Effectiveness-Analysis of one-stage Operation for Combined Ankle Fracture and III Degree Lateral Ligament Injury: A Retrospective Study of 23 Cases

2020 ◽  
Author(s):  
Chunquan Zhu ◽  
Linglong Deng ◽  
Chong Zhang ◽  
Guorong Yu ◽  
Li Yu
Keyword(s):  
Ankle Fracture ◽  
Subtalar Joint ◽  
Ankle Instability ◽  
Lateral Collateral Ligament ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
X Rays ◽  
Foot And Ankle ◽  
One Stage ◽  
Subtalar Arthritis

Abstract Background: Ankle fracture is often accompanied by injuries of lateral collateral ligaments, which results in ankle instability and traumatic arthritis in the later period, causing pain and discomfort in patients. However, the repair of the lateral collateral ligament is still inconclusive. The aim of this study was to investigate the operative outcome of one-stage simultaneous repair of the foot and ankle fracture combined with the III grade injury of lateral ligament. Methods: 15 males and 8 females (mean age 37.8 [10.5] years) underwent X-ray and CT scan to determine the type of fracture. MRI, Ultrasound and intraoperative fluoroscopic stress testing were applied to confirm the ligament injury. After the operative treatment of fracture, the ruptured ligament was repaired with suture anchor in 21 cases, meanwhile 1 case combined with chronic ankle instability was repaired with modified Broström-Gould method and another case with middle ligament rupture was applied with the InternalBrace approach. Routine postoperative X-rays and physical examination were carried out, and the American Orthopaedic Food & Ankle Society score was recorded to assess the function and the pain of the wounded ankle. Results: After the operation, the range of ankle motion in all patients was improved, and the bone healing time of the patients was 6-24 (10.09±3.61) weeks. There was no chronic instability of lateral ankle or subtalar joint in all the cases. Moreover, 2 cases presented as cartilage lesions of the medial talus, and the micro-fracture surgery were performed one year later; 1 case suffered from subtalar arthritis, and underwent subtalar arthrodesis 14 months after operation. Furthermore, the patients’ last follow-up AOFAS score was (83.70±4.69) points. There was no occurrence of adverse events and complications such as neurovascular injury, infection or delayed healing of operative incision.Conclusions: One-stage simultaneous repair of the foot and ankle fracture combined with the III grade injury of lateral ligament contributes to the stability of ankle and subtalar joint, and improves the joint function of ankle. It proved to be safe and effective.

scholarly journals Location and Morphology of Acute Lateral Ligament Injury of the Ankle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Hideo Noguchi
Keyword(s):  
Ankle Instability ◽  
Surgical Reconstruction ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Ligament Injuries ◽  
Ligament Repair ◽  
Reconstruction Procedure ◽  
Side Body ◽  
Lateral Ligament Injury ◽  
Almost All

Category: Ankle, Sports, Trauma Introduction/Purpose: Acute ankle ligament injuries are usually treated non-operatively, even if the injury is severe. However, when chronic ankle instability is symptomatic, operative treatment is required. When planning local repair, the condition of the remaining ligament is important. We surgically treated acute severe lateral ligament injuries in 103 ankles and investigated the locations of the injuries in the anterior talofibular (ATF) and calcaneofibular (CF) ligaments, subdividing each into three parts. This paper should facilitate more precise planning of the surgical reconstruction procedure. Methods: From 2006 to 2014, 1,042 patients visited our outpatient clinic with a diagnosis of acute lateral ligament injury of the ankle. In total, 103 feet underwent surgical treatment and the locations of the ATF and CF ligament ruptures were investigated. The rupture location in the ATF ligament was subclassified as fibular side, body, or talar side, while for the CF ligament it was classified as fibular side, body, or calcaneal side. Results: The ATF ligament was ruptured on the fibular side in 38 feet (36.9%), body in 30 feet (29.1%), and talar side in 35 feet (34.0%). The CF ligament was ruptured on the fibular side in 15 feet (14.6%), body in 26 feet (25.2%), and calcaneal side in 62 feet (60.2%). Conclusion: Almost all surgical reports on lateral ligament reconstruction procedures (Brostrom et al.) describe ATF ligament repair and advancement on the fibular side, although only one-third of the ligaments were injured on the fibular side in our series. About two-thirds of the CF ligaments had damage to the calcaneal side structure of the entheses. When CF ligament repair is needed, surgeons should be aware of our finding that this ligament was ruptured at the fibular attachment in only 15% of cases, and on the calcaneal side in 60%. This knowledge should lead to better results of surgical reconstruction.

