scholarly journals Is Revision Anatomic Ankle Ligament Repair Augmented with Suture-Tape a Valuable Alternative for Patients with Failed Broström Procedure?

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Seung-Myung Choi ◽  
Byung-Ki Cho ◽  
Gi-Soo Lee
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Ligament Repair ◽  
Recurrent Instability ◽  
Ankle Ligament ◽  
Talar Tilt ◽  
Modified Broström Procedure ◽  
Suture Tape

Category: Ankle, Sports Introduction/Purpose: Recurrent instability after previous anatomic ankle ligament repair has been known to be a poor prognostic factor for revision modified Broström procedure, and ligament reconstruction procedures using an allograft or autograft tendon have commonly been recommended. This prospective study was performed to evaluate the intermediate-term outcomes after revision anatomic ankle ligament repair augmented with suture-tape for failed modified Broström procedures. Methods: Thirty patients with failed modified Broström procedures consecutively underwent revision procedures for recurrent ankle instability. Of these patients, 27 patients who could be followed for more than 2 years were analysed in the current study. The clinical evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM) score. Talar tilt angle and anterior talar translation were measured to evaluate radiologically the changes of mechanical ankle stability. Results: FAOS and FAAM scores significantly improved from preoperative averages of 53.6 and 45.6 points to 87.5 and 85.1 points at final follow-up, respectively (p < 0.001). Talar tilt angle and anterior talar translation had significantly improved from preoperative averages of 15.1° and 12.4 mm to 2.8° and 4.1 mm at final follow-up, respectively (p < 0.001). Preoperative side to side comparison in stress radiographs demonstrated statistically significant difference (p < 0.001), but there was not significant side to side difference in these radiographic measures at final follow-up (p > 0.05). Postoperative complications included 2 cases of local wound problems, 2 cases of superficial peroneal nerve injury, and 1 case of recurrent instability. Conclusion: The revision modified Broström procedure augmented with suture-tape appears to be an effective treatment method for recurrent ankle instability in patients with prior failed modified Broström procedure. This combined procedure can provide reliable stability and satisfactory clinical outcomes through supplementation of the anatomic repair of attenuated ligaments using suture-tape.

Effect of Modified Broström Procedure With Periosteal Flap Augmentation After Subfibular Ossicle Excision on Ankle Stability

2019 ◽  
Vol 40 (6) ◽  
pp. 656-660 ◽  
Author(s):  
Chul Hyun Park ◽  
JeongJin Park
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Case Series ◽  
Level Of Evidence ◽  
Periosteal Flap ◽  
Radiographic Outcomes ◽  
The Mean ◽  
Talar Tilt ◽  
Modified Broström Procedure

Background: The study evaluated the clinical and radiographic outcomes of the modified Broström procedure (MBP) with periosteal flap augmentation after large subfibular ossicle excision for chronic lateral ankle instability (CLAI). Methods: Twenty-two CLAI cases with a large ossicle (≥10 mm) were treated consecutively using the MBP with periosteal flap augmentation after ossicle excision. The mean follow-up duration was 20 months (12-33). For clinical assessment, the visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Karlsson-Peterson score were evaluated preoperatively and at the last follow-up. For radiographic assessment, the size of the ossicle was measured by magnetic resonance imaging, and the talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. Results: The VAS, AOFAS, and Karlsson-Peterson scores improved from 6.3, 68.7, and 56.9 preoperatively to 1.6, 94.5, and 92.4 at the last follow-up, respectively. The mean size of the ossicles was 14.8 mm (11-21 mm). The talar tilt angle and anterior talar displacement improved from 11.2 degrees and 8.3 mm preoperatively to 4.4 degrees and 3.9 mm at the last follow-up, respectively. Conclusion: MBP combined with periosteal flap augmentation after ossicle excision provided good clinical and radiographic outcomes in CLAI with a large ossicle. Level of Evidence: Level IV, case series.

