scholarly journals Modified Incision for Brostrom Lateral Ligament Reconstruction of the Ankle

2009 ◽  
Vol 17 (2) ◽  
pp. 199-201 ◽  
Author(s):  
Ravindra H Mahajan ◽  
Rakesh B Dalal
Keyword(s):  
Wound Healing ◽  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Lateral Malleolus ◽  
Lateral Ligament ◽  
Neurological Damage ◽  
Distal Fibula ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Wound Healing Problems

Purpose. To describe a modified incision for the Brostrom procedure to correct lateral ankle instability. Methods. 14 men and 12 women aged 23 to 38 (mean, 27) years with lateral ankle instability underwent the Brostrom procedure with a modified incision to repair both the anterior talofibular and calcaneofibular ligaments, without endangering the sural or superficial peroneal nerves. The incision ran longitudinally over the distal fibula extending 2.5 cm distal to the tip of the lateral malleolus. Results. There were no instances of wound healing problems, neurological damage, and repair failure. Surgical exposure of all patients was graded as excellent. Conclusion. The modified incision enables easy repair without endangering the sural and superficial peroneal nerves. Access to the peroneal tendons is allowed if necessary.

Percutaneous Lateral Ligament Reconstruction with Allograft for Chronic Lateral Ankle Instability

2012 ◽  
Vol 33 (2) ◽  
pp. 99-104 ◽  
Author(s):  
Hyunkook Youn ◽  
Yong Sang Kim ◽  
Jongseok Lee ◽  
Woo Jin Choi ◽  
Jin Woo Lee
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Lateral Ligament ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability

scholarly journals Lateral ankle stabilization with a polyester fiber construct implant as a revision for failed primary lateral ligament reconstruction

2020 ◽  
Vol 14 (1) ◽  
pp. 19-23
Author(s):  
Luis Felipe Hermida Galindo ◽  
Elias Hermida Ochoa ◽  
Armando Torres Gomez
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Lateral Ligament ◽  
Level Of Evidence ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Reconstruction Methods ◽  
Lateral Ankle Instability ◽  
Therapeutic Study ◽  
Bone Tunnels

Objective: The aim of this study is to demonstrate an original technique in which a stable construct is made by fibular and calcaneal bone tunnels producing a figure of 8 with a Polyester implant as revision for failed primary ligament reconstruction. Methods: This is a retrospective study of 19 patients with persistent lateral ankle instability diagnosis after a primary ligament repair treated between 2011 and 2019. The surgical technique is described in detail in which stabilization of the lateral ankle is performed. 11 men and 8 women with a mean age of 30.94 years (15-53). Follow up was 29.05 months (6-109). Pre and postoperative AOFAS ankle score were used as well as an AVS and a satisfaction questionnaire. Results: There was a significant improvement in AOFAS score, 76.31 to 91.47 (<0.001). All the patients except one, stated to have a stable ankle and be Very satisfied (16) or satisfied (2) with the procedure. No infection was presented in any patient. Conclusion: This technique is a reliable alternative in patients in which primary ankle ligaments have failed and no autograft or allograft are wanted to be used. Level of Evidence V; Therapeutic Study; Expert Opinion.

Associated Injuries Found in Chronic Lateral Ankle Instability

2000 ◽  
Vol 21 (10) ◽  
pp. 809-815 ◽  
Author(s):  
Benedict F. DiGiovanni ◽  
Carlos J. Fraga ◽  
Bruce E. Cohen ◽  
Michael J. Shereff
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Lateral Ligament ◽  
Peroneal Tendon ◽  
Associated Injuries ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Anterolateral Impingement

Sixty-one patients underwent a primary ankle lateral ligament reconstruction for chronic instability between 1989 and 1996. In addition to the ligament reconstruction, all patients had evaluation of the peroneal retinaculum, peroneal tendon inspection by routine opening of the tendon sheath, and ankle joint inspection by arthrotomy. A retrospective review of the clinical history, physical exam, MRI examination, and intraoperative findings was conducted on these 61 patients. The purpose was to determine the type and frequency of associated injuries found at surgery and during the preoperative evaluation. At surgery no patients were found to have isolated lateral ligament injury. Fifteen different associated injuries were noted. The injuries found most often by direct inspection included: peroneal tenosynovitis, 47/61 patients (77%); anterolateral impingement lesion, 41/61 (67%); attenuated peroneal retinaculum, 33/61 (54%); and ankle synovitis, 30/61 (49%). Other less common but significant associated injuries included: intra-articular loose body, 16/61 (26%); peroneus brevis tear, 15/61 (25%); talus osteochondral lesion, 14/61 (23%); medial ankle tendon tenosynovitis, 3/61 (5%). The findings of this study indicate there is a high frequency of associated injuries in patients with chronic lateral ankle instability. Peroneal tendon and retinacular pathology, as well as anterolateral impingement lesions, occur most often. A high index of suspicion for possible associated injuries may result in more consistent outcomes with nonoperative and operative treatment of patients with chronic lateral ankle instability.

