scholarly journals Distal Insertion Rupture of Lateral Ankle Ligament as a Predictor of Weakened and Delayed Sports Recovery after Acute Ligament Repair: Mid- to Long-Term Outcomes of 148 Cases

2021 ◽  
Author(s):  
Mingze Du ◽  
Jun Li ◽  
Chen Jiao ◽  
Qinwei Guo ◽  
Yuelin Hu ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Suture Repair ◽  
Return To Sports ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Middle Group ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Tegner Score

Abstract Background Surgical repair has been considered for ankle sprain patients with high sports demanding to achieve stronger ankle stability and allow for an earlier return to sports. However, there is a lack of systematic research regarding arthroscopic treatment followed by ligament repair for severe acute ankle sprain. The purpose of this study was to analyze the mid- to long-term outcome of arthroscopy followed by open anatomic lateral ankle ligament repair surgery for acute lateral ankle sprain and the impact of ligament rupture site on the outcome. Methods 166 professional or semi-professional athletes with clinically- and radiologically-confirmed grade III acute lateral ankle ligament injuries underwent ankle arthroscopy followed by open anatomic ligament repair. Intra-articular lesions and rupture site of the lateral ankle ligament were treated and explored under arthroscopy. Simple suture repair was performed for mid- substance ligament rupture (middle group), while suture repair with anchors were used for the ruptures near the ligament attachment site on the fibular (proximal group), talar or the calcaneal side (distal group). The evaluation parameters included VAS score, AOFAS score, Tegner score, time to return to sports and resumption of pre-injury sports level at final follow-up, sprain recurrence and range of motion (ROM). Results The mean follow-up duration was 64.5 (range, 37–132 months) months and 148 (89.2%) patients were evaluated at final follow-up. Intra-articular lesions were treated under arthroscopy in 63 (43%) patients. The average time to return to pre-injury sports activity was 4.37 ± 1.10 months and 17 (11.5%) patients complaint sprain recurrence after operation. There were 71 (48%) cases in the proximal group, 46 (31%) cases in the middle group and 31 (21%) cases in the distal group respectively. The proximal group achieved shortest time to return to sports (4.14 ± 1.09 months) and highest resumption proportion of pre-injury sports level (94% ± 11%) at final follow-up, followed by middle group (89% ± 15%, 4.61 ± 0.93 months, respectively) and distal group (87% ± 13%, 4.53 ± 1.29 months, respectively) (p =0.008, p =0.04, respectively). At final follow-up, all of the VAS score, AOFAS score and the Tegner score were significantly improved from the pre-operative level (p < 0.001). 18 (12%) patients reported mild ROM restriction and 7 (4.7%) patients experienced transient skin numbness. Conclusions Ankle arthroscopy followed by open anatomic ligament repair is a reliable procedure for patients with high sports demands after severe acute ankle sprains. Rupture near the talar or calcaneal side weakened the sports resumption and delayed about 2 weeks of sports recovery.

scholarly journals Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0032
Author(s):  
G. Matthew Heenan ◽  
Kisan B. Parikh ◽  
Armin Tarakemeh ◽  
Scott M. Mullen ◽  
John Paul Schroeppel ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Newly Diagnosed ◽  
Ligament Repair ◽  
Chronic Instability ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
The Difference ◽  
Articular Pathology

Objectives: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,188) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,141) or lateral ankle ligament reconstruction (n=1,063). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=219), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=325), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Average cost per patient was higher for both arthroscopy groups: repair with arthroscopy ($6,207.78) versus repair without arthroscopy ($3,677.11; p < 0.0001); reconstruction with arthroscopy ($5,758.21) versus reconstruction without arthroscopy ($4,601.13; p = 0.0039). There was a significantly higher proportion of patients with complications in the reconstruction without arthroscopy group than in the reconstruction with arthroscopy group (7.59%, 4.31%; p = 0.0431), but the difference between repair groups was insignificant (p = 0.0626). The proportion of patients with newly diagnosed intra-articular defects was significantly higher in both arthroscopy groups: repair with arthroscopy (53.0%) versus repair without arthroscopy (35.6%; p < 0.0001); reconstruction with arthroscopy (56.0%) versus reconstruction without arthroscopy (39.8%; p < 0.0001). There was a significantly higher proportion of patients who underwent reoperation for intra-articular defects in the combined (repair plus reconstruction) arthroscopy group (7.18%) than in the combined non-arthroscopy groups (4.91%; p = 0.049). Most importantly, the average time until reoperation for intra-articular defects was significantly shorter in the combined arthroscopy group (271.923 days) than in the combined non-arthroscopy group (411.473 days; p = 0.024). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was nearly 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.