scholarly journals Early Outcomes of Arthroscopic Modified Brostrom Operation for Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Dong-Woo Shim ◽  
Yeokgu Hwang ◽  
Yoo Jung Park ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcomes ◽  
Gold Standard ◽  
Ankle Instability ◽  
Lateral Ankle ◽  
Vas Score ◽  
Lateral Ankle Instability ◽  
Talar Tilt ◽  
Outcome Evaluations ◽  
Modified Broström Procedure

Category: Ankle, Arthroscopy Introduction/Purpose: The gold standard for the surgical treatment of chronic lateral ankle instability is the modified Brostrom procedure. Surgery aims to re-establish ankle stability and function, without compromising ankle motion. Recently introduced all inside arthroscopic modified Brostrom procedure coincide with the goal on that aspect. The purpose of this study was to investigate the early outcomes of all inside arthroscopic modified Brostrom operation for chronic ankle instability. Methods: From January 2015 to August 2016, 30 patients were included. The visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) ankle–hindfoot score, Foot and Ankle Outcome Score (FAOS), and Karlsson score were used to evaluate clinical outcomes. Anterior talar translation and talar tilt were used to evaluate radiologic outcomes. All patients had lateral ankle instability. All patients had giving way, persistent pain, and an inability to resume their preinjury activity level for more than 6 months. Clinical outcome evaluations were performed preoperatively, at 3 months and 6 months postoperatively, and at a final follow-up using the VAS score, the AOFAS ankle-hindfoot score, FAOS, and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 1 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: Thirty patients (19 males and 11 females) were followed up for a mean of 11.0 (range 4 – 23) months. The VAS, AOFAS, 1 FAOS subscale (Quality-of-life) and the Karlsson scores were improved significantly at the each follow-up period of 3 month, 6 month and 1 year postoperatively. Other 4 subscales of FAOS showed no significant outcomes (Table 1). The mean anterior talar translation and talar tilt showed significant improvements from 5.8 mm (SD = 0.4) and 7.9° (SD = 1.0) to 5.3 mm (SD = 0.3) and 5.7° (SD = 0.6) at the final follow-up each (p = 0.034, p=0.034). Conclusion: The arthroscopic modified Brostrom technique could be a viable alternative to the gold-standard open modified Brostrom procedure for anatomic repair of chronic lateral ankle instability. It can yield outstanding functional and clinical outcomes without adverse effects in terms of pain.

scholarly journals Obesity as a Risk Factor for Failure following a Modified Brostrom Procedure

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0003
Author(s):  
Daniel Corr ◽  
Ryan G. Rogero ◽  
Justin E. Palm ◽  
Joseph N. Daniel ◽  
Steven M. Raikin ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Postoperative Period ◽  
Ankle Instability ◽  
Clinical Success ◽  
Treatment Success ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Modified Broström Procedure