The Role of Calcaneofibular Ligament Injury in Ankle Instability: Implications for Surgical Management

2018 ◽  
Vol 47 (2) ◽  
pp. 431-437 ◽  
Author(s):  
Kenneth J. Hunt ◽  
Helder Pereira ◽  
Judas Kelley ◽  
Nicholas Anderson ◽  
Richard Fuld ◽  
...  
Keyword(s):  
Contact Mechanics ◽  
Ankle Joint ◽  
Contact Area ◽  
Ankle Instability ◽  
Peak Torque ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Calcaneofibular Ligament

Background: Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, including anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) injury, can be particularly challenging. The precise effect of CFL injury on ankle instability is unclear. Hypothesis: CFL injury will result in decreased stiffness, decreased peak torque, and increased talar and calcaneal motion and will alter ankle contact mechanics when compared with the uninjured ankle and the ATFL-only injured ankle in a cadaveric model. Study Design: Descriptive laboratory study. Methods: Ten matched pairs of cadaver specimens with a pressure sensor in the ankle joint and motion trackers on the fibula, talus, and calcaneus were mounted on a material testing system with 20° of ankle plantarflexion and 15° of internal rotation. Intact specimens were axially loaded to body weight and then underwent inversion along the anatomic axis of the ankle from 0° to 20°. The ATFL and CFL were sequentially sectioned and underwent inversion testing for each condition. Linear mixed models were used to determine significance for stiffness, peak torque, peak pressure, contact area, and inversion angles of the talus and calcaneus relative to the fibula across the 3 conditions. Results: Stiffness and peak torque did not significantly decrease after sectioning of the ATFL but decreased significantly after sectioning of the CFL. Peak pressures in the tibiotalar joint decreased and mean contact area increased significantly after CFL release. Significantly more inversion of the talus and calcaneus as well as calcaneal medial displacement was seen with weightbearing inversion after sectioning of the CFL. Conclusion: The CFL contributes considerably to lateral ankle instability. Higher grade sprains that include CFL injury result in significant decreases in rotation stiffness and peak torque, substantial alteration of contact mechanics at the ankle joint, increased inversion of the talus and calcaneus, and increased medial displacement of the calcaneus. Clinical Relevance: Repair of an injured CFL should be considered during lateral ligament reconstruction, and there may be a role for early repair in high-grade injuries to avoid intermediate and long-term consequences of a loose or incompetent CFL.

scholarly journals Early Functional and Patient Reported Outcomes following Suture Tape Augmented Brostrom

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Kevin D. Martin ◽  
Jeannie Huh ◽  
William Robinson ◽  
Kevin D. Martin
Keyword(s):  
Patient Reported Outcomes ◽  
Ankle Instability ◽  
Active Duty ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Foot And Ankle ◽  
Military Population ◽  
Functional Rehabilitation ◽  
Patient Reported ◽  
Suture Tape

Category: Ankle Introduction/Purpose: Immediately following a lateral ligament reconstruction the strength of the repair is far less than the native anterior talofibular ligament (ATFL). With early functional rehabilitation the repair has shown increased laxity. We hypothesized that a Brostrom augmented with a suture-tape construct would allow early functional rehabilitation while maintaining patient reported outcomes within a military population. Methods: This study is a retrospective cohort of 90 consecutive patients with chronic lateral ankle instability were treated with a Brostrom procedure augmented with a suture-tape construct. All had a preoperative MRI demonstrating ligament insufficiency, and was examined by an orthopaedic foot and ankle surgeon. Subjects were evaluated at 2, 6 and 12 weeks postoperatively. Demographics including Foot and Ankle Disability Index (FADI), Visual Analog Scale (VAS), and clinical measures including single- leg hop and single-leg heel raise were recorded. The population included (14 women [18%], 76 men [84%] mean age of 29.47, BMI 27.3) active duty service members. Results: The mean FADI score pre-operatively (67) improved to 86 and 89 at 6 and 12 weeks. The VAS scores pre-operatively (4.8) improved to 1.4 and 1.3 at 6 and 12 weeks respectively. 95.5% (86/90) of patients were able to complete a single-leg hop and single-leg heel raise at 6 and 12 weeks. Conclusion: Our results suggest that a Brostrom augmented with suture-tape can allow for early functional rehabilitation in an active duty Military population.

