Anatomical reconstruction of the anterior inferior tibiofibular ligament in elite athletes using InternalBrace suture tape

2022 ◽  
Vol 104-B (1) ◽  
pp. 68-75
Author(s):  
Nick J. Harris ◽  
Gareth Nicholson ◽  
Ippokratis Pountos
Keyword(s):  
Elite Athletes ◽  
Contralateral Side ◽  
Return To Play ◽  
Anatomical Reconstruction ◽  
Medial Malleolus ◽  
Anterior Talofibular Ligament ◽  
Return To Sports ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Suture Tape

Aims The ideal management of acute syndesmotic injuries in elite athletes is controversial. Among several treatment methods used to stabilize the syndesmosis and facilitate healing of the ligaments, the use of suture tape (InternalBrace) has previously been described. The purpose of this study was to analyze the functional outcome, including American Orthopaedic Foot & Ankle Society (AOFAS) scores, knee-to-wall measurements, and the time to return to play in days, of unstable syndesmotic injuries treated with the use of the InternalBrace in elite athletes. Methods Data on a consecutive group of elite athletes who underwent isolated reconstruction of the anterior inferior tibiofibular ligament using the InternalBrace were collected prospectively. Our patient group consisted of 19 elite male athletes with a mean age of 24.5 years (17 to 52). Isolated injuries were seen in 12 patients while associated injuries were found in seven patients (fibular fracture, medial malleolus fracture, anterior talofibular ligament rupture, and posterior malleolus fracture). All patients had a minimum follow-up period of 17 months (mean 27 months (17 to 35)). Results All patients returned to their pre-injury level of sports activities. One patient developed a delayed union of the medial malleolus. The mean return to play was 62 days (49 to 84) for isolated injuries, while the patients with concomitant injuries returned to play in a mean of 104 days (56 to 196). The AOFAS score returned to 100 postoperatively in all patients. Knee-to-wall measurements were the same as the contralateral side in 18 patients, while one patient lacked 2 cm compared to the contralateral side. Conclusion This study suggests the use of the InternalBrace in the management of unstable syndesmotic injuries offers an alternative method of stabilization, with good short-term results, including early return to sports in elite athletes. Cite this article: Bone Joint J 2022;104-B(1):68–75.

scholarly journals Diagnostic value of ultrasonography in acute lateral and syndesmotic ligamentous ankle injuries

2020 ◽  
Author(s):  
Thomas P. A. Baltes ◽  
Javier Arnáiz ◽  
Liesel Geertsema ◽  
Celeste Geertsema ◽  
Pieter D’Hooghe ◽  
...  
Keyword(s):  
External Rotation ◽  
Diagnostic Value ◽  
Ankle Injuries ◽  
Anterior Talofibular Ligament ◽  
Neutral Position ◽  
Post Injury ◽  
Calcaneofibular Ligament ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Dynamic Ultrasound

Abstract Objectives To determine the diagnostic value of ultrasonography for complete discontinuity of the anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL) and the anterior inferior tibiofibular ligament (AITFL). Methods All acute ankle injuries in adult athletes (> 18 years old) presenting to the outpatient department of a specialised Orthopaedic and Sports Medicine Hospital within 7 days post-injury were assessed for eligibility. Using ultrasonography, one musculoskeletal radiologist assessed the ATFL, CFL and AITFL for complete discontinuity. Dynamic ultrasound measurements of the tibiofibular distance (mm) in both ankles (injured and contralateral) were acquired in the neutral position (N), during maximal external rotation (Max ER), and maximal internal rotation (Max IR). MR imaging was used as a reference standard. Results Between October 2017 and July 2019, 92 acute ankle injuries were included. Ultrasound diagnosed complete discontinuity of the ATFL with 87% (CI 74–95%) sensitivity and 69% (CI 53–82%) specificity. Discontinuity of the CFL was diagnosed with 29% (CI 10–56%) sensitivity and 92% (CI 83–97%) specificity. Ultrasound diagnosed discontinuity of the AITFL with 100% (CI 74–100%) sensitivity and 100% (CI 95–100%) specificity. Of the dynamic measurements, the side-to-side difference in external rotation had the highest diagnostic value for complete discontinuity of the AITFL (sensitivity 82%, specificity 86%; cut-off 0.93 mm). Conclusions Ultrasound has a good to excellent diagnostic value for complete discontinuity of the ATFL and AITFL. Therefore, ultrasound can be used to screen for injury of the ATFL and AITFL. Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL. Key Points • Ultrasound has a good to excellent diagnostic value for complete discontinuity of the anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament (AITFL). • Ultrasound can be used to screen for injury of the ATFL and AITFL. • Compared with ultrasound, dynamic ultrasound has inferior diagnostic value for complete discontinuity of the AITFL.