454 Brace Brace: Modified Brsotrom-Gould Procedure with and Without Internal Brace for the Treatment of Chronic Lateral Ankle Instability

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
J McGuigan ◽  
A Pillai ◽  
A Hall
Keyword(s):  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Nonoperative Treatment ◽  
Lateral Ligament ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Significant Difference ◽  
Internal Brace

Abstract Introduction The most common ankle injury is a sprain. Surgical management is only indicated when nonoperative treatment fails. Modified Broström-Gould (MBG) is the gold standard surgical technique. MBG technique may be augmented with an internal brace. This study aims to compare the clinical outcomes of MBG with and without internal brace for the treatment of chronic lateral ankle instability using validated patient recorded outcome measures. Method Retrospective analysis of patients that underwent lateral ankle ligament reconstruction between January 2012 and June 2019 were reviewed at and asked to complete the Manchester oxford foot and ankle questionnaire (MOXFQ). 29 patients (30 ankles) underwent lateral ligament reconstruction between these dates and completed the questionnaire, 20 patients (21 ankles) without internal brace and 9 patients with internal brace. Results The group with internal brace displayed significantly better results in the MOXFQ summary index score (20.49 ± 13.15 vs 43.53 ± 34.72, P = 0.014) and standing/walking subscale (15.48 ± 13.00 vs 45.92 ± 36.60, P = 0.023) compared to group without internal brace. There was no significant difference between Pain and Social interactions subscales. Conclusions Our results show that the addition of an internal brace to the MBG procedure for the management of chronic lateral ankle instability improves clinical outcomes.

scholarly journals Radiological and clinical outcome of lateral ankle instability with medial compartment osteoarthritis

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Sungwook Kim ◽  
Hong-Geun Jung ◽  
Jong-Soo Lee ◽  
Hwa Jun Kang ◽  
Mao Yuan Sun
Keyword(s):  
Clinical Outcome ◽  
Pain Score ◽  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Degenerative Change ◽  
Medial Compartment ◽  
Functional Score ◽  
Lateral Ankle ◽  
Lateral Ankle Instability

Category: Ankle, Ankle Arthritis, osteoarthritis, ankle instability Introduction/Purpose: When lateral ankle instability (LAI) is not treated for long period, unbalanced loading on medial ankle may proceed to osteoarthritis (OA). Outcome studies about osteoarthritis with lateral ankle instability after stabilization, however, have rarely been reported. The authors have investigated the radiological and clinical outcome of ligament stabilization for LAI with medial compartment OA. Methods: The study is based on 25 ankles of LAI with medial compartment ankle OA that underwent lateral ankle ligament reconstruction from 2007 to 2014 with at least 1 year follow-up. The medial ankle OA was diagnosed with degenerative change of medial ankle on plain X-ray or MRI or arthroscopic findings. The OA was classified using Takakura stage, and arthroscopic degenerative change was classified by modified Outerbridge grading. Ligament stabilization surgery was done using either modified Broström procedure or lateral ligament reconstruction using semitendinosus tendon allograft. Arthroscopic synovectomy, debridement, and microfracture for osteochondral lesion were performed when needed. Clinical outcomes were evaluated using visual analogue scale (VAS) pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson- Peterson score, and subjective patient satisfaction. Statistical analysis were done using Wilcoxon signed rank test. Results: The average instability duration was 98 (range, 12-480) months and the average follow up period was 46 (range, 13-108) months. Preoperative Takakura stage was mostly I (n=19, 76%) and II (n=4, 17%), and was same postoperatively. MRI OA findings of 18 ankles were medial cartilage denudation (17%), cartilage thinning/erosion (44%), medial osteophyte (50%), and loose bodies (30%). Modified Outerbridge grade 2 and 4 were most common (both 41%). The VAS pain score decreased from 6.1 ± 1.6 preoperatively to 1.8 ± 1.6 postoperatively (P<0.05). The AOFAS score improved from 61.8 ± 14.7 preoperatively to 90.0 ± 6.3 postoperatively, and the Karlsson-Peterson score improved from 54.5 ±14.4 to 89.4 ± 8.4 (P<0.05). There were no significant complications. All patients were satisfied. Conclusion: Ligament stabilization accompanied with arthroscopic procedure could draw good outcome, even without structural bony deformity correction. Even with no improvement in plain radiograph, functional score could be improved.