scholarly journals Development of a Reliable Grading System for the Radiographic Analysis of the Subtalar Joint

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0012
Author(s):  
David Vier ◽  
Thomas Louis ◽  
Justin Kane ◽  
Daniel Fuchs ◽  
Michal Kozanek ◽  
...  
Keyword(s):  
Scoring System ◽  
Subtalar Joint ◽  
Interobserver Reliability ◽  
Signs And Symptoms ◽  
Kappa Statistic ◽  
Grading System ◽  
Foot And Ankle ◽  
Advanced Imaging ◽  
Subtalar Arthritis ◽  
Radiographic Disease

Category: Hindfoot Introduction/Purpose: Subtalar arthritis is frequently diagnosed in the clinical setting by correlating patients’ presenting signs and symptoms with weightbearing radiographs. Due to the naturally undulating surface of the subtalar joint and frequent concomitant hindfoot deformity, radiographic assessment of the severity of subtalar arthrosis can be difficult. The Kellgren-Lawrence (KL) scale for arthritis was not designed for such a unique joint and has not been validated for generalization at the subtalar joint. Previous studies have shown poor interobserver and intraobserver reliability of this grading system in patients with post-traumatic subtalar arthritis and following total ankle replacement. The authors hypothesized this scale would not be reliable for classifying the severity of subtalar arthrosis and sought to establish a novel scoring system with high interobserver reliability and clinical relevance. Methods: A collection of 40 lateral weightbearing ankle radiographs were reviewed by nine independent reviewers, including foot and ankle orthopaedic surgeons and certified musculoskeletal (MSK) radiologists for the severity of subtalar arthrosis using the KL scale. These radiographs were selected from patients with a variety of complaints of pain in the ankle and foot and not necessarily for subtalar pathology. Patients were excluded if they did not have advanced imaging, had a coalition, or prior hindfoot fusion. Interobserver reliability was assessed for KL scores using a marginal kappa statistic. An MSK radiologist graded available advanced imaging on all 40 radiographs and the advanced imaging scores were correlated to the radiographic scores. A novel scoring system, Grades 0 to 2 was created. In a separate sitting, three foot and ankle orthopedic surgeons and one MSK radiologist evaluated the radiographs using the new scale. Interobserver reliability of this new scale was then calculated. Results: There was overall fair reliability amongst reviewers with the traditional KL score, kappa = 0.26. There was moderate agreement amongst reviewers with patients deemed to have zero subtalar arthrosis (k = 0.50). There was fair interobserver reliability with Grade 4 scores (k= 0.28). Grouping Grades 3 and 4 together provided a slight increase in scoring reliability (k= 0.46). There remained only fair agreement when grades 1-2 (k = 0.31) and grades 1-3 (k =0.37) were combined. Radiographic scores did have a moderate correlation with advanced imaging (r=0.56). The nine reviewers only recorded the same score as the advanced imaging score 37.8% of the time, and were within one grade 82.0% of the time. The simpler proposed grading system had improved interobserver reliability (kappa =0.68). Conclusion: The KL scale is unreliable for assessment of the severity of subtalar arthrosis on lateral weightbearing radiographs and carries no clinical correlation. In our study, there was a correlation between radiographic severity of disease and advanced imaging. Our proposed novel scoring system has a substantially improved reliability when compared to the KL scale, is reproducible, and carries potential clinical implications and relevance. This system can be used for clinical reasons and also reliably used for tracking progression of clinically significant radiographic disease of the subtalar joint.

