scholarly journals Arthroscopic Remnant-Preserving Anterior Talofibular Ligament Reconstruction does not Improve the Short-term Function of Ankle

2020 ◽  
Author(s):  
Shi-Ming Feng ◽  
Nicola Maffulli ◽  
Francesco Oliva ◽  
Qing-Qing Sun ◽  
Ai-Guo Wang
Keyword(s):  
Ankle Instability ◽  
Semitendinosus Tendon ◽  
Anatomic Reconstruction ◽  
Functional Score ◽  
Anterior Talofibular Ligament ◽  
Short Term ◽  
Level Of Evidence ◽  
Ankle Function ◽  
Tendon Autograft

Abstract Background Anterior talofibular ligament (ATFL) reconstruction is a valid treatment of chronic lateral ankle instability (CLAI). The purpose of this study was to evaluate the significance of preserving and not preserving remnant in ATFL reconstruction, as well as the clinical efficacy.Methods From January 2015 to July 2017, fifty-three admitted remnant-preserving CLAI patients with ATFL injury were prospectively randomized as remnant-preserving group (preservation of ATFL) and non-preserving group (no preservation of ATFL). All patients received anatomic reconstruction of ATFL using the semitendinosus tendon autograft. The Visual Analogue Scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), and ankle proprioceptive recovery in both groups were compared.Results All patients were followed up for at least 2 years, and difference in the follow-up time between two groups was not statistically significant. Differences in VAS, AOFAS, KAFS, ATT and ankle proprioceptive recovery between two groups were not statistically significant.Conclusions Compared with non-remnant-preserving surgery, there are no short-term follow-up differences in postoperative ankle function, stability and proprioceptive recovery when semitendinosus tendon autograft is used to treat CLAI through remnant-preserving ATFL reconstruction.Level of Evidence: Level III, a prospective comparative study.Trial registration: Xuzhou Central Hospital, ZXYY-2015090. Registered 21 November 2014

scholarly journals Chronic Lateral Ankle Instability with Subtalar Instability: Does Lateral Ligaments Reconstruction Reliable?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Shi-Ming Feng
Keyword(s):  
Ankle Instability ◽  
Anatomical Reconstruction ◽  
Functional Score ◽  
Anterior Talofibular Ligament ◽  
Short Term ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Subtalar Instability

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: To evaluate the functional outcomes of arthroscopic anatomical reconstruction of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in the treatment of chronic lateral ankle instability with subtalar instability during short term follow-up Methods: We retrospectively analyzed data in 8 patients (5 males, 3 females; 2 left ankles, 6 right ankles) aged between 21 and 49 years, with an average age of 31.74 +- 8.48 years presenting with CLAI with subtalar instability from Auguse 2015 to October 2018. The duration of the symptoms lasted for 12 to 43 months, with an average of 24.26 +- 10.17 months. All patients underwent arthroscopic anatomical reconstruction of ATFL and CFL. Pre- and postoperative visual analogue scales (VAS), the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS) and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation Results: After surgery, all incisions healed in stage I and there were no complications. All patients were followed for 12 to 36 months, averaging 26.15 +- 9.34 months. At the final follow-up, the ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and subtalar, and all patients returned to normal gait. The mean VAS score decreased to 1.06 +- 0.27, the AOFAS score increased to 93.16 +- 5.26 and the KAFS score increased to 92.01 +- 6.73. All the follow-up indexes were significantly different from those before surgery Conclusion: Arthroscopic anatomical reconstruction of ATFL and CFL in the treatment of chronic lateral ankle instability with subtalar instability is reliable in short term

Functional Results of All-Inside Arthroscopic Broström-Gould Surgery With 2 Anchors Versus Single Anchor

2020 ◽  
Vol 41 (6) ◽  
pp. 721-727 ◽  
Author(s):  
Shi-Ming Feng ◽  
Ai-Guo Wang ◽  
Qing-Qing Sun ◽  
Zai-Yi Zhang
Keyword(s):  
Ankle Instability ◽  
Functional Results ◽  
High Rate ◽  
Wound Complications ◽  
Functional Score ◽  
Activity Levels ◽  
Level Of Evidence ◽  
Anchor Group ◽  
Significant Difference