Category: Ankle; Hindfoot Introduction/Purpose: The modified Brostrom procedure has been widely accepted as the operative treatment of choice for treating lateral ankle instability in patients that have failed nonoperative management. However, the predisposing risk factors for failure of operative treatment, which has important implications for patient selection, is unknown. Foot and ankle surgeons often raise body mass index (BMI) as a particular concern due to the increased pressure and strain that is applied to the repair with standing and walking in the setting of an elevated BMI. The purpose of this study was to investigate the effect of patient BMI at the time of surgical intervention on preoperative and long-term postoperative functional outcomes, as well as complication and reoperation rates. Methods: A retrospective single institutional study of 160 modified Brostrom procedures, average age 43.8 years, was performed with a minimum of 2-year follow-up. An electronic query based on Current Procedural Terminology codes was initially performed followed by a manual review of the operative report. Patients with any concurrent osteotomy, arthrodesis, or arthroplasty procedures were excluded. Pre- and postoperative Foot and Ankle Ability Measure (FAAM) ADL and Sports survey responses along with Visual Analog Scale for Pain (0-100) patient reports were recorded. Comorbidities and relevant demographic information were manually obtained. Patients were split into two groups based on their preoperative BMI: those patients with BMI <30 and those >=30 (considered obese). Treatment success was defined as achieving the previously established minimal clinically important difference (MCID) FAAM-ADL increase of >=8 and/or FAAM-Sport increase of >=9 from the preoperative to postoperative period. Results: Of 97 patients with BMI <30, 22 (22.7%) did not demonstrate a self-reported MCID in the FAAM-ADL score, and 20 (20.6%) did not demonstrate positive MCID in the FAAM-Sport score. For the 63 patients with BMI >=30, 13 (20.6%) failed to reach FAAM-ADL MCID, while 12 (19%) failed to reach FAAM-Sport MCID. BMI was not shown to be significant in terms of clinical improvement following surgery, as both groups improved significantly on average from preoperative period to follow-up with 125/160 (78.1%) achieving MCID in FAAM-ADL and 128/160 (80%) achieving MCID in FAAM-Sport. However, patients with BMI <30 had significantly higher average preoperative FAAM-ADL scores than those >=30 (66.7 vs 51.2; p=0.003) and higher average postoperative ADL scores that approached significance (92.9 vs 84.5; p=0.075). Conclusion: The modified Brostrom procedure has been previously shown to effectively improve stability and function of the ankle with relatively high rates of success, and such findings are supported by this study. In addition, this study demonstrates that patient BMI is not a prohibitive factor in limiting clinical success in the postoperative period. The procedure was generally effective for both groups of patients. However, data suggests that the condition of lateral ankle instability may simply be more debilitating for those patients with obese BMI, and that these patients should have lower expectations in terms of their absolute recovery of function. [Table: see text]

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 No Differences in Clinical Outcomes of Suture Tape Augmented Repair Versus Broström Repair Surgery for Chronic Lateral Ankle Instability

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712094849
Author(s):  
Hong Li ◽  
Yujie Zhao ◽  
Wenbo Chen ◽  
Hongyun Li ◽  
Yinghui Hua
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Complication Rate ◽  
Ankle Instability ◽  
Foot And Ankle ◽  
Recurrent Instability ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Suture Tape

Background: Suture tape (ST) augmented repair, an alternative to traditional Broström repair (BR), may protect the repaired anterior talofibular ligament during ligament healing. No systematic review of cohort studies has been conducted to compare traditional BR with ST-augmented repair for chronic lateral ankle instability. Purpose: To review the current evidence in the literature to ascertain whether ST-augmented repair is superior to traditional BR in managing chronic lateral ankle instability. Study Design: Systematic review; Level of evidence, 3. Methods: A literature search was performed to identify relevant articles published in PubMed, Embase, and Cochrane Library databases in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search included cohort studies comparing the efficacy of BR and ST-augmented repair procedures in terms of incidence of instability recurrence, functional scores, talar tilt angle (TTA), anterior talar translation (ATT), and complication rate. Methodological quality was assessed using the Jadad scale for randomized studies and the Newcastle-Ottawa Scale for nonrandomized studies. Results: A total of 4 clinical trials with 254 patients were included. No significant differences were detected between BR and ST-augmented repair procedures in terms of incidence of recurrent instability, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, Foot and Ankle Ability Measure, TTA, ATT, or complication rate. The ST group appeared to have a shorter operation time compared with the BR group. Conclusion: No significant differences were found between ST-augmented repair and BR surgery regarding incidence of recurrent instability, functional outcome scores, or complication rates. Although technically challenging, the ST-augmented repair procedure appears to be a safe and fast option.

