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.

Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

2021 ◽  
pp. 036354652110080
Author(s):  
Sung Hyun Lee ◽  
Hyung Gyu Cho ◽  
Je Heon Yang
Keyword(s):  
Clinical Outcomes ◽  
Ankle Instability ◽  
Surgical Techniques ◽  
Chronic Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Extensor Retinaculum ◽  
Level Of Evidence ◽  
Group A ◽  
The Mean ◽  
Inferior Extensor Retinaculum

Background: Although several arthroscopic surgical techniques for the treatment of chronic ankle instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Purpose: To compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI between 2016 and 2018. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into 2 groups according to the surgical technique used for CAI: arthroscopic ATFL repair (group A; n = 37) and arthroscopic ATFL repair with additional IER augmentation (group R; n = 45). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). Results: Out of 101 patients, 19 (18.5%) were excluded per the exclusion criteria, and 82 were evaluated. We identified 6 retears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL retear on MRI (8.1% [3/37] in group A and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement >3 mm as compared with the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups ( P < .001). However, there were no significant differences in the clinical results and radiologic findings between the groups. Conclusion: The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.

Fair evidence consistently supports open surgical treatment for chronic ankle instability: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. 254-269
Author(s):  
Chad Alexander Purcell ◽  
James Calder ◽  
Kentaro Matsui ◽  
Pontus Andersson ◽  
Jón Karlsson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Systematic Evaluation ◽  
Anatomical Reconstruction ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Reconstruction Technique ◽  
Operative Techniques ◽  
Level Of Evidence

ImportancePatients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament. Over 50 operative techniques have been described for the treatment of CAI. However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/ObjectiveThe primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence reviewThe literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017. Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention). All published clinical studies with English translation were included. Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded. Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive. Articles were then assigned a level of evidence (I-V) to denote quality of the research methods. Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.FindingsSeventy one of 1635 identified articles were included for review. There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures. There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevanceAlthough only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices. The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidenceLevel II, systematic review.

Arthroscopic Findings in Patients with Chronic Ankle Instability

2002 ◽  
Vol 30 (3) ◽  
pp. 402-409 ◽  
Author(s):  
Beat Hintermann ◽  
Andreas Boss ◽  
Dirk Schäfer
Keyword(s):  
Structural Changes ◽  
Ankle Instability ◽  
Cartilage Damage ◽  
Case Series ◽  
Chronic Ankle Instability ◽  
Ankle Arthroscopy ◽  
Lateral Ligament ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries

Background There are little objective data on structural changes of the chronically unstable ankle. Such knowledge could help with preoperative planning. Hypothesis Preoperative ankle arthroscopy provides important insights into the causes and mechanisms of ankle instability and the resulting disability. Study Design Case series. Methods From 1993 to 1999, arthroscopic examination was performed in the ankles of 148 patients with symptomatic chronic ankle instability that had lasted 6 months or more. All structural changes were recorded and compared with the clinical diagnosis. Results A rupture or elongation of the anterior talofibular ligament was noted in 86% of ankles, of the calcaneofibular ligament in 64%, and of the deltoid ligament in 40%. Cartilage damage was noted in 66% of ankles with lateral ligament injuries, whereas 98% of the ankles with deltoid ligament injuries had cartilage damage. Although lateral instability could be verified arthroscopically in 127 patients, medial instability was presumed clinically in 38 patients but was actually detected in 54 patients arthroscopically. Conclusion Preoperative ankle arthroscopy revealed an essential amount of information that would otherwise have been undetected. For instance, the ligaments showed typical abnormalities corresponding to different entities of ankle instability and different intra-articular pathologic conditions.

scholarly journals Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096732
Author(s):  
Soichi Hattori ◽  
Kentaro Onishi ◽  
Yuji Yano ◽  
Yuki Kato ◽  
Hiroshi Ohuchi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Open Repair ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Arthroscopic Repair ◽  
Anterior Talofibular Ligament ◽  
Lower Margin ◽  
Level Of Evidence ◽  
The Mean ◽  
Noninferiority Margin