Background: The all-inside arthroscopic Broström-Gould technique gained particular attention among clinicians and researchers due to its high rate of satisfactory results. Thus far, there is a lack of evidence regarding the differences in clinical outcomes between the use of 1 anchor and 2 anchors. The purpose of this study was to compare the differences in clinical function and activity levels in patients treated with 1 or 2 anchors in all-inside arthroscopic Broström-Gould surgery for chronic lateral ankle instability (CLAI). Methods: The data of 75 patients with CLAI (unilateral) admitted from May 2013 to July 2016 were retrospectively analyzed. All patients were treated with all-inside arthroscopic Broström-Gould surgery. The patients were divided into a single-anchor group ( n = 36) and double-anchor group ( n = 39) according to the number of anchors used. There was no statistical difference in general characteristics between the 2 groups before surgery. After 36 to 72 months of follow-up, the pain visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Foot and Ankle Outcome Score (FAOS) were used to evaluate and compare the clinical function results between the 2 groups. Results: The incidence of wound complications; reaction to the suture; injury to the nerve, blood vessel, or tendon; and length of postoperative hospitalization were similar between the 2 groups. At the last follow-up, there was no significant difference in the VAS and AOFAS scores between single- and double-anchor groups, but the KAFS and FAOS in the double-anchor group were significantly higher than in the single-anchor group. Additionally, more patients in the double-anchor group returned to preinjury sports activities. Conclusion: All-inside arthroscopic Broström-Gould surgery for the treatment of CLAI yielded a better functional effect and better recovery to preinjury mobility when 2 anchors were used instead of a single anchor. Level of Evidence: Level III, comparative study.

Lateral Instability in Total Ankle Arthroplasty: A Comparison Between the Brostrom-Gould and Anatomic Lateral Ankle Stabilization (ATLAS)

2021 ◽  
pp. 193864002110418
Author(s):  
Calvin J. Rushing ◽  
Bryon J. Mckenna ◽  
Gregory C. Berlet
Keyword(s):  
Ankle Instability ◽  
Total Ankle Arthroplasty ◽  
Anatomic Reconstruction ◽  
Lateral Instability ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Ankle Arthroplasty ◽  
Patient Demographics ◽  
Lateral Ankle Instability

Background Lateral ankle instability is not uncommon after osseous cuts and soft tissue releases are performed during Total Ankle Arthroplasty (TAA), particularly with varus malalignment. The purpose of the present study was to compare the outcomes of ankles that underwent TAA with concurrent Brostrom-Gould (BG) or Anatomic Lateral Ankle Stabilization (ATLAS) at a minimum of 1-year follow-up. Methods Thirty-eight TAAs underwent BG (21 INFINITY, 4 CADENCE) or ATLAS (13 INBONE-2) between August 2015 and February 2019 at a single institution and were at least 1 year postoperative (mean 18.3 months, range: 12-40). Baseline patient demographics, characteristics, and operative factors were assessed via medical record and chart reviews. Radiographs parameters were measured preoperatively, at 6 weeks postoperative, and during the latest follow-up. Revisions, reoperations, and complications were classified according to the criteria established by Vander Griend et al and Glazebrook et al, respectively. Univariate and multivariate analyses were performed. Results Survivorship for TAA with concurrent BG/ATLAS was 97%. Overall, TAA with concurrent BG had higher incidences of early TAA revision (4%), recurrent instability (4%), reoperation (16%), and complications (29%) compared to ATLAS. Postoperative coronal and sagittal tibiotalar alignment changes were significant for both groups (P < .001, P = .014); however, the differences were greater for ATLAS (P = .045, P < .001). Conclusion The present study is the first to compare outcomes between techniques for addressing ankle instability in the TAA population. At short-term follow-up, anatomic reconstruction produced better outcomes than the traditional BG procedure. Additional comparative studies between techniques to address instability in the TAA population are warranted. Level of Evidence: Level III: Retrospective cohort study

scholarly journals Anatomic reconstruction of anterior talofibular ligament with tibial tuberosity–patellar tendon autograft for chronic lateral ankle instability

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878087 ◽  
Author(s):  
Can Chen ◽  
Hongbin Lu ◽  
Jianzhong Hu ◽  
Xuqiang Qiu ◽  
Xiong Li ◽  
...  
Keyword(s):  
Bone Healing ◽  
Ankle Instability ◽  
Activity Level ◽  
Anatomic Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Talar Tilt ◽  
Tegner Activity Level

