scholarly journals Arthroscopic Posterior Ankle Ligament Anatomy

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110006
Author(s):  
Richard D. Ferkel ◽  
Cory Kwong ◽  
Randall Farac ◽  
Mark Pinto ◽  
Nader Fahimi ◽  
...  
Keyword(s):  
Distal Tibia ◽  
Case Series ◽  
Ankle Arthroscopy ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Tibiofibular Ligament ◽  
Ankle Ligament

Background: The purpose of this article is to document the normal arthroscopic appearance of the posterior ankle capsular and ligamentous structures, and variations in their anatomical relationships. Methods: 102 ankle arthroscopy videotapes were evaluated retrospectively for the configuration of the posterior capsuloligamentous structures. Based on these observations, the variations in the appearance and position of the posterior tibiofibular ligament (PTFL) and transverse (tibiofibular) ligament (TTFL) were documented. In addition, differences in the appearance of the flexor hallucis longus (FHL) were also noted. Results: All patients had evidence of both a PTFL and TTFL, which formed a labrum or meniscus-like addition to the posterior distal tibia. No patients demonstrated disruption of the PTFL; 3 had tears of the TTFL. We noted 4 distinct patterns of the PTFL and the TTFL. Thirty-four patients (33%) had a gap of ≥2 mm between the 2 ligamentous structures. Thirty-three (32.4%) had a gap <2 mm between the PTFL and TTFL. Twenty-six (25.5%) had a confluence of the 2 ligaments without a gap. Nine (9%) demonstrated a sizable gap between the 2 ligaments, and the TTFL appeared as a “cord-like” structure. Conclusion: To our knowledge, this is the first article to describe the variations in the arthroscopic normal posterior capsuloligamentous structures and FHL of the ankle. Level of Evidence: Level IV, case series.

scholarly journals Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis

2019 ◽  
Vol 41 (3) ◽  
pp. 331-341 ◽  
Author(s):  
Wenqiang Qu ◽  
Chi Wei ◽  
Li Yu ◽  
Yu Deng ◽  
Panfeng Fu ◽  
...  
Keyword(s):  
Pain Score ◽  
Early Stage ◽  
Distal Tibia ◽  
Case Series ◽  
Cement Spacer ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Masquelet Technique

Background: The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB). Methods: Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months. Results: No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively ( P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 ( P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 ( P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 ( P < .05). Conclusion: Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs. Level of Evidence: Level IV, case series.

Supramalleolar Osteotomy for Tibial Component Malposition in Total Ankle Replacement

2017 ◽  
Vol 38 (9) ◽  
pp. 952-956 ◽  
Author(s):  
Manja Deforth ◽  
Nicola Krähenbühl ◽  
Lukas Zwicky ◽  
Markus Knupp ◽  
Beat Hintermann
Keyword(s):  
Tibial Component ◽  
Corrective Osteotomy ◽  
Distal Tibia ◽  
Case Series ◽  
Outcome Data ◽  
Total Ankle Replacement ◽  
Level Of Evidence ◽  
Supramalleolar Osteotomy ◽  
Ankle Replacement ◽  
Surface Angle

Background: Persistent pain despite a total ankle replacement is not uncommon. A main source of pain may be an insufficiently balanced ankle. An alternative to the revision of the existing arthroplasty is the use of a corrective osteotomy of the distal tibia, above the stable implant. This strictly extraarticular procedure preserves the integrity of the replaced joint. The aim of this study was to review a series of patients in whom a corrective supramalleolar osteotomy was performed to realign a varus misaligned tibial component in total ankle replacement. We hypothesized that the supramalleolar osteotomy would correct the malpositioned tibial component, resulting in pain relief and improvement of function. Methods: Twenty-two patients (9 male, 13 female; mean age, 62.6 years; range, 44.7-80) were treated with a supramalleolar osteotomy to correct a painful ankle with a varus malpositioned tibial component. Prospectively recorded radiologic and clinical outcome data as well as complications and reoperations were analyzed. Results: The tibial anterior surface angle significantly changed from 85.2 ± 2.5 degrees preoperatively to 91.4 ± 2.9 degrees postoperatively ( P < .0001), the American Orthopaedic Foot & Ankle Society hindfoot score significantly increased from 46 ± 14 to 66 ± 16 points ( P < .0001) and the patient’s pain score measured with the visual analog scale significantly decreased from 5.8 ± 1.9 to 3.3 ± 2.4 ( P < .001). No statistical difference was found in the tibial lateral surface angle and the range of motion of the ankle when comparing the preoperative to the postoperative measurements. The osteotomy healed in all but 3 patients on first attempt. Fifteen patients (68%) were (very) satisfied, 4 moderately satisfied, and 3 patients were not satisfied with the result. Conclusion: The supramalleolar osteotomy was found to be a reliable treatment option for correcting the varus misaligned tibial component in a painful replaced ankle. However, nonunion (14%) should be mentioned as a possible complication of this surgery. Nonetheless, as a strictly extraarticular procedure, it did not compromise function of the previously replaced ankle, and it was shown to relieve pain without having to have revised a well-fixed ankle arthroplasty. Level of evidence: Level IV, case series.

