scholarly journals Absence of ATFL Remnant Does not Affect the Clinical Outcomes of the Modified Broström Operation for Chronic Ankle Instability

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0033
Author(s):  
Sunghoon Park ◽  
Taehun Kim ◽  
Younguk Park
Keyword(s):  
Clinical Outcomes ◽  
Ankle Instability ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Clinical Results ◽  
Multiple Linear Regression Analysis ◽  
Chronic Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Retrospective Case ◽  
Normal Thickness

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: The modified Broström operation (MBO) for chronic ankle instability (CAI) has demonstrated good clinical results. Absence of ligamentous tissue was known as a risk factor for recurrence of ankle instability after the sugery. The aim of this study was to evaluate the effect of quality of ligament tissue (anterior talofibular ligament, ATFL) on prognosis in a cohort of patients with CAI after the MBO. Methods: This study was a retrospective case series. A total of 60 patients underwent the MBO for CAI with a mean follow-up of 30.1 months (range, 24-47 months). Presence of ATFL remnant was assessed on ultrasound (US), magnetic resonance imaging (MRI), and arthroscopy in all patients. The foot and ankle outcome score (FAOS) was used to evaluate functional outcomes. Clinical outcomes were compared according to the condition of the ligament remnant. Association with other risk factors was evaluated using multiple linear regression analysis. Results: ATFL was visible in 51/60 cases on US. Thirty patients had thin or absent ATFL on MRI; 22 patients, normal thickness ATFL; and 8 patients, thick ATFL. ATFL was visible in 15 patients on arthroscopy and nonvisible or not clear in 45 cases. Significant differences in FAOS were not noted according to the presence of ATFL remnant on US, arthroscopy, and the grade of ATFL thickness on MRI. No correlation was found between FAOS and the thickness of ATFL. Conclusion: The results suggest that the MBO for patients with CAI had good results, regardless of the presence or absence of ATFL remnant.

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.

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.

Fully Intra-articular Lasso-Loop Stitch Technique for Arthroscopic Anterior Talofibular Ligament Repair

2021 ◽  
pp. 107110072110444
Author(s):  
Jiajun Qin ◽  
Qiang Fu ◽  
Qing Zhou ◽  
Helin Wu ◽  
Xiaosong Zhi ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Case Series ◽  
Anterior Talofibular Ligament ◽  
Nerve Injuries ◽  
Accidental Injury ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lateral Ankle Instability ◽  
Vas Scores

Background: Arthroscopic techniques have gradually become popular for anterior talofibular ligament (ATFL) repair. However, the reliability of the repair and the risk of nerve injuries are of concern. The aim of this study was to evaluate the fully intra-articular lasso-loop stitch technique for arthroscopic ATFL repair. Methods: From October 2018 to December 2019, 43 cases with chronic lateral ankle instability were treated with this fully intra-articular lasso-loop stitch technique using the Arthro-Pierce instrument. The Karlsson-Peterson score, Cumberland Ankle Instability Tool (CAIT) score, visual analog scale (VAS) score, anterior drawer and talar tilt stress fluoroscopy were evaluated at the preoperative and final follow-up appointments, respectively. All surgical complications were also recorded. Results: A total of 39 cases were followed up for a mean of 28.23 ± 3.64 months (range, 23-34 months). At the final follow-up, the averages of the Karlsson-Peterson, CAIT and VAS scores were 90.26 ± 6.58, 88.56 ± 7.21 and 0.79 ± 1.06, respectively. During surgery, 2 cases were modified with augmentation of the inferior extensor retinaculum. No nerve injuries were encountered. Only 1 female complained about mild knot irritation. A 25-year-old solider required revision surgery due to an accidental injury. Conclusion: We found the fully intra-articular lasso-loop stitch technique for ATFL repair using the Arthro-Pierce instrument to be reliable and safe with a sufficient and good-quality ligament remnant. Level of Evidence: Level IV, retrospective case series.

