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 There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ashish Shah ◽  
Brent Cone ◽  
Cesar de Cesar Netto ◽  
Ibukunoluwa Araoye ◽  
Parke Hudson ◽  
...  
Keyword(s):  
Single Incision ◽  
Ankle Instability ◽  
Demographic Data ◽  
Lateral Ligament ◽  
Complication Rates ◽  
Ligament Repair ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Significant Difference ◽  
Lateral Ankle Ligaments

Category: Ankle Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair. Methods: This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test. Results: Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively. Conclusion: Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.

scholarly journals Lateral Ankle Ligament Repair: Evolution of Technique from Open to Arthroscopy

2014 ◽  
Vol 1 (2) ◽  
pp. 65-68
Author(s):  
Kushal Nag ◽  
Ken Jin Tan
Keyword(s):  
Ankle Instability ◽  
Surgical Techniques ◽  
Asia Pacific ◽  
Lateral Ligament ◽  
Ligament Repair ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Lateral Ankle Ligaments

ABSTRACT One of the most common injuries of the lower extremity is the lateral ankle sprain. In recent years, with greater emphasis on physical fitness, the chronically painful and unstable lateral ankle is an increasing common clinical finding presenting to the outpatient clinic. If residual instability and pain is still present after a course of physiotherapy, the patient should be presented with surgical options to restore ankle stability. Several surgical techniques have been described for the treatment of chronic ankle instability. Recently, some authors have developed arthroscopic suture anchor techniques to repair the lateral ankle ligaments with excellent results. The authors’ aim is to give an overview of the various techniques for repair or reconstruction of the lateral ligament complex with special emphasis on the arthroscopic lateral ligament reconstruction. How to cite this article Nag K, Tan KJ. Lateral Ankle Ligament Repair: Evolution of Technique from Open to Arthroscopy. J Foot Ankle Surg (Asia-Pacific) 2014;1(2):65-68.

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.

scholarly journals Arthroscopic Lateral Ligament Repair

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Jin Woo Lee
Keyword(s):  
Soft Tissue ◽  
Osteochondral Lesion ◽  
Surrounding Tissue ◽  
Lateral Ligament ◽  
Peroneal Tendon ◽  
Ligament Repair ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Diagnostic Arthroscopy ◽  
Lateral Ankle Ligaments

Ankle sprain is one of the most common sports-related injuries and involves the three ligaments of the lateral ligament complex of the ankle. Approximately 80% of patients tear the anterior talo-fibular ligament (ATFL), while the other 20% of patients tear the ATFL and calcaneo-fibular ligament (CFL). Rarely, the posterior talo-fibular ligament (PTFL) is involved. Non-surgical management of ankle sprains leads to excellent results in most cases for the initial phase. An incidence of 10 – 30% of patients would fail conservative treatment and result in chronic lateral ankle instability (CLAI) that may require surgical intervention. And the CLAI is commonly associated with other lesions, such as osteochondral lesion, soft tissue impingement syndrome, loose body, and peroneal tendon disorder so that diagnostic arthroscopy is mandatory with stabilizing lateral ankle. Although more than 50 surgical procedures have been described for stabilizing the lateral ankle ligaments complex. The original technique of Broström, modified by Gould, has become the gold standard procedure with infrequent exception in the literatures. However, the open technique requires at least a 4-cm-long incision with significant dissection and soft tissue debridement. Recently, there has been a recent advent of published descriptions on arthroscopic procedures for CLAI with advanced anatomic and bio-mechanic researches of lateral ankle ligaments complex. As in other minimal invasive surgical techniques in the foot and ankle, arthroscopic lateral ligament repair has advantages of less pain, addressing intra-articular pathologies, less injury to surrounding tissue, faster recovery, shorter hospital stay, and better cosmetic result. However, there are concerns about this new emerging technique with a technically demanding and lack of long-term clinical results. The purpose of this presentation is to review what has been established for the CLAI and discuss the arthroscopic lateral ligament repair technique.

Talar Anchor Placement for Modified Brostrom Lateral Ankle Stabilization Procedure

2008 ◽  
Vol 98 (6) ◽  
pp. 473-476 ◽  
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)

Effect of Lateral Ligament Augmentation Using Suture-Tape on Functional Ankle Instability

2019 ◽  
Vol 40 (4) ◽  
pp. 447-456 ◽  
Author(s):  
Byung-Ki Cho ◽  
Seok-Hyun Hong ◽  
Jae-Hyeon Jeon
Keyword(s):  
Postural Control ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Peak Torque ◽  
Lateral Ligament ◽  
Functional Ankle Instability ◽  
Unaffected Side ◽  
Ligament Augmentation ◽  
Suture Tape

Background: Although lateral ligament augmentation using suture-tape has been effective for restoration of mechanical ankle stability, few data are available regarding changes of peroneal strength, proprioception, and postural control. The aim of this study was to determine effects of suture-tape augmentation on functional ankle instability (FAI). Methods: Twenty-four patients who underwent suture-tape augmentation were eligible and were followed more than 2 years postoperatively. Functional outcomes were evaluated with the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM). Changes of peroneal strength, proprioception and postural control were analyzed with an isokinetic dynamometer and a modified Romberg test. Results: CAIT and FAAM (average of daily and sports activity scores) significantly improved to average 27.2 points and 86.7 points, respectively, at final follow-up. Peak torque for eversion in 60 degrees/s angular velocity significantly improved to 10.6 Nm at final follow-up. Deficit ratio of peak torque for eversion significantly improved from mean 39.5% to 20.9%, and significant side-to-side difference was revealed ( P < .001). There were no significant differences in joint position sense. A significant improvement in balance retention time was revealed at final follow-up, and the relative deficit ratio compared to the unaffected side was 30.9%. Conclusions: Patient-reported functional outcomes significantly improved after lateral ligament augmentation using suture-tape. Although this procedure demonstrated significant effects on FAI based on improvement of isokinetic peroneal strength and postural control, recovery rates compared to the unaffected side were not significant at the intermediate-term follow-up. In addition, there was no positive effect on proprioception of the ankle. Level of Evidence: Level IV, prospective case series.