Introduction: Anatomic repair of the anterior talofibular ligament (ATFL) is challenging when the local ligamentous tissue is severely attenuated. Anatomic reconstruction of the ATFL with tibial tuberosity–patellar tendon (TT-PT) autograft is a feasible choice that can avoid the complicated tendon–bone healing and restore ankle stability. Materials and methods: From 2009 to 2015, 31 chronic lateral ankle instability (CLAI) patients (31 ankles), who had a serious injury on the ATFL only, were treated with anatomic reconstruction of ATFL with TT-PT. American orthopedic foot and ankle society ankle–hindfoot score (AHS), visual analog scale for pain score (VAS), Karlsson–Peterson score, Tegner activity level, and objective examination comprehending range of motion were used to evaluate the clinical outcomes before and after operation. Radiographically, talar tilt angles and anterior drawer were assessed in pre- and postoperative ankle stress views. Results: Among the 31 ankles, 17 ankles with single-bundle ATFL and 14 ankles with double-bundle ATFL were found at operation. At a mean follow-up of 42 months (24–82 months), all patients were satisfied with the procedure. Mean AHS significantly increased from 60.5 ± 8.2 to 93.5 ± 4.8. Mean Karlsson–Peterson score significantly increased from 55.2 ± 11.0 preoperatively to 91.2 ± 6.9 at final follow-up. Average VAS significantly decreased from 5.9 ± 1.6 preoperatively to 1.4 ± 1.0 at the latest follow-up. Mean Tegner activity level was 3.7 ± 0.9 before operation, compared with 7.0 ± 0.8 after operation. On stress radiographs, mean talar tilt angle was 17.0 ± 3.4° before operation and 3.8 ± 2.1° at the latest follow-up. In addition, mean anterior tibiotalar translation was 7.5 ± 2.2 mm before operation and 1.8 ± 1.1 mm at the latest follow-up. Conclusion: Anatomic reconstruction of the ATFL using a TT-PT autograft allows bone–bone healing in talus and tendon–tendon/periosteum healing in fibula rather than requiring tendon–bone healing, which is an alternative choice for treating CLAI caused by single ATFL insufficiency.

scholarly journals Modified arthroscopic Broström procedure using a soft anchor for chronic lateral ankle instability: Short-term follow-up results

2021 ◽  
Author(s):  
Ramin Moradi ◽  
Bertan Cengiz
Keyword(s):  
Postoperative Period ◽  
Ankle Instability ◽  
Functional Improvement ◽  
Invasive Technique ◽  
Return To Sports ◽  
Complication Rates ◽  
Short Term ◽  
The Mean ◽  
Ankle Function

Objectives: This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Broström technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports. Patients and methods: A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months. Results: The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine patients (64.3%) returned to sports activities after surgery at a mean period of 9±2.1 months. Conclusion: In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique.

Arthroscopic-Assisted Broström-Gould for Chronic Ankle Instability

2011 ◽  
Vol 39 (11) ◽  
pp. 2381-2388 ◽  
Author(s):  
Caio Nery ◽  
Fernando Raduan ◽  
Angelo Del Buono ◽  
Inacio Diogo Asaumi ◽  
Moises Cohen ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Case Series ◽  
Anatomic Reconstruction ◽  
Lateral Ligament ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Lateral Ankle ◽  
Cartilage Lesions ◽  
Lateral Ankle Instability