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 Results of an Accelerated Rehabilitation Program after Arthroscopic Broström Ankle Ligament Repair Augmented with an Arthroscopically Applied Suture Tape

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0035
Author(s):  
James R. McWilliam ◽  
Andres A. Cedeno ◽  
Jorge I. Acevedo
Keyword(s):  
Physical Therapy ◽  
Ankle Instability ◽  
Lateral Ligament ◽  
Ligament Repair ◽  
Recurrent Instability ◽  
Ankle Ligaments ◽  
Open Procedure ◽  
Tegner Score ◽  
Lateral Ankle Ligaments ◽  
Suture Tape

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: The Broström-Gould is the gold standard in repair of the lateral ankle ligaments for chronic instability and arthroscopic Broström repairs have become increasingly popular with outcomes comparable to the open procedure. Despite demonstrated success, the arthroscopic Broström, like the open procedure, does not achieve the same mechanical strength as the intact native ankle ligaments and is therefore not appropriate for early aggressive rehabilitation. Suture tape augmentation of an open Broström procedure has been shown to further strengthen the repair and produce favorable outcomes in preventing recurrent instability. Studies reporting long-term clinical outcomes of patients who undergo this procedure are lacking. This study reports clinical and functional outcomes after an arthroscopic repair with arthroscopically applied suture tape augmentation and an accelerated post-operative rehabilitation protocol. Methods: Ninety-three patients with chronic recurrent ankle instability who had failed non-operative treatment (bracing, taping, physical therapy) underwent arthroscopic lateral ligament repair augmented by a suture tape applied in a novel all-arthroscopic fashion (double stranded polyethylene tape fixed to talus and fibula with interference screws). Postoperatively patients were placed in a CAM walker and allowed to bear weight immediately. On postoperative day 8 patients were placed in a functional brace and began physical therapy to include motion, strength, and proprioceptive activities. At week 4 patients began sports specific activities and were allowed to return to unrestricted activity at week 8. Foot and Ankle Ability Measure (FAAM), Visual Analog Score (VAS), Tegner Score, and range of motion measurements were performed. Statistical analysis was done to determine averages, ranges, and standard deviations of scores. Paired t-test was utilized to find statistically significant differences in scores. Results: Eighty-five patients (42 males, 43 females; average age 30.42 years) were available at a minimum of 24 months post- operatively (range 24-68). Postoperatively, average VAS scores fell to 0.85 from 4.67, (p<2.2e-16), average FAAM ADL scores rose from 69.44 to 93.09, (p<2.2e-16), average FAAM Sports scores rose from 49.76 to 89.61. (p<2.2e-16), average Ankle ROM scores decreased from 56.12o to 54.76o, (p=.001523) and average HF ROM decreased from 20.07o to 18.19o (p=1.225e-11). The average Tegner score postoperatively was 7.45 (4-10). Patients reported 75% excellent, 24% good, and 1% fair results. Average time to desired level of activity was 5.14 months. There were 5 complications: one wound dehiscence, 2 cases of anterolateral impingement, and two cases of superficial peroneal neuritis. There was no recurrent instability. Conclusion: The results indicate that acclerated rehabilitation after arthroscopic lateral ligament repair augmented with arthroscopically applied suture tape is a safe and effective procedure that produces favorable outcomes for patients with chronic recurrent ankle instability.

scholarly journals Comparison between Absorbable and Nonabsorbable Suture Material in Modified Broström Operation

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Chan Kang ◽  
Donghun Kang ◽  
Jaehwang Song ◽  
Chang-Kyun Noh ◽  
Ki-Jun Ahn ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Suture Material ◽  
Ankle Instability ◽  
Tilt Test ◽  
Absorbable Suture ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Suture Group ◽  
Talar Tilt

