scholarly journals Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

2021 ◽  
Vol 9 (5) ◽  
pp. 232596712110040
Author(s):  
Ji Hye Choi ◽  
Kug Jin Choi ◽  
Chin Youb Chung ◽  
Moon Seok Park ◽  
Ki Hyuk Sung ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Tilt Angle ◽  
Ankle Instability ◽  
Interobserver Reliability ◽  
Initial Presentation ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Stress Radiographs ◽  
Lateral Ankle Instability

Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.

scholarly journals Comparison of Clinical Outcomes in Patients with Generalized Ligamentous Laxity and without Generalized Laxity in the Arthroscopic Modified Broström Operation for Chronic Lateral Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
YoungKoo Lee ◽  
Jungwoo Yoo ◽  
Keon Hee Yun ◽  
Ji Yong Park
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Tilt Angle ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Ligamentous Laxity ◽  
Lateral Ankle Instability ◽  
Talar Tilt

Category: Sports Introduction/Purpose: The arthroscopic modified Broström operation (MBO) has been developed and frequently used to treat chronic lateral ankle instability (CLAI). Clinical outcome of arthroscopic MBO was reported as good or excellent. But there were no report about comparison of clinical outcomes between patients with generalized ligamentous laxity (laxity) and without generalized ligamentous laxity (no laxity). The purpose of this study is to compare the clinical outcomes of the group with generalized ligamentous laxity and without generalized ligamentous laxity in chronic lateral ankle instability. Methods: From January 2013 to November 2015, Arthroscopic MBO was performed in 99 patients for CLAI. We retrospectively analyzed 99 consecutive patients were included in terms of inclusion criteria. All patients had giving way, persistent pain and an inability to resume one’s preinjury activity level for more than 6 months. Patients were divided into 2 groups: laxity group (24 ankles) and no laxity group (75 ankles). Evaluation was performed preoperatively and at a final follow-up a minimum of 12 months postoperatively using the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score, pain Visual Analogue Scale (VAS)(0~100), and talar tilt angle. Results: In terms of radiological outcomes, the preoperatively talar tilt angle was greater in patients in laxity group than in no laxity group (p < .001). The last follow-up talar tilt angle was the same between in patients in laxity group and in no laxity group (p=0.413). But preoperative-last follow up difference was found between two groups (p=0.03). The variation from preoperative to last follow up talar tilt angle showed significant greater value in laxity group (-6.9 ± 5.2) than in no laxity group (-4.2 ± 4.2)(p=0.03). In terms of clinical outcome, last follow up AOFAS and VAS in all groups were improved than preoperative scores (27.5 ± 23.7, 24.1 ± 18.4, respectively). But preoperative-last follow up differences were not found between two groups (P=0.52). Conclusion: In terms of radiologic outcomes, there was difference outcome variation between two groups, in terms of clinical outcomes, there were no difference outcome variations between two groups. All groups achieved successful clinical and radiological last follow up outcomes even though there was difference outcome variation in talar tilt. Arthroscopic MBO should be considered as a reasonable method in patients who have chronic lateral ankle instability regardless of generalized ligamentous laxity.

scholarly journals All-inside Arthroscopic Modified Broström Operation for Lateral Ankle Instability with Os Subfibulare

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0029
Author(s):  
Woo Jong Kim ◽  
Young Koo Lee
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Varus Stress ◽  
Accessory Ossicle ◽  
Vas Scores ◽  
Talar Tilt