Arthroscopic Assessment for Intra-articular Disorders in Residual Ankle Disability after Sprain

2005 ◽  
Vol 33 (5) ◽  
pp. 686-692 ◽  
Author(s):  
Masato Takao ◽  
Yuji Uchio ◽  
Kohei Naito ◽  
Ikuo Fukazawa ◽  
Mitsuo Ochi
Keyword(s):  
Ankle Sprain ◽  
Ankle Arthroscopy ◽  
Diagnostic Tools ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries ◽  
Level Of Evidence ◽  
Double Blind ◽  
Talocrural Joint ◽  
Tibiofibular Ligament

Background After ankle sprain, there can be many causes of disability, the origins of which cannot be determined using standard diagnostic tools. Hypothesis Ankle arthroscopy is a useful tool in identifying intra-articular disorders of the talocrural joint in cases of residual ankle disability after sprain. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The authors gathered the independent diagnostic results of physical examination, standard mortise and lateral radiography, stress radiography of the talocrural joint, and magnetic resonance imaging for 72 patients with residual ankle disability lasting more than 2 months after injury (mean, 7 months after injury). They performed arthroscopic procedures and compared the double-blind results. Results In all cases, the arthroscopic results matched those of other means of diagnosis. In 14 cases, the arthroscopic approach exceeded the capabilities of the other methods. Including duplications, 39 patients (54.2%) had anterior talofibular ligament injuries, 17 patients (23.6%) had distal tibiofibular ligament injuries, 29 patients (40.3%) had osteochondral lesions, 13 patients (18%) had symptomatic os subfibulare, 3 patients (4.2%) had anterior impingement exostosis, and 3 patients (4.2%) had impingement due to abnormally fibrous bands. There were only 2 cases in which the cause of symptoms could not be detected by ankle arthroscopy, compared with 16 cases in which the cause of disability could not be detected using standard methods. In 3 cases (17.6%) of distal tibiofibular ligament injuries, 8 cases (27.6%) of osteochondral lesions, and all 3 cases (100%) of impingement of an abnormal fibrous band, ankle arthroscopy was the only method capable of diagnosing the cause of residual ankle pain after a sprain. Conclusion The present results suggest that arthroscopy can be used to diagnose the cause of residual pain after an ankle sprain in most cases that are otherwise undiagnosable by clinical examination and imaging study.

scholarly journals The Role of Arthroscopic Debridement after Ankle Fractures Treated with ORIF

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Paolo Ceccarini ◽  
Giuseppe Rinonapoli ◽  
Julien Teodori ◽  
Auro Caraffa
Keyword(s):  
Distal Tibia ◽  
Case Series ◽  
Activity Level ◽  
Ankle Arthroscopy ◽  
Ankle Fractures ◽  
Osteochondral Lesions ◽  
Operation Rate ◽  
Patient Reported

Category: Ankle, Ankle Arthritis, Arthroscopy Introduction/Purpose: The role of ankle arthroscopy in managing the consequences of ankle fractures is yet to be fully estab- lished. This study aims to assess this procedure in terms of the accuracy of preoperative diagnosis, re-operation rate and patient- reported outcomes. Methods: We compared two homogeneous groups of 16 patients (32 in total, average age 40.6 years) operated for a fracture of the distal tibia and/or fibula treated with ORIF. For all fractures the AO classification was used. The baseline was 6 months after surgery. Inclusion criteria were: patients aged between 19 and 50 a pre-trauma Tegner score >3, FAOS score <75 at the baseline, R.O.M. <20° vs contralateral; we included patients with well-aligned osteosynthesis and with radiographic union. Patients with open fractures, with osteochondral lesions and with previous were excluded. In the first group we planned an arthroscopy of the ankle from 6 to 12 months after trauma, in the second group, we continued with conservative rehabilitation treatment. All patients were then re-evaluated at 3,6 and 12 months with questionnaires (Tegner activity level, and FAOS). The mean follow-up was 18.2 months. For all data statistical analysis was performed. Results: The results of our case-series showed excellent patient satisfaction (12/14) with a FAOS Score and an improved R.O.M. statistically significant (p <.001) in patients treated with ankle arthroscopy. Eighty percent was able to return to previous activity. The average time until return to sport was 5.3 ± 2.4 months. Seventy percent of the athletes still had occasional pain with sport. Conclusion: The literature on arthroscopic treatment after fracture is still poor but results obtained, even with a limited number of cases, and with a short follow-up, are positive, especially in those patients where the functional demand is highest.