scholarly journals Epidemiology of Lateral Ankle Ligament Injury: Trends in Clinical Management and Likelihood of Progression to Surgical Intervention

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0024
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
William G. Messamore ◽  
Matthew Vopat ◽  
Brandon L. Morris ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Physical Therapy ◽  
Ankle Sprain ◽  
Ligament Reconstruction ◽  
Surgical Intervention ◽  
Surgical Patients ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: Lateral ankle ligament sprains occur frequently in both general and athletic populations. Most patients recover from their injury without complication, however, some experience persistent pain and instability following lateral ankle injury, which requires treatment with surgical stabilization. The purpose of this study is to determine the utilization and associated costs of non-operative treatment modalities, such as physical therapy (PT), non-steroidal anti-inflammatory medication, and ankle bracing, as well the incidence of lateral ankle sprains that receive surgical treatment and the costs incurred by surgical treatment of chronic lateral ankle instability. Methods: Data was collected using the Pearl Diver Humana dataset using ICD-9, ICD-10, and CPT codes pertaining to ankle sprain, ankle ligament repair or reconstruction, physical therapy, ankle brace ordering, and non-steroidal anti-inflammatory medication (NSAID) ordering. Patients diagnosed with an ankle sprain were sub-divided into three categories: non-operative treatment, surgical ligament repair, and surgical ligament reconstruction. Incidence, cost, and PT usage was compared between patient groups. Cost analysis was performed per group using associated ICD/CPT cost and physical therapy cost. NSAID use and ankle bracing use was also examined. Results: Of patients who sustained lateral ankle injury, 64% were female and 36% were male. 306,180 (98.8%) patients successfully completed non-operative management. 2,774 (1.2%) patients underwent surgical intervention. 63,276 (20.7%) non- operative patients received physical therapy, whereas 1,536 (55.4%) surgically treated patients received PT after surgery. Only 725 (26.1%) surgical patients received pre-operative PT. Median time for total PT treatment of surgical patients was 21.8 weeks, while non-operative patients received treatment for a median time of 58.7 weeks. On average non-operative patients generated 11 billed days in PT while surgical patients received 8 days of PT before surgery and 11 days in PT after surgery. Average total cost per patient was $923.32 for non-operative patients, $3,384.63 for surgical ligament repair, and $3,659.98 for surgical ligament reconstruction. Conclusion: The vast majority of patients with lateral ankle ligament sprains do not progress to surgical treatment. Patients treated non-operatively used fewer physical therapy visits per patient and generated less cost compared to surgically treated patients. Only 20% of non-operative patients received physical therapy. Additionally, a higher proportion of surgically treated patients participated in PT compared to patients treated non-operatively.

scholarly journals Arthroscopy in Lateral Ankle Ligament Stabilization Surgery: Costs, Complications, Intra-Articular Defect Diagnosis, and Reoperations

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0020
Author(s):  
G. Matthew Heenan ◽  
Kisan Parikh ◽  
Armin Tarakemeh ◽  
J. Paul Schroeppel ◽  
Scott Mullen ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Newly Diagnosed ◽  
Ligament Repair ◽  
Chronic Instability ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
Articular Pathology ◽  
Lateral Ankle Ligament Reconstruction