Background: Arthroscopic repair is a widely accepted surgical treatment for chronic ankle instability; however, recent studies have shown that arthroscopic repair is nonanatomic in its anchor placement and resultant biomechanics. Ultrasound may improve the accuracy of the anchor placement. Hypothesis: Our hypothesis was that the accuracy of anchor placement in sonographically guided anterior talofibular ligament (ATFL) repair will be comparable with that in open ATFL repair. Study Design: Cohort study; Level of evidence, 3. Methods: The study included 26 patients who received surgical treatment between April 2012 and October 2019 for chronic ankle instability. Fifteen patients underwent open modified Broström repair and 11 underwent sonographically guided ATFL repair. The distance between the anchor hole and the fibular obscure tubercle was measured using 3-dimensional computed tomography and was compared between the operative procedures. For comparison, a noninferiority trial was employed, with open modified Broström repair as the reference surgery. The noninferiority margin was defined as 5 mm. Results: The mean ± SD distance between the anchor and fibular obscure tubercle was 6.0 ± 2.7 mm in open repair and 5.6 ± 3.3 mm in sonographically guided repair. The mean difference in distance between the techniques ( open repair – sonographically guided repair) was 0.37 mm (95% CI, –2.1 to 2.9 mm). The lower margin of the confidence interval was within the noninferiority margin (–5 to 5 mm). Conclusion: Anchor placement under sonographically guided ATFL repair was equivalent to that of open ATFL repair and can be considered anatomic and accurate.

Bone Mineralization Changes in the Subchondral Bone of the Medial Gutter in Chronic Lateral Ankle Instability

2020 ◽  
Vol 41 (11) ◽  
pp. 1419-1426
Author(s):  
Tomoyuki Nakasa ◽  
Yasunari Ikuta ◽  
Yuki Ota ◽  
Munekazu Kanemitsu ◽  
Junichi Sumii ◽  
...  
Keyword(s):  
Subchondral Bone ◽  
Ankle Instability ◽  
Bone Mineralization ◽  
Hounsfield Unit ◽  
Control Group ◽  
Anterior Talofibular Ligament ◽  
Bone Change ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Subchondral Bone Change

Background: Chronic ankle instability (CAI) induces osteoarthritis (OA) by inflicting abnormal stresses on the medial gutter. It is important to detect early OA change and to explore factors likely to induce the OA. The purpose of this study was to evaluate subchondral bone change in the medial gutter of CAI using computed tomography (CT) scans. Methods: Thirty-five ankles with CAI (CAI group) and 35 ankles without CAI (control group) were included. The region of interest (ROI) in the subchondral bone of the medial gutter on CT axial images was set on the tibia and talus. The Hounsfield unit (HU) in ROIs was measured and corrected by the HU of the fibula in the same slice. HU ratios were compared between the CAI and control groups. In the CAI group, the relationship between the HU ratio and the talar tilt angle (TTA), OA change, and the anterior talofibular ligament (ATFL) remnant quality were analyzed. Results: The mean HU ratio in the CAI group was significantly higher than that in the control. In the CAI group, HU ratios in ≥10 degrees of TTA were significantly higher than those in <10 degrees. But there was no significant difference in the HU ratios with or without OA change in the medial gutter. A good-quality ATFL remnant showed a low HU ratio compared with that with poor quality. Conclusion: CAI patients exhibited subchondral bone change in the medial gutter, which suggests that the elimination of instability may help to prevent or decrease the development and/or progression of osteoarthritis. Level of Evidence: Level III, comparative series.

scholarly journals Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for chronic ankle instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0054
Author(s):  
Yunfeng Zhou ◽  
Bin Song
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomical Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Aofas Score ◽  
Anterior Translation ◽  
Talar Tilt ◽  
American Orthopaedic

Category: Arthroscopy Introduction/Purpose: To evaluate the clinical results of an anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament under arthroscopy in treatment of chronic ankle instability. Methods From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Methods: From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Results: The operations were lasted for 75.8 minutes(72~104 minutes). 28 cases were received a mean follow up of 14.8 months(range, 12~25 months. The mean VAS pain score decreased from 5.79 to 1.54(t=26.63, P<0.01), and the medial AOFAS score improved from 63.64 to 90.21(t=-16.57, P<0.01). Imageological examination were completed 16.8 months after the operation (range, 12~25 months). The mean talar tilt decreased from 15.6°to 6.01°(t=25.39, P<0.01),and anterior translation of the talar reduced from a mean of 10.82 to 4.03 mm(t=15.79, P<0.01). Conclusion: Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament could improve the function and stability of ankle joints effectively, providing a valid option for treating chronic ankle instability.

scholarly journals Bilateral Proprioceptive Evaluation in Individuals With Unilateral Chronic Ankle Instability

2017 ◽  
Vol 52 (4) ◽  
pp. 360-367 ◽  
Author(s):  
Andreia S. P. Sousa ◽  
João Leite ◽  
Bianca Costa ◽  
Rubim Santos
Keyword(s):  
Outcome Measure ◽  
Ankle Instability ◽  
Position Sense ◽  
Chronic Ankle Instability ◽  
Joint Position Sense ◽  
Control Group ◽  
Injured Limb ◽  
History Of ◽  
Ankle Proprioception ◽  
Force Sense