Suture Anchor Augmentation for Acute Unstable Isolated Ankle Syndesmosis Disruption in Athletes

2021 ◽  
pp. 107110072110151
Author(s):  
Jin Su Kim ◽  
Hyuck Soo Shin
Keyword(s):  
Suture Anchor ◽  
External Rotation ◽  
Activity Level ◽  
Return To Play ◽  
Level Of Evidence ◽  
Chronic Instability ◽  
Sports Activity ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament

Background: Isolated ankle syndesmosis disruption (without fibula fracture) causes acute pain and may cause chronic instability and pain. The aim of the present study was to evaluate the outcomes after anterior inferior tibiofibular ligament (AITFL) anatomical fixation using anchor sutures for unstable isolated syndesmosis disruption without fibular fractures. Methods: This study assessed 22 athletes who were diagnosed with unstable isolated syndesmosis disruption with a positive external rotation test, had more than 2-mm diastasis on ultrasound, and had complete AITFL rupture on magnetic resonance imaging between 2004 and 2020. Eighteen patients (82%) were elite-level athletes, and the remaining 4 were recreational athletes. Twelve patients (55%) were injured by an external rotation force. The athletes underwent open anatomical suture anchor fixation between the AITFL attachment sites, the fibula and tibia. The mechanism of injury, return-to-play time, and Foot and Ankle Outcome Score (FAOS) were evaluated. Results: All athletes returned to previous play except 1 retired elite athlete. Twenty-two athletes returned to jogging, team training, and official game play at an average of 62, 89, and 102 days, respectively. The final average follow-up FAOS symptom, pain, daily activity, sports activity, and quality of life scores were 98, 97, 100, 99, and 97, respectively. Two athletes were reinjured, and 1 required reoperation in the follow-up period. Conclusion: Athletes with isolated syndesmosis disruption had a high likelihood to return to their previous activity level after suture anchor augmentation. Level of Evidence: Level IV.

Anterior Syndesmotic Augmentation Technique Using Nonabsorbable Suture-Tape for Acute and Chronic Syndesmotic Instability

2020 ◽  
Vol 41 (10) ◽  
pp. 1307-1315
Author(s):  
John Y. Kwon ◽  
Derek Stenquist ◽  
Michael Ye ◽  
Caroline Williams ◽  
Eric Giza ◽  
...  
Keyword(s):  
Expert Opinion ◽  
Current Work ◽  
Level Of Evidence ◽  
Operative Strategy ◽  
Nonabsorbable Suture ◽  
Preliminary Results ◽  
Patient Cohort ◽  
Tibiofibular Ligament ◽  
Anterior Inferior Tibiofibular Ligament ◽  
Suture Tape

Syndesmotic instability is a source of significant pain and disability. Both subtle instability and gross diastasis, whether acute or chronic, require stabilization and may benefit from reconstruction with ligamentous augmentation. The use of nonabsorbable suture-tape has emerged as a promising operative strategy, allowing surgeons to anatomically reconstruct the syndesmosis, in particular the anterior inferior tibiofibular ligament. The current work provides a detailed description of the technique and preliminary results of a patient cohort treated using nonabsorbable suture-tape for syndesmotic augmentation. Level of Evidence: Level V, expert opinion.

Stress Fractures of the Medial Malleolus—Review of the Literature and Report of a 15-Year-Old Elite Gymnast

2002 ◽  
Vol 23 (7) ◽  
pp. 647-650 ◽  
Author(s):  
S. Shabat ◽  
K.B. Sampson ◽  
G. Mann ◽  
R. Gepstein ◽  
A. Eliakim ◽  
...  
Keyword(s):  
Stress Fracture ◽  
Elite Athletes ◽  
Medial Malleolus ◽  
Return To Sports ◽  
Review Of The Literature ◽  
Cancellous Screw ◽  
Early Recovery ◽  
Open Physes ◽  
Complete Fracture ◽  
Sports Activities

Stress fracture of the medial malleolus is rare and not reported in children. We report a case of a 15-year-old elite gymnast with open physes sustaining a medial malleolar stress fracture. The patient was treated initially by rest and gradually returned to sport with full recovery. Two months later she developed a complete fracture of the medial malleolus of the same side. This was treated surgically by open reduction and internal fixation with a cancellous screw and soon after the operation she returned to full activities. Emphasis is given to the suspected mechanism which led to this unique fracture and to the hormonal aspects in the professional adolescent gymnast. We recommend surgical treatment of stress fracture of the medial malleolus especially for elite athletes, leading to early recovery and return to sports activities.

scholarly journals Return to Play after Arthroscopic Microfracture for Osteochondral Lesions of the Talus in Young Elite Athletes