Outcome Following a Modified Broström Procedure and Arthroscopic Debridement of Medial Gutter Osteoarthritis Combined With Chronic Ankle Instability

2018 ◽  
Vol 39 (12) ◽  
pp. 1473-1480 ◽  
Author(s):  
Byung-Ki Cho ◽  
Young-Duck Shin ◽  
Hyun-Woo Park
Keyword(s):  
Operative Treatment ◽  
Ankle Instability ◽  
Case Series ◽  
Chronic Ankle Instability ◽  
Arthroscopic Debridement ◽  
Limited Information ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Aged Patients ◽  
Modified Broström Procedure

Background: There is limited information regarding the outcomes of operative treatment for ankle instability with coexisting arthritic changes in the medial gutter. This study was performed to evaluate the intermediate-term clinical and radiological outcomes following a modified Broström procedure and arthroscopic debridement in middle-aged patients with combined medial gutter osteoarthritis and chronic ankle instability. Methods: Twenty-two patients with medial gutter osteoarthritis related to chronic lateral ankle instability were followed for more than 3 years after operative treatment. All patients showed medial joint space narrowing of Takakura stage II at the time of surgery. The clinical evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS) for medial ankle pain during walking, and Foot and Ankle Ability Measure (FAAM). Results: Mean AOFAS and FAAM scores significantly improved from 51.2 and 45.7 points preoperatively to 80.3 and 78.4 points at final follow-up, respectively ( P < .001). Although mean pain-VAS significantly improved from 6.8 points to 3.5 points ( P < .001), 8 patients (36.4%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.5%) with recurrent ankle instability, while 6 patients (27.3%) showed a progression of arthritis stage. Conclusions: Modified Broström procedure combined with arthroscopic debridement appears to be an effective operative option for medial gutter osteoarthritis secondary to chronic ankle instability. Despite the onset of arthritis, most patients were able to achieve significant improvement in reducing pain while eliminating instability. Level of Evidence: Level IV, retrospective case series.

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.

scholarly journals Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1453
Author(s):  
Chiara Fabbroni ◽  
Giovanni Fucà ◽  
Francesca Ligorio ◽  
Elena Fumagalli ◽  
Marta Barisella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Case Series ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Well Differentiated ◽  
The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

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 Efficacy of threading lasso fixation in repairing partial articular supraspinatus tendon avulsion lesions: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sun-Yu Chen ◽  
Zhan-Hao Xiao ◽  
Jian-Kun Wang
Keyword(s):  
Los Angeles ◽  
Clinical Outcomes ◽  
Case Series ◽  
Visual Analog Scale Score ◽  
Supraspinatus Tendon ◽  
Fixation Technique ◽  
Retrospective Case ◽  
The Mean ◽  
Tendon Avulsion

Abstract Background The partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function. Methods Twenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery. Results There were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01). Conclusions Arthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.

scholarly journals No Difference in Neck Pain or Health-Related Quality Measures Between Patients With or Without Degenerative Cervical Spondylolisthesis

2021 ◽  
pp. 219256822110469
Author(s):  
Ian David Kaye ◽  
Arjun S. Sebastian ◽  
Scott C. Wagner ◽  
Nicholas Semenza ◽  
Daniel Bowles ◽  
...  
Keyword(s):  
Neck Pain ◽  
Linear Regression Analysis ◽  
Univariate Analysis ◽  
Degenerative Spondylolisthesis ◽  
Multiple Linear Regression Analysis ◽  
Retrospective Case ◽  
Related Condition ◽  
Arm Pain ◽  
Age Related ◽  
Related Quality

Study Design This study is a retrospective case control. Objectives This study aims to determine whether cervical degenerative spondylolisthesis (DS) is associated with increased baseline neck/arm pain and inferior health quality states compared to a similar population without DS. Methods Patient demographics, pre-operative radiographs, and baseline PROMs were reviewed for 315 patients undergoing anterior cervical decompression and fusion (ACDF) with at least 1 year of follow-up. Patients were categorized based on the presence (S) or absence of a spondylolisthesis (NS). Statistically significant variables were further explored using multiple linear regression analysis. Results 49/242 (20%) patients were diagnosed with DS, most commonly at the C4–5 level (27/49). The S group was significantly older than the NS group (58.0 ± 10.7 vs 51.9 ± 9.81, P = .001), but otherwise, no demographic differences were identified. Although a higher degree of C2 slope was found among the S cohort (22.5 ± 8.63 vs 19.8 ± 7.78, P = .044), no differences were identified in terms of preoperative visual analogue scale (VAS) neck pain or NDI. In the univariate analysis, the NS group had significantly increased VAS arm pain relative to the S group (4.93 ± 3.16 vs 3.86 ± 3.30, P = .045), which was no longer significant in the multivariate analysis. Conclusions Although previous reports have suggested an association between cervical DS and neck pain, we could not associate the presence of DS with increased baseline neck or arm pain. Instead, DS appears to be a relatively frequent (20% in this series) age-related condition reflecting radiographic, rather than necessarily clinical, disease.

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