scholarly journals Incidence of Coexisting Talar and Tibial Osteochondral Lesions Correlates With Patient Age and Lesion Location

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879096 ◽  
Author(s):  
Rebecca M. Irwin ◽  
Yoshiharu Shimozono ◽  
Youichi Yasui ◽  
Robin Megill ◽  
Timothy W. Deyer ◽  
...  
Keyword(s):  
Older Patients ◽  
Distal Tibia ◽  
Case Series ◽  
Lesion Size ◽  
Magnetic Resonance Images ◽  
Osteochondral Lesions ◽  
Level Of Evidence ◽  
Patient Age ◽  
Morphologic Characteristics ◽  
Patient Âgé

Background: The incidence of coexisting osteochondral lesions (OCLs) of the tibia and talus has been negatively correlated with successful clinical outcomes, yet these lesions have not been extensively characterized. Purpose: To determine the incidence of coexisting tibial and talar OCLs, assess the morphologic characteristics of these lesions, and evaluate whether these characteristics are predictive of outcome. Study Design: Case series; Level of evidence, 4. Methods: A total of 83 patients who underwent surgery for a talar OCL were evaluated for coexisting OCLs of the distal tibia with preoperative magnetic resonance images. Size, location, containment, International Cartilage Repair Society (ICRS) grade, patient age, and patient sex were analyzed for predictors of coexisting lesions or patient outcome. The talar and tibial surfaces were each divided into 9 zones, with 1 corresponding to the most anteromedial region and proceeding laterally and then posteriorly. The Foot and Ankle Outcome Score (FAOS) was evaluated pre- and postoperatively. Results: Twenty-six patients (31%) had coexisting tibial and talar OCLs, with 9 (35%) identified as kissing lesions. Age correlated with coexisting lesion incidence, as older patients were more likely to have a coexisting tibial OCL ( P = .038). More than half of talar OCLs were found in zone 4 (61%), whereas the majority of tibial OCLs were located in zones 2, 4, and 5 (19% each). Patients with coexisting lesions were more likely to have a lateral talar OCL ( P = .028), while those without a coexisting tibial lesion were more likely to have a talar OCL in zone 4 ( P = .016). There was no difference in FAOS result or lesion size between patients with and without coexisting OCLs, but patients with coexisting lesions were more likely to have an ICRS grade 4 talar OCL ( P = .034). For patients with coexisting lesions, kissing lesions were more likely to be located in zone 6 ( P = .043). There was no difference in OCL size or containment between kissing and nonkissing coexisting OCLs. Conclusion: The incidence of coexisting talar and tibial OCLs may be more prevalent than what previous reports have suggested, with older patients being more likely to present with this pathology. The location of a talar OCL correlates with the incidence of a coexisting tibial OCL.

scholarly journals Endoscopic Adhesiolysis of the Flexor Hallucis Longus Muscle

2014 ◽  
Vol 7 (6) ◽  
pp. 492-494 ◽  
Author(s):  
T.H. Lui
Keyword(s):  
Tibial Fracture ◽  
Distal Tibia ◽  
Hallux Rigidus ◽  
Flexor Hallucis Longus ◽  
Therapeutic Level ◽  
Ankle Pain ◽  
Level Of Evidence ◽  
Soft Tissue Dissection ◽  
Longus Muscle ◽  
Hallux Flexus

Flexor hallucis longus muscle can adhere to the distal tibia after tibial fracture. The patient may complain of deep posteromedial ankle pain, checkrein deformity of the hallux, hallux flexus or development of hallux rigidus. Surgical treatment of release of the FHL muscle or lengthening of the FHL tendon has been proposed. We described an endoscopic approach of release of the FHL muscle from the distal tibia with the advantage of minimal soft tissue dissection. Level of Evidence: Therapeutic Level V: Expert Opinion/Technique

