Chronic Ankle Instability Influences Laxity and Stiffness during Anterior Drawer But Not Inversion Talar Tilt

2007 ◽  
Vol 39 (Supplement) ◽  
pp. S68
Author(s):  
Jay Hertel ◽  
Patrick O. McKeon ◽  
Sae Yong Lee
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anterior Drawer ◽  
Talar Tilt

scholarly journals Chronic ankle instability: the value of talar tilt under general anaesthesia.

1995 ◽  
Vol 29 (2) ◽  
pp. 103-104 ◽  
Author(s):  
A W McCaskie ◽  
D W Gale ◽  
D Finlay ◽  
M J Allen
Keyword(s):  
General Anaesthesia ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Talar Tilt

A Modified Chrisman-Snook Procedure for Reconstruction of the Lateral Ligaments of the Ankle: Review of 18 Cases

1995 ◽  
Vol 16 (5) ◽  
pp. 259-266 ◽  
Author(s):  
Patrick A. Smith ◽  
Stephen J. Miller ◽  
Anthony J. Berni
Keyword(s):  
Ankle Instability ◽  
Joint Inversion ◽  
Symptomatic Patient ◽  
Anatomic Reconstruction ◽  
Calcaneofibular Ligament ◽  
Anterior Drawer ◽  
Stress Radiographs ◽  
Hop Test ◽  
Ligamentous Reconstruction ◽  
Talar Tilt

The outcome of 18 ankles of 16 patients who underwent a modification of the Chrisman-Snook lateral ligamentous reconstruction was analyzed. The modification described herein attempts a more anatomic reconstruction of the calcaneofibular ligament, while the anterior talofibular ligamentous reconstruction remains unchanged. All patients were evaluated before and after surgery by physical examinations and stress inversion radiographs were taken to measure the degree of talar tilt. Additional postoperative assessment consisted of a questionnaire, inversion and eversion isokinetic strength measurements, subtalar joint inversion stress radiographs (stress Brodén's views), and a hop test to assess ankle confidence. An average preoperative talar tilt of 13.7° was reduced to an average of 2.3° after surgery. Postoperative subtalar stress radiographs revealed an average of 2.8° of subtalar tilt compared with the “normal” average of 7.2° in the nonoperative ankles. While no ankles were found before surgery to have a 3+ anterior drawer sign, 11 ankles had 3+ inversion laxity. Excessive inversion laxity, which can occur through both the ankle and subtalar joints, more than anterior drawer laxity, may appear to be the primary determinant of functional ankle instability in the chronic setting. We recommend subtalar stress radiographs, in addition to routine talar stress radiographs, to quantify the relative contributions of each of these joints to inversion laxity in a symptomatic patient to guide appropriate treatment. The described procedure will anatomically stabilize both joints to inversion stress.

scholarly journals Dynamic Evaluation Of The Effect Of Syndesmotic Injury On Lateral Ankle Stability Using Fluoroscopy

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0002
Author(s):  
Rohan Bhimani ◽  
Go Sato ◽  
Jirawat Saengsin ◽  
Noortje Hagemeijer ◽  
Bart Lubberts ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Anterior Drawer ◽  
Intact State ◽  
Tibiofibular Ligament ◽  
Clear Space ◽  
Lateral Ankle Ligament ◽  
Talar Tilt ◽  
The Stability

Category: Ankle; Sports; Trauma Introduction/Purpose: There is a high incidence of concomitance between lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Stress radiographs are an accepted technique to assess the degree of lateral ankle instability by providing a static view of the ankle when subjected to the anterior drawer (AD) and talar tilt (TT) tests. The aim of this study is to assess the effect of syndesmotic injury as well as combined syndesmotic and lateral ankle injury on the stability of the lateral ankle. Methods: Sixteen fresh frozen above-knee amputated cadaveric specimens, divided into two groups, underwent fluoroscopic evaluation for lateral ankle stability. In both the groups, the assessment was first done with all ligaments intact and later with sequential transection of anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), posterior inferior tibiofibular ligament (PITFL), anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL). In all scenarios, two loading conditions were considered: (1) Anterior drawer test: 50N and 80N and (2) Talar tilt and Lateral clear space (LCS): 1.7Nm torque. The talar translation, talar tilt, and LCS were measured using Image J. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A p-value <0.05 was considered statistically significant. Results: In group 1 after transection of the AITFL and IOL, an increase in the anterior drawer, talar tilt, and lateral clear space values was found as compared to the intact state. Similarly, in group 2 the anterior drawer, talar tilt, and lateral clear space values significantly increased after transection of the AITFL and ATFL as compared to the intact state (p-values = 0.001). Conclusion: Lateral ankle instability appears after injury to two syndesmotic ligaments (AITFL and IOL), or after one syndesmotic ligament rupture (AITFL) with a concomitant anterior talofibular ligament rupture (ATFL). These findings suggest that surgeons should lower their threshold for stabilizing the syndesmosis if there is a concomitant lateral ankle ligament injury.

scholarly journals Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for chronic ankle instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0054
Author(s):  
Yunfeng Zhou ◽  
Bin Song
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomical Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Aofas Score ◽  
Anterior Translation ◽  
Talar Tilt ◽  
American Orthopaedic