Category: Sports Introduction/Purpose: Os Subfibulare(OSF) is an accessory ossicle that lies at the tip of the lateral malleolus of the ankle. Patients with chronic lateral ankle instability (CLAI) have a high incidence of OSF, and there relationship implies that there is a correlation between OSF and CLAI. The all-inside arthroscopic Modified Broström Operation (MBO) has been developed for the treatment of chronic lateral ankle instability (CLAI) and the outcome was reported as good or excellent. But there were no report about comparison of the outcome between OSF and non-OSF patients with chronic lateral ankle instability treated by all-inside arthroscopic MBO. The purpose of this study was to evaluate the clinical and radiologic outcomes of the arthroscopic MBO procedure for CLAI with or without OSF. Methods: From January 2013 to september 2016, arthroscopic MBO was performed on 133 patients with CLAI. Of these, 126 ankles were evaluated for this study. Patients were divided into two groups: the OSF group (26 patients), without OSF group (100 patients). Evaluation tools included the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot ankle score and pain Visual Analogue Scale (VAS) at preoperatively, 6 and 12 months postoperatively for clinical outcomes. And we also evaluated the talar tilt angle in the varus stress radiograph at preoperatively, 6 and 12 months postoperatively for radiologic outcomes. Results: There were no difference in age, sex, preoperative AOFAS hindfoot ankle scores and VAS scores and talar tilt angle between the two groups preoperatively(P >.05). And there also were no difference at the final follow-up (P >.05).The final follow-up AOFAS hindfoot ankle score and Vas in both group showed improvement compared with preoperaive values. Conclusion: There were no difference in both clinical and radiologic outcomes between OSF group and non-OSF group at a minimum 12 months follow-up. We achieved similar successful outcomes in both groups using All-inside arthroscopic MBO. Arthroscopic MBO should be considered as a reasonable alternative method in patients who have chronic lateral ankle instability regardless of the presence of OSF.

scholarly journals Demographic Predictors of Concomitant Osteochondral Lesion of the Talus in Patients With Chronic Lateral Ankle Instability

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110133
Author(s):  
Yong Sang Kim ◽  
Tae Yong Kim ◽  
Yong Gon Koh
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Case Series ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Female Patients ◽  
Lateral Ankle Instability ◽  
Talar Tilt

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Broström operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9 ± 24.9 mm2 vs 100.7 ± 18.0 mm2, P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle ( P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0 ± 2.0 degrees vs 10.3 ± 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. Level of Evidence: Level IV, retrospective case series.

Magnetic Resonance Imaging T2* Mapping of the Talar Dome and Subtalar Joint Cartilage 3 Years After Anterior Talofibular Ligament Repair or Reconstruction in Chronic Lateral Ankle Instability

2021 ◽  
Vol 49 (3) ◽  
pp. 737-746
Author(s):  
Yiwen Hu ◽  
Yuyang Zhang ◽  
Qianru Li ◽  
Yuxue Xie ◽  
Rong Lu ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Resonance Imaging ◽  
Talar Dome ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability

Background: Cartilage degeneration is a common issue in patients with chronic lateral ankle instability. However, there are limited studies regarding the effectiveness of lateral ligament surgery on preventing talar and subtalar joint cartilage from further degenerative changes. Purpose: To longitudinally evaluate talar and subtalar cartilage compositional changes using magnetic resonance imaging T2* mapping in anatomic anterior talofibular ligament (ATFL)–repaired and ATFL-reconstructed ankles and to compare them with measures in asymptomatic controls. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2015 and December 2016, patients with chronic lateral ankle instability who underwent anatomic ATFL repair (n = 19) and reconstruction (n = 20) were prospectively recruited. Patients underwent 3.0-T magnetic resonance imaging at baseline and 3-year follow-up. As asymptomatic controls, 21 healthy volunteers were recruited and underwent imaging at baseline. Talar dome cartilage was divided into (1) medial anterior, central, and posterior and (2) lateral anterior, central, and posterior. Posterior subtalar cartilage was divided into (1) central talus and calcaneus and (2) lateral talus and calcaneus. Ankle function was assessed using the American Orthopaedic Foot & Ankle Society scores. Results: There were significant increases in T2* values in medial and lateral posterior and central talus cartilage from baseline to 3-year follow-up in patients who underwent repair. T2* values were significantly higher in ATFL-repaired ankles at follow-up for all cartilage regions of interest, except medial and lateral anterior and lateral central, compared with those in healthy controls. From baseline to 3-year follow-up, ATFL-reconstructed ankles had a significant increase in T2* values in lateral central and posterior cartilage. T2* values in ATFL-reconstructed ankles at follow-up were elevated in all cartilage regions of interest, except medial and lateral anterior, compared with those in healthy controls. ATFL-repaired ankles showed a greater decrease of T2* values from baseline to follow-up in lateral calcaneus cartilage than did ATFL-reconstructed ankles ( P = .031). No significant differences in American Orthopaedic Foot & Ankle Society score were found between repair and reconstruction procedures (mean ± SD, 19.11 ± 7.45 vs 16.85 ± 6.24; P = .311). Conclusion: Neither anatomic ATFL repair nor reconstruction could prevent the progression of talar dome and posterior subtalar cartilage degeneration; however, ankle function and activity levels were not affected over a short period. Patients who underwent ATFL repair exhibited lower T2* values in the lateral calcaneus cartilage than did those who underwent reconstruction.