Context:  Despite extensive research on chronic ankle instability, the findings regarding proprioception have been conflicting and focused only on the injured limb. Also, the different components of proprioception have been evaluated in isolation. Objective:  To evaluate bilateral ankle proprioception in individuals with unilateral ankle instability. Design:  Cohort study. Setting:  Research laboratory center in a university. Patients or Other Participants:  Twenty-four individuals with a history of unilateral ankle sprain and chronic ankle instability (mechanical ankle instability group, n = 10; functional ankle instability [FAI] group, n = 14) and 20 controls. Main Outcome Measure(s):  Ankle active and passive joint position sense, kinesthesia, and force sense. Results:  We observed a significant interaction between the effects of limb and group for kinesthesia (F = 3.27, P = .049). Increased error values were observed in the injured limb of the FAI group compared with the control group (P = .031, Cohen d = 0.47). Differences were also evident for force sense (F = 9.31, P &lt; .001): the FAI group demonstrated increased error versus the control group (injured limb: P &lt; .001, Cohen d = 1.28; uninjured limb: P = .009, Cohen d = 0.89) and the mechanical ankle instability group (uninjured limb: P = .023, Cohen d = 0.76). Conclusions:  Individuals with unilateral FAI had increased error ipsilaterally (injured limb) for inversion movement detection (kinesthesia) and evertor force sense and increased error contralaterally (uninjured limb) for evertor force sense.

scholarly journals Magnetic resonance imaging in traumatic injuries of the ankle joint in children

2020 ◽  
Vol 24 (4) ◽  
pp. 266-271
Author(s):  
N. Yu. Serova ◽  
T. A. Akhadov ◽  
I. A. Melnikov ◽  
O. V. Bozhko ◽  
N. A. Semenova ◽  
...  
Keyword(s):  
Ankle Joint ◽  
Soft Tissues ◽  
Diagnostic Value ◽  
Ankle Injuries ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Mri Findings ◽  
Traumatic Injuries ◽  
Sport Activities ◽  
Bone Fragments

Introduction. Sprain of the ankle joint is one of the most common injuries in children during sport activities. Purpose. To define MRI diagnostic value in ankle joint injuries. Material and methods. 30 patients , 18 boys and 12 girls aged 8-17 ( average age 14.6 years), were enrolled into the study. 20 of them (66.7%) were 12-14 years old, 3 (10%) - < 10 years old and 7 (23.3 %) - > 14 years old. A Philips AchievadStream 3.0 Tesla scanner was used for MRI examination. Results. MRI findings showed that 17 (56.7%) patients had damage of the anterior talofibular ligament; 8 patients had avulsion of bone fragments of the lateral ankle; 9 patients (30.0%) had partial deltoid ligament injuries. Complete rupture of ligaments was rare and was seen only in two patients (6.7%). Conclusion. MRI is a method of choice in assessing ankle injuries due to high contrast of soft tissues, high resolution and multi-planar potentials. MRI is especially useful in examining soft ankle tissue structures such as tendons, ligaments, nerves and fascia, as well as in revealing hidden / subtle bone damage.

scholarly journals Morphometric relationships between dimensions the anterior talofibular ligament and calcaneofibular ligament in routine magnetic resonance imaging

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Pawel Szaro ◽  
Khaldun Ghali Gataa ◽  
Nektarios Solidakis ◽  
Przemysław Pękala
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Negative Correlation ◽  
Biomechanical Model ◽  
Anterior Talofibular Ligament ◽  
Resonance Imaging ◽  
Calcaneofibular Ligament ◽  
Level Of Evidence ◽  
Human Foot ◽  
Routine Magnetic Resonance Imaging

Abstract Purpose This study aimed to test the hypothesis that routine MRI ankle can be used to evaluate dimensions and correlations between dimensions of single and double fascicular variants of the ATFL and the CFL. Methods We reviewed ankle MRIs for 251 patients. Differences between the length, thickness, width, and length of the bony attachments were evaluated twice. P < .05 was considered as significant. Results For the ATFL, we observed a negative correlation between thickness and width, with a positive correlation between thickness and length (p < 0.001). The average values for the ATFL were thickness, 2.2 ± 0.05 mm; length, 21.5 ± 0.5 mm; and width, 7.6 ± 0.6 mm. The average values for the CFL were thickness, 2.1 ± 0.04 mm; length, 27.5 ± 0.5 mm; and width, 5.6 ± 0.3 mm. A negative correlation was found between length and width for the CFL (p < 0.001). Conclusions Routine MRI showed that most dimensions of the ATFL and CFL correlate with each other, which should be considered when planning new reconstruction techniques and developing a virtual biomechanical model of the human foot. Level of evidence III

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