Category: Ankle, Arthroscopy Introduction/Purpose: Lateral ankle ligament stabilization may be performed with concomitant arthroscopy. Arthroscopy has been shown to aid in the diagnosis of intra-articular defects that often accompany lateral ankle ligament injuries. This study compares the differences in cost, complications, newly diagnosed intra-articular defects, and reoperations among patients with ankle sprain/chronic instability who underwent lateral ankle ligament repair/reconstruction with or without concomitant arthroscopic procedures. Methods: Data was collected from the PearlDiver Technologies Humana dataset using CPT and ICD9/10 codes. Patients included in this study (n=2,428) had records of ankle sprain or ankle instability prior to or on the same day as one of two procedures: lateral ankle ligament repair (n=1,236) or lateral ankle ligament reconstruction (n=1,211). This population was subdivided by whether patients had records of arthroscopic procedure(s) on the same day as the ligament surgery. This yielded four groups: repair with arthroscopy (n=314), repair without arthroscopy (n=922), reconstruction with arthroscopy (n=473), reconstruction without arthroscopy (n=738). Cost, complications, newly diagnosed intra-articular defects, and reoperations were assessed. Results: Cost was higher for arthroscopy groups: repair with arthroscopy ($5,991.32) versus repair without arthroscopy ($3,677.11; p<0.001); reconstruction with arthroscopy ($5,744.83) versus reconstruction without arthroscopy ($4,601.13; p=0.001). Proportionately more patients had complications in the repair without arthroscopy group than in the repair with arthroscopy group (9.87%, 5.41%; p=0.013). Proportionately more patients had newly-diagnosed intra-articular defects in arthroscopy groups: repair with arthroscopy (57.0%) versus repair without arthroscopy (35.6%; p<0.001); reconstruction with arthroscopy (63.0%) versus reconstruction without arthroscopy (39.8%; p<0.001). Proportionately more patients underwent reoperation for intra-articular defects in the combined arthroscopy group (6.89%) than in the combined non-arthroscopy group (4.18%; p=0.006). The average time until reoperation for intra-articular defects was shorter in the combined arthroscopy group (302.536 days) than in the combined non-arthroscopy group (473.886 days; p=0.045). Conclusion: Concomitant arthroscopy with lateral ankle ligament surgery is more expensive but does not appear to increase the overall complication rate and may allow surgeons to diagnose and treat more intra-articular pathology. Among patients requiring reoperation for intra-articular defects, the average time to reoperation was over 5 months shorter for patients receiving arthroscopy than for patients who did not receive arthroscopy.

Optimal suture anchor direction in arthroscopic lateral ankle ligament repair

2017 ◽  
Vol 26 (7) ◽  
pp. 2110-2115 ◽  
Author(s):  
Ichiro Yoshimura ◽  
Tomonobu Hagio ◽  
Masahiro Noda ◽  
Kazuki Kanazawa ◽  
So Minokawa ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

scholarly journals Immediate Unrestricted Weight Bearing with Simple Stirrup Brace Following Single Anchor Lateral Ankle Ligament Stabilization

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000 ◽  
Author(s):  
Christopher Diefenbach ◽  
Linda Dunaway ◽  
Larissa White ◽  
Gregory Lundeen
Keyword(s):  
Range Of Motion ◽  
Ligament Reconstruction ◽  
Weight Bearing ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Recurrent Instability ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament

Category: Ankle Introduction/Purpose: Anatomic lateral ankle ligament reconstruction has been shown to reliably restore the functional stability of the joint. Current orthopedic literature supports accelerated rehabilitation and protected weight bearing advancement as a safe and effective means to timely patient recovery. To our knowledge, there have not been clinical outcome reports of a protocol utilizing immediate unrestricted weight bearing in a stirrup brace following single anchor lateral ligament stabilization. The purpose of this study is to report on a series of patients treated with a more progressive protocol resulting in durable ankle stability and favorable clinical outcomes. Methods: A total of 28 patients with chronic lateral ankle ligament instability who failed conservative management underwent arthroscopy and modified Brostrom-Gould lateral ligament reconstruction between 2014 and 2015 were identified. The anterior talofibular and calcaneofibular ligaments were released from the fibula and advanced using one double-loaded metallic 3.5 mm suture anchor. Immediate unrestricted full weightbearing in a stirrup brace was allowed from the first postoperative day and accelerated physical therapy was initiated at 2 weeks postoperatively. Patients were assessed preoperatively, and at a minimum 1- year follow-up, using the AOFAS Hindfoot scale and VAS pain score. Additional postoperative outcome measures included the FAOS and a custom clinical questionnaire. Range of motion, ligamentous stability and single-blinded examination with Star Excursion Balance Test (SEBT) functional testing were performed postoperatively. Complication and recurrent instability rates were also recorded. Results: Twelve patients participated in the study (8F, 4 M). Mean age at final follow-up was 49 years (21-70). Average follow-up was 21 months (16 to 26). Average satisfaction score was 94%, and all patients reported they would have the procedure again. AOFAS Hindfoot score and VAS improved significantly from preoperative to postoperative, respectively (55.6 to 89.8, 5.4 to 1.6). Average postoperative FAOS score was 80.3 (51.8-100) . No measurable difference was observed on examination of range of motion, ligamentous stability, or SEBT testing in the anterior, posterolateral or posteromedial planes of the contralateral side, respectively (61.5 to 62.2 cm, 62.4 to 64.1 cm, 56.4 to 57.6 cm). No patients reported recurrent instability. Conclusion: This study demonstrates that anterior talofibular ligament and calcaneofibular ligament advancement utilizing a single 3.5 mm anchor construct followed by immediate unrestricted weight bearing is a safe and effective protocol for the treatment of chronic lateral ankle instability. Ligamentous stability was achieved and maintained in all patients across a wide variety of patient ages and desired activity levels. Patient satisfaction was excellent. This surgical technique and postoperative protocol may help reduce surgical time and implant cost, and may facilitate a more timely return to preinjury functional level.

Donor Site Morbidity After Lateral Ankle Ligament Reconstruction Using the Anterior Half of the Peroneus Longus Tendon Autograft

2016 ◽  
Vol 45 (4) ◽  
pp. 922-928 ◽  
Author(s):  
Chul Hyun Park ◽  
Woo-Chun Lee
Keyword(s):  
Ligament Reconstruction ◽  
Plantar Flexion ◽  
Lateral Ligament ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
The Mean ◽  
Lateral Ankle Ligament Reconstruction ◽  
Ankle Plantar Flexion

Background: The anterior half of the peroneus longus tendon (AHPLT) has been reported to be an effective autograft for ligament reconstruction with respect to strength and safety. However, there is little information regarding donor site morbidity after harvesting the AHPLT. Furthermore, to the best of our knowledge, there has not been a study on the isokinetic evaluation of ankle plantar flexion and eversion after AHPLT harvesting. Purpose: To evaluate the clinical and radiographic results after lateral ankle ligament reconstruction using the AHPLT. We further investigated whether harvesting the AHPLT for lateral ankle ligament reconstruction decreases the strength of ankle plantar flexion and eversion. Study Design: Case series; Level of evidence, 4. Methods: Thirty consecutive patients (31 cases) were treated by anatomic lateral ligament reconstruction using the AHPLT. For the clinical assessment, visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS), and Karlsson-Peterson scores were evaluated preoperatively and at the last follow-up. For the radiographic assessment, talar tilt angle and anterior talar displacement were measured preoperatively and at the last follow-up. The peak isokinetic torques for ankle plantar flexion at angular velocities of 30 and 120 deg/s and eversion at angular velocities of 30 and 60 deg/s were measured at a minimum of 1 year after surgery. Results: The mean VAS score improved significantly from 6.4 ± 1.7 preoperatively to 1.6 ± 1.5 at the last follow-up ( P < .001). The mean respective AOFAS and Karlsson-Peterson scores improved significantly from 57.2 ± 12.8 and 66.9 ± 13.6 preoperatively to 89.0 ± 10.0 and 93.3 ± 5.7 at the last follow-up ( P < .001). The mean talar tilt angle improved significantly from 15.3° ± 6.2° preoperatively to 3.4° ± 3.0° at the last follow-up ( P < .001), and the mean anterior talar displacement improved significantly from 10.2 ± 3.3 mm preoperatively to 6.3 ± 1.9 mm at the last follow-up ( P < .001). No significant differences were observed between the uninvolved and involved legs in the mean peak torque for plantar flexion at angular speeds of 30 deg/s ( P = .517) and 120 deg/s ( P = .347) or for eversion at angular speeds of 30 deg/s ( P = .913) and 60 deg/s ( P = .983). Conclusion: Anatomic lateral ligament reconstruction using the AHPLT showed good clinical and radiographic results without a significant decrease in the peroneus longus strength. Lateral ligament reconstruction using the AHPLT may be a good surgical option for the treatment of chronic ankle instability.