scholarly journals Location and Morphology of Acute Lateral Ligament Injury of the Ankle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Hideo Noguchi
Keyword(s):  
Ankle Instability ◽  
Surgical Reconstruction ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Ligament Injuries ◽  
Ligament Repair ◽  
Reconstruction Procedure ◽  
Side Body ◽  
Lateral Ligament Injury ◽  
Almost All

Category: Ankle, Sports, Trauma Introduction/Purpose: Acute ankle ligament injuries are usually treated non-operatively, even if the injury is severe. However, when chronic ankle instability is symptomatic, operative treatment is required. When planning local repair, the condition of the remaining ligament is important. We surgically treated acute severe lateral ligament injuries in 103 ankles and investigated the locations of the injuries in the anterior talofibular (ATF) and calcaneofibular (CF) ligaments, subdividing each into three parts. This paper should facilitate more precise planning of the surgical reconstruction procedure. Methods: From 2006 to 2014, 1,042 patients visited our outpatient clinic with a diagnosis of acute lateral ligament injury of the ankle. In total, 103 feet underwent surgical treatment and the locations of the ATF and CF ligament ruptures were investigated. The rupture location in the ATF ligament was subclassified as fibular side, body, or talar side, while for the CF ligament it was classified as fibular side, body, or calcaneal side. Results: The ATF ligament was ruptured on the fibular side in 38 feet (36.9%), body in 30 feet (29.1%), and talar side in 35 feet (34.0%). The CF ligament was ruptured on the fibular side in 15 feet (14.6%), body in 26 feet (25.2%), and calcaneal side in 62 feet (60.2%). Conclusion: Almost all surgical reports on lateral ligament reconstruction procedures (Brostrom et al.) describe ATF ligament repair and advancement on the fibular side, although only one-third of the ligaments were injured on the fibular side in our series. About two-thirds of the CF ligaments had damage to the calcaneal side structure of the entheses. When CF ligament repair is needed, surgeons should be aware of our finding that this ligament was ruptured at the fibular attachment in only 15% of cases, and on the calcaneal side in 60%. This knowledge should lead to better results of surgical reconstruction.

scholarly journals Surgical Management of Lateral Ankle Instability in Athletes

2019 ◽  
Vol 54 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Luis D. Camacho ◽  
Zachary T. Roward ◽  
Yu Deng ◽  
L. Daniel Latt
Keyword(s):  
Surgical Management ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomic Reconstruction ◽  
Ankle Sprains ◽  
Functional Rehabilitation ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Initial Surgery ◽  
Lateral Ankle Ligaments

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.

scholarly journals Cost Comparison of Suture Anchor Modified Broström Repair and Augmentation of the Modified Broström with FiberTape Device

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0047
Author(s):  
Emily Vannatta ◽  
Chris M. Stauch ◽  
Jesse King ◽  
Morgan S. Kim ◽  
Laura R. Luick ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Return To Work ◽  
Ankle Instability ◽  
Group Versus ◽  
Cost Savings ◽  
Chronic Ankle Instability ◽  
Cost Comparison ◽  
Suture Anchors ◽  
Ligament Repair ◽  
The Cost

Category: Ankle; Sports Introduction/Purpose: Augmentation of the Broström procedure with FiberTape device has been described for the treatment of chronic ankle instability. However, it has yet to be determined if the cost of the implant is negated by the benefits to the patient. The purpose of this study was to perform a comprehensive cost analysis by comparing the cost of surgical procedure, physical therapy visits, time off work, and any costs related to revision surgery between the Broström reconstruction with suture anchors alone versus augmentation with a FiberTape device. Methods: 166 patients undergoing lateral ankle ligament repair were analyzed retrospectively. Patients underwent either a modified Broström ligament repair with two suture anchors or Broström ligament repair with FiberTape augmentation. All patients followed the same post-operative protocol for early weight bearing and initiation of physical therapy once the wound was healed. Timing of return to work and the total number of visits of physical therapy before discharge were recorded. Implant costs, facility charges and professional fees were obtained from billing records. Lost income for missed days of work was based on the Pennsylvania Bureau of Labor Statistics. Complications requiring return to the operating room were recorded. Patients were followed out to one year. Results: Aggregate cost in the modified Broström group was $2,219 more expensive than when augmenting with FiberTape ($20,970 vs. $18,751) despite an increased implant cost of $900. This difference was the result of a greater number of therapy visits and days out of work in the modified Broström group versus the augmentation group (14.9 vs 12.4) as well as a significantly higher amount of days out of work in the modified Broström group versus augmentation (63.3 vs. 53.8 days respectively). No statistically significant difference was found for operation time between groups, and failure rates were similar; 2.0% (1/49) for FiberTape and 3.4% (4/117) for modified Broström. Conclusion: The aim of this study was to explore the cost comparison of the modified Broström procedure for chronic ankle instability versus the FiberTape augmentation. Despite an upfront increase in implant costs, the average cost per procedure was lower for the augmentation group. The majority of cost savings occurred in decreases in the number of physical therapy visits and faster return to work times. The results of this study suggest that the use of FiberTape to augment modified Broström repair may have a financial benefit and cost savings to patients and the healthcare system.

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