Sports and Recreation Activity of Varus and Valgus Ankle Osteoarthritis before and after Realignment Surgery

2008 ◽  
Vol 29 (10) ◽  
pp. 985-993 ◽  
Author(s):  
Geert Pagenstert ◽  
André Leumann ◽  
Beat Hintermann ◽  
Victor Valderrabano
Keyword(s):  
Revision Surgery ◽  
Revision Rate ◽  
Distal Tibia ◽  
Case Series ◽  
Joint Surface ◽  
Ankle Pain ◽  
Ankle Osteoarthritis ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Sports Activity

Background: Realignment-surgery to unload ankle osteoarthritis (OA) has been proposed as treatment alternative for varus and valgus ankle OA. Sports activity after this procedure has not been analyzed. Realignment-surgery increases sports activity. Sports activity correlates with ankle pain, function, and alignment, but does not influence revision rate. Materials and Methods: Prospective case series of 35 consecutive patients with post-traumatic varus or valgus ankle OA limited to half tibiotalar joint surface were treated by OA unloading realignment-surgery. Distal tibia osteotomy was used in all cases; additional osteotomies, tendon, ligament procedures in 92% of cases. Main Outcome Measurements: Pain (visual-analogue-scale; VAS), ankle range-of-motion (ROM); function (American-Orthopaedic-Foot-and-Ankle-Society (AOFAS) ankle-score; Swiss-symptom-related-Ankle-Activity-Scale (SAAS); Sports-Frequency-Score (SFS), OA and tibiotalar-alignment-grade (Takakura-Score), and revision surgery. Mean followup was 5 years. Results: Mean values from preoperative to followup: VAS decreased ( p = 0.0001) 4 points; ankle ROM increased ( p = 0.001) 5 degrees; AOFAS-Score increased ( p = 0.0001) 46 points; SAAS increased ( p = 0.0001) 42 points; SFS increased ( p = 0.02) 0.5 grades; Takakura-score decreased ( p = 0.0001) 1.0 grades. Revision surgery was performed in 10 cases (29%). Three of these were revised to ankle arthroplasty. At follow-up, SAAS correlated with VAS, AOFAS score, Takakura score, and not with ROM or SFS. SFS did not correlate with other variables. Patients needing revision surgery had a higher ( p = 0.003) SFS than patients who needed no revision. Conclusion: Realignment-surgery increased sports activity of ankle OA patients. Improved ankle pain and function correlated with ability to perform activity without symptoms; however, sports frequency had no correlation to patients' symptoms but showed higher revision rate. Level of Evidence: II, Prospective Comparative Study

Patient-Reported Outcomes After Structural Autograft for Large or Cystic Talar Dome Osteochondral Lesions

2020 ◽  
Vol 41 (5) ◽  
pp. 549-555
Author(s):  
Todd Kim ◽  
Andrew Haskell
Keyword(s):  
Patient Reported Outcomes ◽  
Distal Tibia ◽  
Case Series ◽  
Osteochondral Lesions ◽  
Measurement Information ◽  
Talar Dome ◽  
Level Of Evidence ◽  
Structural Bone Graft ◽  
Patient Reported

Background: While smaller talar dome osteochondral lesions (OCLs) are successfully treated with bone marrow stimulation techniques, the optimal treatment for large or cystic OCLs remains controversial. This study tested the hypothesis that transferring structural autograft bone from the distal tibia to the talus for large or cystic OCLs improves pain and function. Methods: Thirty-two patients with large or cystic OCLs underwent structural bone grafting from the ipsilateral distal tibia to the talar dome. Patients were assessed with subjective patient-centered tools and objective clinical outcomes. Average age was 48.6 ± 14.9 years, and average follow-up was 19.5 ± 13.3 months. Average lesion area was 86.2 ± 23.5 mm2, and average depth was 8.4 ± 3.0mm. Results: At final follow-up, improvement compared to preoperative scores was seen in American Orthopaedic Foot & Ankle Society (65.4 ± 21.2 to 86.9 ± 15.0, P < .05), Foot Function Index (48.9 ± 20.8 to 21.1 ± 18.9, P < .05), visual analog scale for pain (4.7 ± 3.0 to 1.4 ± 1.5, P < .05), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (40.4 ± 5.4 to 45.5 ± 7.4, P < .05) scores. There was no improvement in PROMIS pain interference (54.7 ± 18.1 to 52.4 ± 7.3, P > .05). Satisfaction with surgery was 8.4 ± 1.3/10, and 96% of patients would have the procedure again. Ninety-four percent of patients returned to work and/or play. One patient had a deep vein thrombosis 6 weeks postoperatively, and 1 patient underwent ankle fusion at 18 months postoperatively. Conclusion: This study demonstrates that structural bone graft harvested from the distal tibia transferred to the talus was a safe and effective treatment for large and cystic OCLs. Outcomes compare favorably to other described techniques for treatment of these injuries. Level of Evidence: Level IV, case series.

