Morphology of Anterior Talofibular Ligament After Arthroscopic Lateral Ankle Ligament Repair

2020 ◽  
Vol 41 (8) ◽  
pp. 993-1001
Author(s):  
Tomonobu Hagio ◽  
Ichiro Yoshimura ◽  
Kazuki Kanazawa ◽  
So Minokawa ◽  
Takuaki Yamamoto
Keyword(s):  
Signal Intensity ◽  
Healing Process ◽  
Attachment Site ◽  
High Signal Intensity ◽  
High Signal ◽  
Anterior Talofibular Ligament ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Background: Arthroscopic lateral ankle ligament repair for chronic lateral ankle instability (CLAI) yields good clinical results. However, the healing process of the ligament after anatomical repair remains unclear. This study evaluated the functional and patient-based outcomes for CLAI patients who underwent arthroscopic lateral ankle ligament repair and the morphological condition of the repaired anterior talofibular ligament (ATFL). Methods: We retrospectively reviewed 47 patients (50 ankles) who underwent arthroscopic lateral ankle ligament repair for CLAI (mean follow-up, 14 months). The Japanese Society for Surgery of the Foot Ankle-Hindfoot (JSSF) scale score and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed preoperatively and 12 months postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 and 12 months postoperatively to evaluate the ATFL. The functional and patient-based outcomes were compared between the group with repaired ATFLs and high signal intensity and the group with repaired ATFLs and low signal intensity. Results: The mean JSSF score improved significantly from 72.3 ± 11.6 preoperation to 95.3 ± 5.4 at 12 months postoperation. The MRI findings at 12 months postoperation showed that each repaired ATFL had a linear band structure from the talar to the fibular attachment site, and 41 of 50 ankles (82%) had low signal intensity of the ligament. On the SAFE-Q, the social functioning scores at 12 months postoperation were significantly higher in the low signal intensity group than in the high signal intensity group. Conclusion: Arthroscopic lateral ankle ligament repair for CLAI yielded good functional and patient-based outcomes and restored the morphological condition of the ATFL. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Evaluation of the Anterior Talofibular Ligament Using MRI after Arthroscopic Lateral Ankle Ligament Repair

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0044
Author(s):  
Ichiro Yoshimura ◽  
Kazuki Kanazawa ◽  
So Minokawa ◽  
Takuaki Yamamoto ◽  
Tomonobu Hagio
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Signal Intensity ◽  
High Signal Intensity ◽  
High Signal ◽  
Anterior Talofibular Ligament ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprain commonly occurs in sports activities and most patients are successfully managed with conservative treatment. An incidence of 10–30% of patients will fail conservative treatment and result in chronic lateral ankle instability (CLAI) that may require surgical treatment. Recently, several systematic reviews reported that arthroscopic lateral ankle ligament repair for CLAI are provided good clinical results. However, the pathologic condition of the lateral ankle ligament after anatomical repair has not been clarified. Previous investigations have reported that ligament signal intensity using MRI has a strong negative linear relationship with material biomechanical strength properties. The purpose of this study was to report the clinical outcome and evaluation of the anterior talofibular ligament (ATFL) using MRI after arthroscopic lateral ankle ligament repair. Methods: We retrospectively reviewed 40 patients (40 ankles) who underwent arthroscopic lateral ankle ligament repair for CLAI. The average age at the time of surgery was 28 years (range 12–66 years). The average follow-up was 13 months (range 12– 18 months). Clinical outcomes were assessed preoperatively and 12 months postoperatively using Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and Self-Administered Foot Evaluation Questionnaire (SAFE-Q). The ATFL was evaluated using 3.0-T MRI at the preoperatively, six months postoperatively and 12 months postoperatively. The ATFL characteristics classified into the following categories: nonvisualization of the ligament, discontinuity, a wavy or curved contour, or high signal intensity within the ligament. Results: The mean JSSF score increased from 72 preoperatively to 95 at 12 months postoperatively. The preoperative MRI findings of the ATFL were categorized as discontinuity (11 ankles), a wavy or curved contour (14 ankles), or high signal intensity within the ligament (22 ankles). The all ATFL findings at the six months postoperatively had straight band extending from the talus to the fibular malleolus, and nine of 40 ankles had high signal intensity within the ligament. The ATFL findings at the 12 months postoperatively revealed residual high signal intensity within the ligament in six of nine ankles. A comparison of the postoperative ATFL with high signal intensity and with low signal intensity group, there were no significant difference in postoperative clinical outcomes between the groups. Conclusion: This study demonstrated that arthroscopic lateral ankle ligament repair was an effective procedure for the treatment of CLAI and restored the condition of ATFL.