scholarly journals Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability

2014 ◽  
Vol 1 (1) ◽  
pp. 12-16
Author(s):  
Qian-bo Chen ◽  
Xiao-kang Tan ◽  
Chen-song Yuan ◽  
Xu Tao ◽  
Hong-hui Cao ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Ankle Instability ◽  
Asia Pacific ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Peroneus Brevis

ABSTRACT Background Chronic lateral ankle instability causes significant problems in physical activity and accelerates development of osteoarthritic changes. Many procedures were designed to reconstruct the anterior talo-fibular ligament (ATFL) in the treatment of chronic lateral ankle instability. Although most of them were effective, but brought big trauma and sacrifice of some tendons. Objective To design a minimally invasive ATFL reconstruction with partial peroneus brevis tendon and evaluate its clinical outcomes. Study design Nonrandomized controlled clinical trial. Materials and methods From 2004 to 2012, 29 patients of chronic lateral ankle instability were treated with minimally invasive ATFL reconstruction with partial peroneus brevis tendon. A 3 cm curved incision was made to explore the ATFL origin and its insertion. Half peroneus brevis tendon was taken to reconstruct the ATFL through the bone tunnel from the insertion of CFL to the insertion of ATFL in the fibular, and then fixed to ATFL insertion location on the talus. All patients were followed-up by radiology and clinical examination at least two years. Their ATFLs were always evaluated by standard stress X-ray examination and magnetic resonance imaging (MRI) prior to surgery and every 1 year after the operation. Functional results were assessed in terms of Karlsson score and the American Orthopaedic Foot and Ankle Society (AOFAS) anklehind foot score. Results The average follow-up period was 57.9 months (24- 114 months). The majority of results (93.1%) were satisfactory. The mean Karlsson score improved from 41.7 prior to surgery to 88.6 and AOFAS from an average 47.2 preoperatively to 91.7 postoperatively at the final follow-up visit. Paired t-tests showed improvements of great significance (p < 0.01). The ligaments were proved be reconstructed well in all patients by MRI. It showed the negative talar tilt sign postoperatively by stress X-rays. There was no recurrence of lateral ankle instability. Conclusion The minimally invasive ATFL reconstruction with partial peroneus brevis tendon has advantages of small trauma, good reconstruction and excellent clinical outcomes, thus, is a safe and effective method for the treatment of chronic lateral ankle instability. How to cite this article Chen Q, Tan X, Yuan C, Tao X, Cao H, Xu J, Tang K. Minimally Invasive Reconstruction of Anterior Talofibular Ligament with Partial Peroneus Brevis Tendon in the Treatment of Chronic Lateral Ankle Instability. J Foot Ankle Surg (Asia-Pacific) 2014;1(1):12-16.