Direct Plantar Approach to Henry's Knot for Flexor Hallucis Longus Transfer

2012 ◽  
Vol 33 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Michael Amlang ◽  
Maria C. Rosenow ◽  
Adina Friedrich ◽  
Hans Zwipp ◽  
Stefan Rammelt
Keyword(s):  
Achilles Tendon ◽  
Case Series ◽  
Contralateral Side ◽  
Flexor Hallucis Longus ◽  
Distal Stump ◽  
Level Of Evidence ◽  
Medial Plantar Nerve ◽  
Flexor Hallucis Longus Transfer ◽  
Wound Healing Problems ◽  
Flexor Digitorum

Background: Transfer of the flexor hallucis longus (FHL) tendon is an established method to replace a dysfunctional Achilles tendon. When using a single incision, the FHL tendon has to be transferred as a single stranded graft into the calcaneus and the distal FHL stump cannot be directly attached to the flexor digitorum longus tendon (FDL). Another concern with tendon retrieval is neurovascular damage. We report our results with a direct plantar approach for tendon harvest. Methods: A direct plantar approach to the master knot of Henry with reattachment to its distal stump while protecting the medial plantar nerve was used allowing a double stranded FHL-transfer in 25 cases of a severely dysfunctional Achilles tendon in 24 consecutive patients. Patients were evaluated prospectively and at an average followup of 73 (range, 20 to 121) months. Results: No wound healing problems and no lesion of the medial plantar nerve occurred. The subjective result was rated as excellent in 18 (72%), good in five (20%), and fair in one case (8%). The AOFAS hindfoot score averaged 95.4 (range, 61 to 100) points and the AOFAS hallux score averaged 97.6 (range, 87 to 100) points. No loss of plantarflexion force was observed in the big toe as compared to the contralateral side. Conclusion: The plantar approach to Henry's knot allowed the use of a double stranded FHL transplant. The distal stump was attached to the FDL tendon to preserve flexion at the great toe without damaging to the medial plantar nerve. Level of Evidence: IV, Case Series

Ankle Salvage Following Nonunion of Distal Tibia Fractures

2018 ◽  
Vol 39 (10) ◽  
pp. 1210-1218 ◽  
Author(s):  
Giovanni Lovisetti ◽  
Alexander Kirienko ◽  
Charles Myerson ◽  
Ettore Vulcano
Keyword(s):  
Ankle Joint ◽  
Distal Tibia ◽  
Case Series ◽  
Bone Transport ◽  
Radiographic Evaluation ◽  
Leg Length ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Close Proximity ◽  
American Orthopaedic

Background: Nonunions of the distal tibia in close proximity to the ankle joint can be a challenge to treat. The purpose of this study was to evaluate radiographic and clinical outcomes of patients who underwent ankle-sparing bone transport for periarticular distal tibial nonunions. Methods: Twenty-one patients underwent ankle-sparing bone transport between January 2006 and July 2016. The mean age of the patients was 48.6 years, and 71% (15/21) were male. Patients were followed for an average of 14.6 months (range, 10.6-17.7 months), with an average of 8.6 months in-frame. Thirteen of 21 patients had infected nonunions. Primary endpoints included time to union and American Orthopaedic Foot & Ankle Society (AOFAS) score. Results: All fractures achieved union. Mean time to union was 37.4 weeks. Mean AOFAS score was 86.3 points (range, 37-100). A score of 37 was observed in 1 patient with preexisting Charcot foot. Radiographic evaluation at 6 months revealed a mean lateral distal tibial angle of 89.2 degrees and a mean anterior distal tibial angle of 76 degrees. Leg length discrepancy was less than 1.2 cm in all patients. Superficial pin infection was observed in 7 patients, and operative wound infection at the level of bone resection was observed in 3 patients. Conclusion: The ankle-sparing bone transport technique was an effective alternative to bone graft and arthrodesis for the treatment of periarticular nonunions of the distal tibia and was safe for use in patients with infected nonunions in close proximity to the ankle joint. Level of Evidence: Level IV, case series.

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