Review of Variability in Rehabilitation Protocols after Lateral Ankle Ligament Surgery

2020 ◽  
Vol 13 ◽  
pp. 152-159 ◽  
Author(s):  
Christina Hermanns ◽  
Reed Coda ◽  
Sana Cheema ◽  
Matthew Vopat ◽  
Megan Bechtold ◽  
...  
Keyword(s):  
Weight Bearing ◽  
Return To Sport ◽  
Full Weight Bearing ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Operative Care ◽  
Ankle Ligament ◽  
Rehabilitation Protocols ◽  
Lateral Ankle Ligament ◽  
Suture Tape

Introduction. Ankle sprains are one of the most common athletic injuries. If a patient fails to improve through conservative management, surgery is an option to restore ankle stability. The purpose of this study was to analyze and assess the variability across different rehabilitation protocols for patients undergoing either lateral ankle ligament repair, reconstruction, and suture tape augmentation. Methods. Using a web-based search for published rehabilitation protocols after lateral ankle ligament repair, reconstruction, and suture tape augmentation, a total of 26 protocols were found. Inclusion criteria were protocols for post-operative care after an ankle ligament surgery (repair, reconstruction, or suture tape augmentation). Protocols for multi-ligament surgeries and non-operative care were excluded. A scoring rubric was created to analyze different inclusion, exclusion, and timing of protocols such as weight-bearing, range of motion (ROM), immobilization with brace, single leg exercises, return to running, and return to sport (RTS). Protocols inclusion of different recommendations was recorded along with the time frame that activities were suggested in each protocol. Results. Twenty-six protocols were analyzed. There was variability across rehabilitation protocols for lateral ankle ligament operative patients especially in the type of immobilizing brace, time to partial and full weigh bearing, time to plantar flexion, dorsiflexion, eversion and inversion movements of the ankle, and return to single leg exercise and running. For repair and reconstruction, none of these categories had greater than 60% agreement between protocols. All (12/12) repair, internal brace, and unspecified protocols and 86% (12/14) of reconstruction protocols recommended no ROM immediately postoperatively. Eighty-six percent (6/7) of repair and 78% (11/14) of reconstruction protocols recommended no weight-bearing immediately after surgery, making post-operative ROM and weight-bearing status the most consistent aspects across protocols. Five protocols allowed post-operative weight-bearing in a cast to keep ROM restricted. Sixty-six percent (2/3) of suture tape augmentation protocols allowed full weight-bearing immediately post-operatively. Suture tape augmentation protocols generally allowed rehabilitation to occur on a quicker time-line with full weight-bearing by week 4-6 in 100% (3/3) of protocols and full ROM by week 8-10 in 66% (2/3) protocols. RTS was consistent in repair protocols (100% at week 12-16) but varied more in reconstruction. Conclusion. There is significant variability in the post-operative protocols after surgery for ankle instability. ROM was highly variable across protocols and did not always match-up with supporting literature for early mobilization of the ankle. Return to sport was most likely to correlate between protocols and the literature. Weight-bearing was consistent between most protocols but requires further research to determine the best practice. Overall, the variability between programs demonstrated the need for standardization of rehabilitation protocols.

Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction

2016 ◽  
Vol 44 (5) ◽  
pp. 1301-1308 ◽  
Author(s):  
Lauren M. Matheny ◽  
Nicholas S. Johnson ◽  
Daniel J. Liechti ◽  
Thomas O. Clanton
Keyword(s):  
Activity Level ◽  
Ligament Repair ◽  
Lateral Ankle ◽  
Ankle Ligament ◽  
Lateral Ankle Ligament ◽  
And Function
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