Background: Lateral ankle sprains account for 85% of ankle lesions. Hypothesis: Combined open and arthroscopic procedures could improve the diagnosis and management of intra-articular lesions and allow surgeons to perform minimally invasive anatomic reconstruction of the lateral ligament complex. Study Design: Case series; Level of evidence, 4. Methods: Forty consecutive patients underwent ankle arthroscopy for recurrent (2 or more episodes) lateral ankle instability unresponsive to nonoperative measures. The clinical diagnosis of mechanical instability was confirmed at imaging (plain radiographs and magnetic resonance imaging [MRI]) and arthroscopic assessment. All patients underwent arthroscopic Broström-Gould repair for management of lateral ankle instability; secondary lesions were also managed. Postoperatively, the American Orthopaedic Foot & Ankle Society (AOFAS) score was administered to assess the functional status; clinical examination and conventional radiographs were performed in all patients. Results: Thirty-eight patients were reviewed at an average postoperative follow-up of 9.8 years. The mean AOFAS score was 90 (range, 44-100) at the last follow-up. No significantly different outcomes were found in patients who had undergone microfractures for management of grade III to IV cartilage lesions compared with patients with no cartilage lesions. Postoperative AOFAS scores were graded as excellent and good in almost all patients (94.7%). Concerning failure rate, 2 patients (5.3%) reported a low AOFAS score: one patient underwent soft tissue removal for anterior impingement, and one received simultaneous medial ankle instability repair. Conclusion: The arthroscopic Broström-Gould–assisted technique could be a viable alternative to the gold-standard Broström-Gould procedure for anatomic repair of chronic lateral ankle instability and management of intra-articular lesions. Prospective randomized controlled trials are needed.

Fully Intra-articular Lasso-Loop Stitch Technique for Arthroscopic Anterior Talofibular Ligament Repair

2021 ◽  
pp. 107110072110444
Author(s):  
Jiajun Qin ◽  
Qiang Fu ◽  
Qing Zhou ◽  
Helin Wu ◽  
Xiaosong Zhi ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Case Series ◽  
Anterior Talofibular Ligament ◽  
Nerve Injuries ◽  
Accidental Injury ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lateral Ankle Instability ◽  
Vas Scores

Background: Arthroscopic techniques have gradually become popular for anterior talofibular ligament (ATFL) repair. However, the reliability of the repair and the risk of nerve injuries are of concern. The aim of this study was to evaluate the fully intra-articular lasso-loop stitch technique for arthroscopic ATFL repair. Methods: From October 2018 to December 2019, 43 cases with chronic lateral ankle instability were treated with this fully intra-articular lasso-loop stitch technique using the Arthro-Pierce instrument. The Karlsson-Peterson score, Cumberland Ankle Instability Tool (CAIT) score, visual analog scale (VAS) score, anterior drawer and talar tilt stress fluoroscopy were evaluated at the preoperative and final follow-up appointments, respectively. All surgical complications were also recorded. Results: A total of 39 cases were followed up for a mean of 28.23 ± 3.64 months (range, 23-34 months). At the final follow-up, the averages of the Karlsson-Peterson, CAIT and VAS scores were 90.26 ± 6.58, 88.56 ± 7.21 and 0.79 ± 1.06, respectively. During surgery, 2 cases were modified with augmentation of the inferior extensor retinaculum. No nerve injuries were encountered. Only 1 female complained about mild knot irritation. A 25-year-old solider required revision surgery due to an accidental injury. Conclusion: We found the fully intra-articular lasso-loop stitch technique for ATFL repair using the Arthro-Pierce instrument to be reliable and safe with a sufficient and good-quality ligament remnant. Level of Evidence: Level IV, retrospective case series.

scholarly journals Anterior Talofibular Ligament Reconstruction could Produce Comparable Functional Outcomes with or without Calcaneofibular Ligament Reconstruction for Chronic Lateral Ankle Instability

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0020
Author(s):  
Shi-Ming Feng
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
Functional Score ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
American Orthopaedic ◽  
Tendon Autograft

Category: Ankle; Arthroscopy; Sports Introduction/Purpose: This study evaluates the effects on functional outcomes of with or without calcaneofibular ligament reconstruction when reconstructing the ATFL for chronic lateral ankle instability Methods: This retrospective cohort study included 48 chronic lateral ankle instability patients with later ligament reconstruction that underwent either with or without a calcaneofibular ligament reconstruction using an ipsilateral free semitendinosus tendon autograft from June 2014 to October 2017. The Visual Analogue Scale score, the American Orthopaedic Foot & Ankle Society score, Karlsson Ankle Functional Score and Anterior Talar Translation in both groups were compared. Results: All patients were followed up for at a mean of 30 months, Visual Analogue Scale score, the American Orthopaedic Foot & Ankle Society score, Karlsson Ankle Functional Score and Anterior Talar Translation between two the groups were not statistically significant different. Conclusion: There are no differences at 2.5 years in postoperative ankle function and stability when an ipsilateral free semitendinosus tendon autograft is used to manage CLAI with anterior talofibular ligament reconstruction with and without reconstructing the calcaneofibular ligament.

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