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 Immediate Unrestricted Weight Bearing with Simple Stirrup Brace Following Single Anchor Lateral Ankle Ligament Stabilization

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Christopher Diefenbach ◽  
Linda Dunaway ◽  
Larissa White ◽  
Gregory Lundeen
Keyword(s):  
Range Of Motion ◽  
Ligament Reconstruction ◽  
Weight Bearing ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Recurrent Instability ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: Anatomic lateral ankle ligament reconstruction has been shown to reliably restore the functional stability of the joint. Current orthopedic literature supports accelerated rehabilitation and protected weight bearing advancement as a safe and effective means to timely patient recovery. To our knowledge, there have not been clinical outcome reports of a protocol utilizing immediate unrestricted weight bearing in a stirrup brace following single anchor lateral ligament stabilization. The purpose of this study is to report on a series of patients treated with a more progressive protocol resulting in durable ankle stability and favorable clinical outcomes. Methods: A total of 28 patients with chronic lateral ankle ligament instability who failed conservative management underwent arthroscopy and modified Brostrom-Gould lateral ligament reconstruction between 2014 and 2015 were identified. The anterior talofibular and calcaneofibular ligaments were released from the fibula and advanced using one double-loaded metallic 3.5 mm suture anchor. Immediate unrestricted full weightbearing in a stirrup brace was allowed from the first postoperative day and accelerated physical therapy was initiated at 2 weeks postoperatively. Patients were assessed preoperatively, and at a minimum 1- year follow-up, using the AOFAS Hindfoot scale and VAS pain score. Additional postoperative outcome measures included the FAOS and a custom clinical questionnaire. Range of motion, ligamentous stability and single-blinded examination with Star Excursion Balance Test (SEBT) functional testing were performed postoperatively. Complication and recurrent instability rates were also recorded. Results: Twelve patients participated in the study (8F, 4 M). Mean age at final follow-up was 49 years (21-70). Average follow-up was 21 months (16 to 26). Average satisfaction score was 94%, and all patients reported they would have the procedure again. AOFAS Hindfoot score and VAS improved significantly from preoperative to postoperative, respectively (55.6 to 89.8, 5.4 to 1.6). Average postoperative FAOS score was 80.3 (51.8-100) . No measurable difference was observed on examination of range of motion, ligamentous stability, or SEBT testing in the anterior, posterolateral or posteromedial planes of the contralateral side, respectively (61.5 to 62.2 cm, 62.4 to 64.1 cm, 56.4 to 57.6 cm). No patients reported recurrent instability. Conclusion: This study demonstrates that anterior talofibular ligament and calcaneofibular ligament advancement utilizing a single 3.5 mm anchor construct followed by immediate unrestricted weight bearing is a safe and effective protocol for the treatment of chronic lateral ankle instability. Ligamentous stability was achieved and maintained in all patients across a wide variety of patient ages and desired activity levels. Patient satisfaction was excellent. This surgical technique and postoperative protocol may help reduce surgical time and implant cost, and may facilitate a more timely return to preinjury functional level.

scholarly journals A Case Report of Tarsal Navicular Body Fracture with Lateral Ankle Ligament Complex Tear – a New Injury Combination

2021 ◽  
Vol 11 (8) ◽  
Author(s):  
Ankur Singh ◽  
Peter Gföller ◽  
Patryk Ulicki
Keyword(s):  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Mri Scan ◽  
Rare Injury ◽  
Lateral Ankle ◽  
Body Fracture ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Tarsal Navicular Bone ◽  
Lateral Ankle Ligament Complex

Introduction: Fractures of tarsal navicular bone are a rare injury. A navicular fracture can occur either in isolation or associated with other bony or ligamentous injuries, depending on the severity and mechanism of trauma at the time of impact. We report a previously undescribed injury combination of navicular fracture with tear of the lateral ankle ligament complex. Case Report: An 18-year-old professional long jump athlete presented with a history of twisting injury immediately before taking off, while attempting a jump. A detailed clinical examination and radiological assessment with computed tomography (CT) and magnetic resonance imaging (MRI) scan were performed. She was diagnosed to have a navicular body fracture with complete rupture of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). Acute fixation of navicular body fracture along with primary repair of ATFL and CFL was done. The final outcome of the patient was good with return to unrestricted physical activities after 4 months. Conclusion: A new injury combination of navicular fracture along with lateral ankle ligament complex tear is reported in a professional athlete. A high index of clinical suspicion and early detection using CT and MRI scan can identify this rare injury combination. Surgical treatment can result in favorable outcomes. Keywords: Tarsal navicular bone, fracture, anterior talofibular ligament, calcaneofibular ligament, computed tomography scan, magnetic resonance imaging scan.

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.

Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction

2016 ◽  
Vol 44 (5) ◽  
pp. 1301-1308 ◽  
Author(s):  
Lauren M. Matheny ◽  
Nicholas S. Johnson ◽  
Daniel J. Liechti ◽  
Thomas O. Clanton
Keyword(s):  
Activity Level ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
And Function

A New Snowboard Injury Caused by “FLOW” Bindings

2014 ◽  
Vol 104 (3) ◽  
pp. 287-290
Author(s):  
Daniel Haverkamp ◽  
Daniel Hoornenborg ◽  
Mario Maas ◽  
Gino Kerkhoffs
Keyword(s):  
Surgical Repair ◽  
Anterior Talofibular Ligament ◽  
Syndesmotic Injury ◽  
Lateral Ankle ◽  
Ligament Rupture ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and existence of medial and lateral ankle ligament rupture without osseous and syndesmotic involvement and to create awareness of these types of injuries.

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