scholarly journals Early Versus Delayed Mobilization Post-Operative Protocols for Primary Lateral Ankle Ligament Reconstruction: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 14 ◽  
pp. 141-148
Author(s):  
Matthew Vopat ◽  
Alexander Wendling ◽  
Brennan Lee ◽  
Maaz Hassan ◽  
Brandon Morris ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Meta Analysis ◽  
Early Mobilization ◽  
Lateral Ligament ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Lateral Ankle Ligament Reconstruction ◽  
Primary Lateral

Introduction. Lateral ankle instability represents a common orthopaedic diagnosis. Nonoperative treatment through focused physical therapy provides satisfactory results in most patients. However, some patients experience persistent chronic lateral ankle instability despite appropriate nonoperative treatment. These patients may require stabilization which can include primary lateral ligament reconstruction with a graft to restore ankle stability. Optimal post-operative rehabilitation of lateral ankle ligament reconstruction remains unknown, as surgeons vary in how long they immobilize their patients post-operatively. The aim of this review is to provide insight into early mobilization (EM) versus delayed mobilization (DM) post-operative protocols in patients undergoing primary lateral ankle ligament reconstructions to determine if an optimal evidence-based post-operative rehabilitation protocol exists in the literature. Methods. Following PRIMSA criteria, a systematic review/meta-analysis using the PubMed/Ovid Medline database was performed (10/11/1947-1/28/2020). Manuscripts that were duplicates, non-lateral ligament repair, biomechanical and non-English language were excluded. Protocols were reviewed and divided into two categories; early mobilization (within 3 weeks of surgery) and delayed mobilization (after 3 weeks of surgery). Functional outcome scores (AOFAS, Karlsson scores), radiographic measurements (anterior drawer, talar tilt) and complications evaluated using weighted mean differences (pre- and post-operative scores) and mixed-effect models. Results. After our search, we found 12 out of 1,574 studies that met the criteria for the final analysis, representing 399 patients undergoing lateral ankle reconstruction. Using weighted mean differences the DM group showed superior AOFAS functional scores compared to the EM group; 28.0 (5.5) vs. 26.3 (0.0) respectively, p < 0.001; although sample size was small. Conversely, no significant differences were found for Karlsson functional score (p = 0.246). With regards to radiographic outcome, no significant differences were observed; anterior drawer was p = 0.244 and talar tilt was p = 0.937. A meta-analysis using mixed-effects models confirmed these results, although heterogeneity was high. Conclusions. While there were some conflicting results, findings suggest that EM post-operative protocols for patients undergoing lateral ankle ligament reconstruction may not compromise functional outcomes or post-operative stability. Because heterogeneity was high, future studies are still needed to evaluate these protocols in less diverse patient groups and/or more consistent techniques for lateral ankle ligament reconstruction.

scholarly journals Timing of arthroscopy does not impact recurrence rate of ankle instability in patients undergoing lateral ligament repair surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ashish Shah ◽  
Brent Cone ◽  
Cesar de Cesar Netto ◽  
Parke Hudson ◽  
Ibukunoluwa Araoye ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Ankle Instability ◽  
Demographic Data ◽  
Single Stage ◽  
Arthroscopic Treatment ◽  
Lateral Ligament ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Surgical Failure

Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Although the initial treatment is conservative, some patients may develop chronic instability requiring surgical repair. Arthroscopy is often performed prior to ligament reconstruction to evaluate concomitant intraarticular and cartilage injuries. Arthroscopic treatment may be performed immediately prior to ligament repair (single stage), or it may be scheduled days/weeks prior to ligament repair (double stage). Concerns of single stage arthroscopic treatment are related to the increased difficulty in dealing with ligaments and soft-tissue injuries hindered by fluid extravasation. Our study compares outcomes between single and double stage arthroscopy in patients undergoing lateral ligament repair surgery. Methods: In this retrospective study we reviewed charts of patients with chronic lateral ankle instability who underwent ankle arthroscopy followed by lateral ligament repair from 2011 to through 2015. A total of 102 patients were included in the study, 65 patients in the single stage group, and 37 in the double stage group. Surgical failure was defined as recurrence of ankle instability at any point in the follow up period after the procedure. Demographic data and recurrence rate of instability were compared between the groups using chi-squared test. Results: Women comprised 72% (73/102) percent of the total patient population. No significant differences in demographic data were found between the two groups. There was no difference in the recurrence rate of lateral ankle instability between patients who underwent 1-stage versus 2-stage arthroscopic treatment. The rate was similar between the groups: 10.8% (7/65) of patients with the single stage technique and 8.1% (3/37) of patients in the double stage group (p=0.6208). Conclusion: In the treatment of chronic lateral ankle instability, the use of single-stage arthroscopy and lateral ligament repair showed similar rates of surgical failure when compared to the double-stage procedure. A single stage approach may be a more efficient use of time and hospital resources, and avoids the need to place the patient under anesthesia multiple times. Arthroscopy may be performed immediately prior to lateral ligament repair without concern for increased risk of recurrence of instability.

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