Obesity as a Risk Factor for Failure following a Modified Brostrom 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]

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Early Outcomes of Arthroscopic Modified Brostrom Operation for Chronic Ankle Instability

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000372 ◽

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.

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Functional outcomes and return-to-sports rate after modified Brostrom repair for lateral ankle instability with absorbable sutures and immediate postoperative weightbearing

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000009 ◽

2017 ◽

Vol 2 (2) ◽

pp. 2473011416S0000 ◽

Cited By ~ 1

Author(s):

Somen Agrawal ◽

Greg Keene ◽

James Clayton

Keyword(s):

Functional Outcomes ◽

Ankle Instability ◽

Weight Bearing ◽

Return To Sport ◽

Cost Effective ◽

Foot And Ankle ◽

Lateral Ankle ◽

Absorbable Sutures ◽

Lateral Ankle Instability

Category: Sports Introduction/Purpose: The ankle is commonly injured in sporting activities occurring in up to 1 in 10,000 people a day. About 80% of ankle sprains recover with nonoperative management, with the remaining 20% of patients developing symptomatic instability requiring surgery. There are various surgical options being used, including anatomic repair (Brostrom technique and modifications), anatomic recon- struction with autograft or allograft, and nonanatomic reconstructions such as the Watson-Jones, Evans, and Chrisman-Snook procedures. The outcome of the direct anatomic repair is likely dependent on tissue quality, ability to tension the ligaments, and the security of the fixation. Secure fixation is critical to enable an early rehabilitation without compromising clinical outcome. We hypothesized that using absorbable suture for anatomic reconstruction is not only cost effective but also allows early rehabilitation with immediate postoperative weightbearing with good functional outcomes. Methods: The study included 71 patients presenting with chronic lateral ankle instability (who failed non-operative management) who underwent modified Brostrom repair by a single surgeon between Jan 2012 and Feb 2014.The anterior talofibular ligament and calcaneo- fibular ligament were anatomically repaired , and the repair was augmented with inferior extensor retinaculum proximal advancement, both with 1 vicryl suture. Full weight bearing in normal shoe was allowed from the day of surgery. Physiotherapy commenced prior to discharge from day surgery with gentle active range of motion, calf strength, and static peroneii exercises. From 3 to 4 weeks proprioceptive, theraband, and dynamic peroneal exercises were started. No boots, braces, or casts were used at any stage in the post-operative period. Patients were assessed preoperatively and at a minimum 2-year follow-up using the Foot and Ankle Outcome Score (FAOS). Complication, failure (recurrent instability), and return-to-sport rates were also recorded. Results: There were 41 were males and 30 females with mean age at surgery of 27 years (range 16 - 47 years), mean duration of symptoms of 2 years (range, 6 months to 8 years)and a mean follow-up duration of 34 months (range 24- 49 months). Significant improvement was seen in the FAOS from preoperatively to postoperatively (from 37 to 79): the pain subscale , the symptom subscale, the function subscale, the function in sports and recreation subscale, and the foot and ankle–related quality of life subscale improved from 38 to 79, 42 to 81, 43 to 82 , 31 to 79 and 32 to 77 respectively. All these findings were statistically significant. The failure rate was 4%, with 3 patients reporting instability after subsequent traumatic re-rupture. Two case of temporary neuropraxia of the superficial peroneal nerve was observed. Fifty four out of 71 patients were involved in sports prior to injury and forty seven (87%) returned to sport after reconstruction. Conclusion: This study demonstrates that lateral ligament reconstruction using absorbable sutures is an effective procedure for the treatment of chronic lateral ankle instability and allows immediate weight bearing. This allows a cost-effective approach to management with minimal impact on a patient’s activities of daily living in the post-operative period. The procedure also has high return-to-sport rate.

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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

10.25259/jassm_34_2020 ◽

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.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00140 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0014

Author(s):

Byung-Ki Cho ◽

Seung-myung Choi

Keyword(s):

Operative Treatment ◽

Ankle Instability ◽

Joint Space ◽

Arthroscopic Debridement ◽

Limited Information ◽

Aged Patients ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Modified Broström Procedure

Category: Ankle Arthritis Introduction/Purpose: 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 lateral ankle instability. Methods: Twenty-four 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 3.1 points (P < .001), 5 patients (20.8%) complained of gait discomfort with considerable pain of 4 or more points. There was only 1 patient (4.2%) with recurrent ankle instability, while 6 patients (25%) showed a progression of arthritis stage. Conclusion: 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.

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The Modified Brostrom Procedure for Lateral Ankle Instability

Foot & Ankle ◽

10.1177/107110079301400101 ◽

1993 ◽

Vol 14 (1) ◽

pp. 1-7 ◽

Cited By ~ 187

Author(s):

William G. Hamilton ◽

Francesca M. Thompson ◽

Stephen W. Snow

Keyword(s):

Ankle Instability ◽

Full Range ◽

Lateral Ankle ◽

Fair Result ◽

Ballet Dancers ◽

Recreational Athletes ◽

Lateral Ankle Instability ◽

High Level ◽

Modified Broström Procedure

Twenty-eight ankles in twenty-seven patients (average age 28) underwent the Gould modification of the Brostrom repair for symptomatic lateral ankle instability. Fifty-four percent were high level professional ballet dancers, 35% were recreational athletes, and 11% were nonathletes. Follow-up averaged 64.3 months (range 30–132 months). Of the 28 operations performed, there were 26 excellent results, one good result, and one fair result. All the professional dancers obtained excellent results. There were no failures, stretch-outs, re-dos, or complications. This operation is believed to be an excellent choice for the dancer, athlete, or nonathlete who needs a stable ankle with a full range of plantarflexion and dorsiflexion and normal peroneal function.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211004099 ◽

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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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

The American Journal of Sports Medicine ◽

10.1177/0363546520982240 ◽

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.

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Talar Anchor Placement for Modified Brostrom Lateral Ankle Stabilization Procedure

Journal of the American Podiatric Medical Association ◽

10.7547/0980473 ◽

2008 ◽

Vol 98 (6) ◽

pp. 473-476 ◽

Cited By ~ 5

Author(s):

Arush K. Angirasa ◽

Michael J. Barrett

Keyword(s):

Research Study ◽

Ankle Instability ◽

Suture Technique ◽

Anatomic Reconstruction ◽

Ankle Ligaments ◽

Lateral Ankle ◽

Lateral Ankle Instability ◽

Stabilization Procedure ◽

Lateral Ankle Ligaments ◽

Modified Broström Procedure

The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor placement, suture technique, or both. In this research study, we propose placing a bone screw anchor into the lateral shoulder of the talus rather than the typical placement at the lateral malleolus for anatomic reconstruction of the lateral ankle ligaments. (J Am Podiatr Med Assoc 98(6): 473–476, 2008)

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000243 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0002

Author(s):

Sungwook Kim ◽

Hong-Geun Jung ◽

Jong-Soo Lee ◽

Hwa Jun Kang ◽

Mao Yuan Sun

Keyword(s):

Clinical Outcome ◽

Pain Score ◽

Ligament Reconstruction ◽

Ankle Instability ◽

Degenerative Change ◽

Medial Compartment ◽

Functional Score ◽

Lateral Ankle ◽

Lateral Ankle Instability

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

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

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1004 ◽

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.

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