scholarly journals A new arthroscopic BrostrÖm procedure for chronic lateral ankle instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0051
Author(s):  
Hailin Xu
Keyword(s):  
Suture Anchor ◽  
Ankle Instability ◽  
Clinical Success Rate ◽  
Anterior Talofibular Ligament ◽  
Neurologic Symptom ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Anterolateral Portal

Category: Arthroscopy Introduction/Purpose: Chronic lateral ankle instability is usually progressed from previous lateral ankle sprain which is not treated properly. Although patients with acute lateral ankle ligament injury are often managed successfully with conservative treatment, approximately 20%-40% will go on developing symptomatic chronic recurrent lateral ankle instability. Several procedures have been introduced to address these patients including open or arthroscopic techniques, the most common of which is the BrostrÖm procedure. The aim of this study was to describe a new outside-in arthroscopic BrostrÖm procedure and its results for treating patients with chronic lateral ankle instability. Methods: Of the 32 patients that were treated, 18 males and 14 females, and aged from 15~57 years (mean 27.8 years). All patients were symptomatic with a combination of recurrent ankle sprains, giving way and avoidance of sports, as well as presented positive anterior drawer test in the physical examination. The history of all patients was over 6 months and conservative treatments were not enough to relieve the symptoms. Standard anteromedial and anterolateral portal was established. Using a suture anchor (2.9 mm Lupine BR, preloaded with double orthocord sutures, DePuy Synthes) and a cannulated needle as a suture passer, anterior talofibular ligament repair was achieved with an outside-in technique. Follow-up was 6~14 months (mean 8.7). Results: Subjective instability and mechanical instability were all significantly improved. No recurrences of ankle instability were reported. The mean AOFAS Ankle-Hindfoot score increased from 74 preoperatively to 95 at final follow-up. 2 patients reported superficial peroneal nerve (SPN) irritation symptom postoperatively but only 1 persisted. 2 patients complained mild pain anteroinferior to the lateral ankle. Conclusion: The arthroscopic outside-in BrostrÖm procedure with a single suture anchor was a safe, effective and reproducible technique for chronic lateral ankle instability. The ankle stability resumed with high clinical success rate. The main complication of this procedure was injury to SPN, which crossed the area of repair. The transient neurologic symptom may be related to stretch injury when establishing the anterolateral portal, while the persistent one may be due to nerve entrapment.

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.

scholarly journals Chronic Lateral Ankle Instability with Subtalar Instability: Does Lateral Ligaments Reconstruction Reliable?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Shi-Ming Feng
Keyword(s):  
Ankle Instability ◽  
Anatomical Reconstruction ◽  
Functional Score ◽  
Anterior Talofibular Ligament ◽  
Short Term ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Subtalar Instability

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: To evaluate the functional outcomes of arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability with subtalar instability during short term follow-up Methods: We retrospectively analyzed data in 8 patients (5 males, 3 females; 2 left ankles, 6 right ankles) aged between 21 and 49 years, with an average age of 31.74 +- 8.48 years presenting with CLAI with subtalar instability from Auguse 2015 to October 2018. The duration of the symptoms lasted for 12 to 43 months, with an average of 24.26 +- 10.17 months. All patients underwent arthroscopic anatomical reconstruction of ATFL and CFL. Pre- and postoperative visual analogue scales (VAS), the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS) and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation Results: After surgery, all incisions healed in stage I and there were no complications. All patients were followed for 12 to 36 months, averaging 26.15 +- 9.34 months. At the final follow-up, the ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and subtalar, and all patients returned to normal gait. The mean VAS score decreased to 1.06 +- 0.27, the AOFAS score increased to 93.16 +- 5.26 and the KAFS score increased to 92.01 +- 6.73. All the follow-up indexes were significantly different from those before surgery Conclusion: Arthroscopic anatomical reconstruction of ATFL and CFL in the treatment of chronic lateral ankle instability with subtalar instability is reliable in short term

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.