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0029
Author(s):  
Sung-Jae Kim ◽  
Kyung-tai Lee
Keyword(s):  
Elite Athletes ◽  
Return To Play ◽  
Rate Of Return ◽  
Osteochondral Lesions ◽  
Return To Sports ◽  
Sports Activity ◽  
Vas Score ◽  
Arthroscopic Microfracture ◽  
The Mean

Category: Ankle; Arthroscopy Introduction/Purpose: The current scientific evidence for the clinical and sports-related outcomes of the surgical treatment of osteochondral lesions of the talus (OLTs) with arthroscopic microfracture (MF) in elite athletes is scarce. The purpose of curretn study is to evaluate the clinical outcomes and return to sports activity after arthroscopic MF for OLTs in elite athletes. Methods: The files of 41 elite athletes (mean age 19.34 +- 3.76 years) who had undergone arthroscopic MF for OLTs at our institution between January 2011 and September 2015 were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot and visual analog pain (VAS) score, time and rate of ‘return-to-competition’ (RTC, defined as return to an official match for at least one minute after treatment), and rate of ‘return- to-play’ (RTP, defined as participation in at least two entire seasons after treatment) were used to evaluate the outcomes. We compared athletes who were able to RTP (RTP-group) with those who were not (No-RTP group). Results: The mean follow-up was 54.9 +- 13.72 months. All five subscales of preoperative FAOS were significantly improved at the final follow-up. The mean preoperative AOFAS hindfoot score of 74.46 +- 8.10 improved to 91.62 +- 2.99 (P < 0.001) at the final follow-up. The mean preoperative VAS score of 5.44 +- 1.57 improved to 2.66 +- 1.04 (P < 0.001). All patients achieved RTC (100%) at mean time of 5.45 +- 3.18 months, and 74.4% of patients were able to RTP. The RTP-group showed significantly smaller lesions compared to the No-RTP group (71.52 +- 43.29 vs. 107.00 +- 45.28 mm2, P = 0.009). The cut-off OLT size for predicting RTP was 84.0 mm2, with a sensitivity of 90.0% and specificity of 75.9%. Conclusion: All athletes were able to RTC at average of 5.45 months after MF for OLTs, and 74.4% were able to RTP. The only prognostic variable for RTP was lesion size, and its predictive cut-off was 84 mm2.

scholarly journals Outcomes and rate of return to play in elite athletes following arthroscopic surgery of the hip

2021 ◽  
Author(s):  
R. Elwood ◽  
O. El-Hakeem ◽  
Y. Singh ◽  
H. Shoman ◽  
O. Weiss ◽  
...  
Keyword(s):  
Hip Arthroscopy ◽  
Elite Athletes ◽  
Arthroscopic Surgery ◽  
Return To Play ◽  
Rate Of Return ◽  
Labral Repair ◽  
Return To Sports ◽  
Post Surgery ◽  
Patient Reported

Abstract Background The tremendous physical demands of elite performance increase the risk of elite athletes sustaining various orthopaedic injuries. Hip pain is common in high-level athletes representing up to 6% of all athletic injuries. Expedient diagnosis and effective treatment are paramount for their future sporting careers and to prevent subsequent joint degeneration. Purpose This systematic review aimed to evaluate the outcome and the rate of return to play (RTP) following arthroscopic procedures in the hip (osteoplasty, chondroplasty, labral repair and/or debridement, capsulotomy, capsulorrhaphy or any soft tissue procedure) in elite athletes. Elite athletes were defined as those who represented their country in international contests or were competing professionally for the purpose of this study. Methods A computer-based systematic search, following the PRISMA Guidelines, was performed on CENTRAL, PUBMED, EMBASE, SCOPUS, EBSCO, Google Scholar and Web of Science from inception until January 1, 2020, identifying studies that looked at return to sports post-hip arthroscopy in elite athletes. Weighted means were calculated for the RTP rate and duration and for patient-reported outcome measures (PROMs). Results After eligibility screening, 22 articles were included with a total of 999 male and seven female patients, 1146 hips and a mean age of 28.4 ± 3.2 years. The mean follow-up period was 35.8 ± 13.4 months and 15.9 ± 9.6% of athletes had undergone bilateral procedures. Overall, 93.9% (95% CI: 90.5, 96.6, P < 0.0001) of patients demonstrated RTP after 6.8 ± 2.1 months post-surgery and all PROMs improved post-operatively. During follow-up, 9.6% (95% CI: 5.2, 15.2, P = 0.025) patients needed further intervention. Conclusion A high percentage of elite athletes return to the same level of competition after hip arthroscopy, with a low rate of further interventions. Hip arthroscopy appears to be an efficacious treatment for hip and/or groin pain, caused by pathologies such as FAI or labral tears, in elite athletes in the shorter term. Long term outcomes need further evaluation.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

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