Category: Ankle, Trauma Introduction/Purpose: The current clinical standard for the surgical treatment of lateral ankle instability remains the modified Broström procedure. Almost surgeons are using non-absorbable suture material because of their strength & permanent. But this has several complications such as irritation, surface tenderness, etc. So we compare the clinical result between nonabsorbable and absorbable suture material. Methods: All patients who underwent the modified Broström operation of the anterior talofibular ligament and/or the calcaneofibular ligament by a single surgeon between July 2011 and May 2015 were included in this study. A total of 96 patients were included in this study: 63 men and 33 women (mean age, 33.16 years; range, 14-72 years). Non-absorbable suture(2-0 Fiberwire®, Arthrex, Naples, FL) patient were 50 (33 men, 17 women) and absorbable suture(0-Vicryl®, Ethicon, Sommerville, NJ) patient were 46(30 men, 16 women). Mean follow-up duration was 2.5 years (range, 1.0-4.7 years). Patients completed a subjective questionnaire. Outcomes measures included the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot and Ankle Society (AOFAS) and Reoperation cases by the recurred lateral ankle instability. All data were collected prospectively and reviewed retrospectively. Results: In non-absorbable suture group, The mean talar tilt angle in preoperative talar tilt test was 14.4 and in absorbable suture group, 13.7, respectively. The mean talar tilt angle in postoperative talar tilt test was 5.3 and in absorbable suture group, 6.1, respectively. There were no significant differences between non-absorbable suture method and absorbable suture method with talar tilt angle in varus stress x-ray (P > .05). There was no significant difference in FADI (87 vs 91; P = .553), AOFAS (83 vs 87; P = .372) score between non-absorable suture method group and the absorbable suture method group. During follow up, Except of 2 patients, they were no clinical symptom. Each one patient in non-absorbable and absorbable suture group underwent revision lateral ligament surgery. Conclusion: As compared with non-absorbable suture in open modified Broström procedure, absorbable suture method produced similarly favorable outcomes.

scholarly journals Ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large accessory malleolar ossicles

2019 ◽  
Author(s):  
Yongxing Cao(Former Corresponding Author) ◽  
Qiang Huang ◽  
Yang Xu ◽  
Yuan Hong ◽  
Xiangyang Xu(New Corresponding Author)
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomic Reconstruction ◽  
Clinical Effects ◽  
Lateral Ligaments ◽  
Talar Tilt ◽  
Average Size ◽  
Effective Procedures

Abstract BackgroundAccessory malleolar ossicles are often found in patients with chronic ankle instability. For the large ossicles more than 10mm, there are still uncertainties about the suitable surgical option.This study was aimed at evaluating the clinical efficacy of ossicle resection and anatomic reconstruction of the lateral ligaments for chronic ankle instability with large accessory malleolar ossicles.MethodsSixteen chronic ankle instability patients with large accessory malleolar ossicles were treated with ossicle resection and anatomic reconstruction of lateral ligaments between December 2014 and February 2018. The clinical effects were evaluated with Visual Analogue Scale, Karlsson-Peterson ankle scoring system, and subjective satisfaction of patients. The varus talar tilt angle and anterior talar displacement between bony surfaces of the tibia and talus were included as radiographic parameters.ResultsThere were 11 males and 5 females in this study group. The average age at the time of surgery was 28.9 years old. The average final follow-up time was 26.9 months (range, 12 to 47). The average size of the ossicles was 11.7mm. The VAS score declined from 3.5 ± 1.6 preoperatively to 1.4 ± 1.0 at the final follow up (p < 0.01). The Karlsson-Peterson score was significantly improved from 52.7 ± 15.1 before surgery to 86.4 ± 8.2 at the last follow up (p < 0.01). Radiologically, the average varus talar tilt angle was decreased from 15.4 ± 2.0 degrees preoperatively to 6.2 ± 1.6 degrees at the final follow up (p < 0.01), and the average anterior talar displacement was decreased from 14.3 ± 2.1 mm preoperatively to 6.3 ± 1.4 mm at final follow up (p < 0.01). Fourteen patients (87.5%) were satisfied (‘excellent’ or ’good’) with treatment outcome.ConclusionsOssicle resection and anatomic reconstruction of the lateral ligaments provided good clinical outcomes for chronic ankle instability with large accessory malleolar ossicles. This method appears to be one of the reliable and effective procedures for the treatment of chronic ankle instability with large accessory malleolar ossicles.

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.

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