Category: Arthroscopy Introduction/Purpose: To evaluate the clinical results of an anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament under arthroscopy in treatment of chronic ankle instability. Methods From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Methods: From June 2013 to August 2016, 27 patients (28 ankles) with chronic ankle instability were treated with the anatomical reconstruction of anterior talofibular ligaments and calcaneofibular ligaments. All patients were evaluated preoperatively and at the last follow up using the visual analog scale(VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. Results: The operations were lasted for 75.8 minutes(72~104 minutes). 28 cases were received a mean follow up of 14.8 months(range, 12~25 months. The mean VAS pain score decreased from 5.79 to 1.54(t=26.63, P<0.01), and the medial AOFAS score improved from 63.64 to 90.21(t=-16.57, P<0.01). Imageological examination were completed 16.8 months after the operation (range, 12~25 months). The mean talar tilt decreased from 15.6°to 6.01°(t=25.39, P<0.01),and anterior translation of the talar reduced from a mean of 10.82 to 4.03 mm(t=15.79, P<0.01). Conclusion: Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament could improve the function and stability of ankle joints effectively, providing a valid option for treating chronic ankle instability.

scholarly journals Clinical outcomes of anterior tibiofibular ligament’s distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients

2021 ◽  
Author(s):  
Jiaxin Tian ◽  
Tsz-Ngai Mok ◽  
Tat-Hang Sin ◽  
Zhengang Zha ◽  
Xiaofei Zheng ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Clinical Effectiveness ◽  
Chronic Ankle Instability ◽  
Anterior Drawer ◽  
Anterior Drawer Test ◽  
Tibiofibular Ligament ◽  
Transfer Group

Abstract Purpose Treatment of chronic ankle instability (CAI) for ankle sprain patients remains a challenge. If initial treatments fail, surgical stabilization techniques including ligament reconstruction should be performed. Anterior tibiofibular ligament (ATiFL) distal fascicle transfer for CAI was recently introduced. The goal of the study is to assess the 1-year clinical effectiveness of ATiFL’s distal fascicle transfer versus ligament reconstruction with InternalBrace™ (Fa. Arthrex, Naples). Methods Between October 2019 and February 2021, 25 patients (14 males and 11 females) scheduled for ligament reconstruction treatment of CAI were enrolled after propensity score matching. Twelve underwent ligament reconstruction with InternalBrace™ (InternalBrace™ group) and thirteen underwent ATiFL’s distal fascicle transfer (ATiFL’s distal fascicle transfer group). We recorded the American Orthopedic Foot & Ankle Society (AOFAS) score, Visual Analogue Scale (VAS), anterior drawer test grade, patient satisfaction and complications. All results of this study were retrospectively analyzed. Results Statistically significant (p = 0.0251, independent-samples t test) differences in the AOFAS can be found between the ATiFL’s distal fascicle transfer group and the InternalBrace™ group. No substantial changes in the VAS (p = 0.1778, independent-samples t test), patient satisfaction (p = 0.1800, independent-samples t test) and anterior drawer test grade (p = 0.9600, independent-samples t test) were found between the two groups. There was one patient with superficial wound infection and one patient with sural nerve injury in the InternalBrace™ group and ATiFL’s distal fascicle transfer group, respectively. Conclusion This is the first study that assessed a cohort of CAI patients and suggests that the ATiFL’s distal fascicle transfer operation has the potential to attain good-to-excellent clinical outcomes after 1-year recovery. The AOFAS scores were significantly higher for patients with ATiFL’s distal fascicle transfer, indicating that this technique may be considered a viable option for both patients and their surgeon, while long-term outcomes should be investigated in the future.

scholarly journals Ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large accessory malleolar ossicles

2019 ◽  
Author(s):  
Yongxing Cao(Former Corresponding Author) ◽  
Qiang Huang ◽  
Yang Xu ◽  
Yuan Hong ◽  
Xiangyang Xu(New Corresponding Author)
Keyword(s):  
Tilt Angle ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomic Reconstruction ◽  
Clinical Effects ◽  
Lateral Ligaments ◽  
Talar Tilt ◽  
Average Size ◽  
Effective Procedures

Abstract BackgroundAccessory malleolar ossicles are often found in patients with chronic ankle instability. For the large ossicles more than 10mm, there are still uncertainties about the suitable surgical option.This study was aimed at evaluating the clinical efficacy of ossicle resection and anatomic reconstruction of the lateral ligaments for chronic ankle instability with large accessory malleolar ossicles.MethodsSixteen chronic ankle instability patients with large accessory malleolar ossicles were treated with ossicle resection and anatomic reconstruction of lateral ligaments between December 2014 and February 2018. The clinical effects were evaluated with Visual Analogue Scale, Karlsson-Peterson ankle scoring system, and subjective satisfaction of patients. The varus talar tilt angle and anterior talar displacement between bony surfaces of the tibia and talus were included as radiographic parameters.ResultsThere were 11 males and 5 females in this study group. The average age at the time of surgery was 28.9 years old. The average final follow-up time was 26.9 months (range, 12 to 47). The average size of the ossicles was 11.7mm. The VAS score declined from 3.5 ± 1.6 preoperatively to 1.4 ± 1.0 at the final follow up (p < 0.01). The Karlsson-Peterson score was significantly improved from 52.7 ± 15.1 before surgery to 86.4 ± 8.2 at the last follow up (p < 0.01). Radiologically, the average varus talar tilt angle was decreased from 15.4 ± 2.0 degrees preoperatively to 6.2 ± 1.6 degrees at the final follow up (p < 0.01), and the average anterior talar displacement was decreased from 14.3 ± 2.1 mm preoperatively to 6.3 ± 1.4 mm at final follow up (p < 0.01). Fourteen patients (87.5%) were satisfied (‘excellent’ or ’good’) with treatment outcome.ConclusionsOssicle resection and anatomic reconstruction of the lateral ligaments provided good clinical outcomes for chronic ankle instability with large accessory malleolar ossicles. This method appears to be one of the reliable and effective procedures for the treatment of chronic ankle instability with large accessory malleolar ossicles.

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