatomic landmarks should be essential to avoid unwated injuries.

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