Chronic lateral ankle instability: Results of two-staged approach, correlation with magnetic resonance imaging findings, and incidence of associated pathologies – A 4-year follow-up study

2020 ◽  
Vol 0 ◽  
pp. 1-8
Author(s):  
Shaival Dalal ◽  
Geralt Morgan
Keyword(s):  
Ankle Instability ◽  
Treatment Protocol ◽  
Ankle Arthroscopy ◽  
Resonance Imaging ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Staged Treatment ◽  
Modified Broström Procedure

Objectives: About 20% of ankle sprains have persistent symptoms even after 6 weeks–3 months of conservative treatment of physiotherapy and bracing. We followed a two-staged operative treatment protocol for the management of patients with persistent chronic lateral ankle instability. This study aims to analyze the outcomes of this two-staged treatment protocol and also to compare the magnetic resonance imaging (MRI) and arthroscopic findings in such patients and note the presence of associated pathologies. Materials and Methods: This is a retrospective study of 87 patients operated for chronic lateral ankle instability in two stages: (1) Diagnostic examination under anesthesia and ankle arthroscopy and (2) modified Brostrom procedure. Results: With a mean follow-up of 4 years, 31% of the patients had a complete resolution of their symptoms 4 months after the first procedure. Mean American Orthopaedic Foot and Ankle Score (AOFAS) and visual analog scale (VAS) scores show a significant improvement in functional outcomes in both the groups (P < 0.05). Moreover, the MRI findings were equivocal or false negative in 60% of the patients. We also observed associated pathologies such as synovitis, osteochondral defect of talus, and anterolateral impingement in 40% of the patients. Conclusion: The two-staged treatment of ankle arthroscopy and modified Brostrom procedure is highly effective in resolution of the symptoms of patients with chronic lateral ankle instability. As MRI is not very sensitive and because of the associated intra-articular lesions found in this spectrum of patients, a primary ankle arthroscopy followed by a staged Brostrom procedure has shown to improve outcomes significantly with optimal intervention.

scholarly journals A comparison between arthroscopic and open surgery for treatment outcomes of chronic lateral ankle instability accompanied by osteochondral lesions of the talus

2019 ◽  
Author(s):  
Can Xu ◽  
Mingqing Li ◽  
Chenggong Wang ◽  
Hua Liu
Keyword(s):  
Complication Rate ◽  
Ankle Instability ◽  
Arthroscopic Surgery ◽  
Arthroscopic Treatment ◽  
Functional Score ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Arthroscopic Procedure ◽  
Lateral Ankle Instability

Abstract Background : The present study aimed to examine the efficacy and safety of concurrent arthroscopic treatment of osteochondral lesion of talus (OLT) and lateral ankle instability. It was hypothesized that the outcome of all arthroscopic surgery was no worse than that of the combined open and arthroscopic surgery for treating chronic lateral ankle instability accompanied by OLT. Methods : All the patients diagnosed of chronic lateral ankle instability accompanied by OLT who were surgically treated between May 2015 and May2017 were targeted for inclusion. A total of 32 patients received concurrent arthroscopic treatment of OLT and lateral ankle instability, and 35 patients received arthroscopic treatment of OLT and open lateral ankle stabilization. All these patients were followed up using Karlsson Ankle Functional Score, visual analog scale (VAS) scores, Tegner activity score, and American Orthopaedic Foot and Ankle Society Score (AOFAS). The satisfaction and complication rate was evaluated and compared. Results : At 24-month follow-up, the Karlsson score, VAS score, Tegner score and AOFAS score were significantly improved in both groups in relation to the pre-operative condition. The two groups did not differ significantly from each other in terms of functional outcomes, satisfaction and complication rate. Conclusion : In comparison with the open lateral ankle stabilization and arthroscopic treatment of OLT, the all arthroscopic procedure showed no difference in clinical outcome at 24-month follow-up for treating chronic lateral ankle instability accompanied by OLT. With the benefits of minimal invasive arthroscopic procedure and an aggressive rehabilitation protocol, the treatment efficacy for the patients with chronic lateral ankle instability accompanied by OLT was still inferior to that for the patients with chronic ankle instability. Trial registration : The present study was carried out with the retrospectively registered data starting from May 28, 2015

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