Open Broström-Gould Repair vs Arthroscopic Anatomical Repair of the Anterior Talofibular Ligament for Chronic Lateral Ankle Instability

2019 ◽  
Vol 41 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Gang Zeng ◽  
Xumin Hu ◽  
Wenzhou Liu ◽  
Xuemei Qiu ◽  
Tao Yang ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Open Surgery ◽  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Significant Difference ◽  
Surgical Cost ◽  
Surgery Duration

Background: The comparative studies on open vs arthroscopic anterior talofibular ligament (ATFL) repair are limited. This study aimed to compare the early therapeutic efficacy and cost between the traditional open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL for chronic lateral ankle instability. Methods: A total of 27 of patients with chronic lateral ankle instability undergoing repair of the ATFL between January 2013 and June 2015 were retrospectively included with a traditional open surgery (n = 10) group and arthroscopy (n = 17) group. The surgery duration, surgical cost, postoperative complications, and the preoperative/postoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Karlsson-Peterson score were compared between groups. Results: Compared to the arthroscopy group, the open surgery group had significantly shorter surgery duration and lower surgical cost. However, there was no significant difference in hospitalization duration between groups. At 3 years after operation, the AOFAS and Karlsson scores were significantly improved in both groups. Nevertheless, there was no significant difference in the AOFAS and Karlsson scores between groups at both preoperative and postoperative assessment. No significant difference was found in the incidence of postoperative complications between the 2 groups. Conclusion: These results suggest that open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL have comparable therapeutic efficacy for chronic lateral ankle instability. The arthroscopic surgery had a smaller incision, while the open Broström-Gould had a shorter surgery duration and lower cost. Level of Evidence: Level III, comparative study.

Biomechanical Properties of Commonly Used Autogenous Transplants in the Surgical Treatment of Chronic Lateral Ankle Instability

2002 ◽  
Vol 23 (7) ◽  
pp. 661-664 ◽  
Author(s):  
Michael Bohnsack ◽  
Bert Sürie ◽  
Ludger Kirsch ◽  
Nikolaus Wülker
Keyword(s):  
Ankle Instability ◽  
Biomechanical Properties ◽  
Anterior Talofibular Ligament ◽  
Biomechanical Stability ◽  
Lateral Ankle ◽  
Periosteal Flap ◽  
Peroneus Longus ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Peroneus Brevis

The purpose of this study was to evaluate the biomechanical properties of commonly used autogenous transplants for the surgical stabilization of chronic lateral ankle instability. We dissected the transplants (peroneus longus, peroneus brevis, Achilles and plantaris tendon, periosteal flap, fascia, corium) and the anterior talofibular ligament from 13 fresh anatomic specimens. After laser-assisted measurement of the transplant diameter, we assessed their biomechanical properties with a universal testing device. Biomechanical stability of the peroneus longus, peroneus brevis, and Achilles tendons was significantly higher than the other transplants. The stability parameters of the periosteal flap were in the range of the anterior talofibular ligament but inferior to the tendons. The application of a transplant with low biomechanical stability, such as the periostal flap, requires more postoperative immobilization as in a strong orthosis or cast.

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.

Extensor Retinaculum Flap and Fibular Periosteum Ligamentoplasty After Failed Surgery for Chronic Lateral Ankle Instability

2020 ◽  
Vol 41 (12) ◽  
pp. 1546-1552
Author(s):  
Ernesto Pintore ◽  
Lucio Cipollaro ◽  
Raffaele Pintore ◽  
Francesco Oliva ◽  
Nicola Maffulli
Keyword(s):  
Ankle Instability ◽  
Case Series ◽  
High Rate ◽  
Anterior Talofibular Ligament ◽  
Low Grade ◽  
Reconstructive Procedures ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability

Background: The anterior talofibular ligament and the calcaneofibular ligament are 2 of the most frequently injured structures in sports, being damaged in 30% to 45% of all sports injuries. Most reconstructive procedures are successful but can deteriorate with time and can lead to low-grade radiographic degeneration. Methods: We operated on 26 consecutive patients from 2001 to 2008 who had failed previous surgical procedures for the lateral ligamentous complex of the ankle, with an average of 104 (range, 75-140) months. Results: The overall functional rating was excellent in 14 ankles, good in 10, fair in 1, and poor in 1. Twenty-four patients (92.3%) were satisfied with the procedure and 15 (57.7%) were able to return to their preinjury level of activity. Local complications were detected in 2 patients who presented with skin necrosis; 1 patient developed severe reflex sympathetic dystrophy. Conclusion: Revision surgery for the management of failure after surgical treatment of chronic lateral ankle instability is under debate, and the literature is devoid of clinical studies with long-term follow-up. The technique described offers a high rate of long-term excellent and good results, with a low rate of complications and a good rate of return to preinjury level. Level of Evidence: Level IV, retrospective case series.

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