scholarly journals Is Magnetic Resonance Imaging (MRI) Reliable in the Diagnosis of Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Triin Nurm ◽  
Paulo Torres ◽  
Jayasree Ramas Ramaskandhan
Keyword(s):  
Ankle Instability ◽  
Lateral Ligament ◽  
Time Interval ◽  
Consecutive Series ◽  
X Rays ◽  
Mri Scan ◽  
Chi Square ◽  
Ankle Ligaments ◽  
Retrospective Clinical Study ◽  
Chi Square Analysis

Category: Ankle, Sports, Trauma Introduction/Purpose: MRI is the preferred modality for the diagnosis of ankle joint pathology. The aim of this study was to specifically analyse the reliability of MRI reported lateral ligament findings in relation to examination under anaesthesia and stress X-rays in patients with symptomatic ankle instability. Methods: A single centre, single surgeon consecutive series of patients who had undergone examination under anaesthesia and stress X-rays preceded by an MRI scan for symptomatic ankle pathology were included in this retrospective clinical study. All MRI scans were reported by a musculoskeletal radiologist. MRI reports and procedure findings were extracted and analysed. Results: Between April 2012 and December 2016, 49 patients who fulfilled the above criteria were included. There were 25 male and 24 female patients, the average age was 43.1. The average time interval between MRI scan and examination under anaesthesia was 9.7 months (2-49 months). There is a significant association between MRI reported lateral ligament findings and status of ankle stability detected on examination under anaesthesia and stress views, p=0.003 (Chi-square analysis for association). In 34 patients who had abnormal lateral ligament findings on MRI, 20 patients (58.8%) had stable findings and 14 (41.2%) had unstable findings on stress views. There was, however, a 100% concordance between MRI reported normal lateral ligament findings and stability on examination under anaesthesia and stress views (N=15). Conclusion: MRI is accurate in diagnosing the status of ankle ligaments and in particular, in predicting true stability.

scholarly journals Lateral talocalcaneal ligament substitution for calcaneofibular ligament difficient chronic ankle lateral instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Chen Jiao
Keyword(s):  
Tilt Angle ◽  
Subtalar Joint ◽  
Ankle Instability ◽  
Stress Test ◽  
Lateral Ligament ◽  
Lateral Instability ◽  
Calcaneofibular Ligament ◽  
Anterior Translation ◽  
Negative Results ◽  
Talar Tilt

Category: Ankle, Hindfoot, Sports, Trauma Introduction/Purpose: Introduction: Treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament via tendon reconstruction or artificial grafts has several disadvantages. The method of substitution with lateral talocalcaneal ligament has never been reported. Purpose: To investigate the role of lateral talocalcaneal ligament substitution for the treatment of chronic ankle lateral instability associated with defective calcaneofibular ligament. Methods: Repair of ankle lateral ligament was performed on 32 patients with chronic ankle instability. The mean age was 26.4±8.7 years. The calcaneofibular ligament was absent in all the patients and was confirmed surgically. The calcaneofibular ligament was repaired via transfer of talar insertion of the lateral talocalcaneal ligament. Patients were followed up for an average of 22.3±4.0 months. AOFAS, Mazur and Tegner scores, objective examinations (anterior drawer test and varus stress test) and re-injury were assessed before and after the operation. The anterior translation distance of the talus and the talar tilt angle were also measured. Results: In all the patients, postoperative AOFAS, Mazur and Tegner scores were significantly improved. Postoperative evaluation (drawer test and lateral stress test) yielded negative results. The anterior translation distance was reduced from 4.9±1.0 mm to 2.0±0.8 mm. The talar tilt angle was reduced from 12.7º±2.5º to 5.0º±1.4º. The average satisfaction score was 7.4. No subjective instability or re-injury, subtalar joint (tarsal sinus) pain or/and instability occurred. Conclusion: Lateral talocalcaneal ligament substitution was effective against chronic ankle lateral instability associated with the absence of calcaneofibular ligament, without any significant effect on subtalar joint clinically.

scholarly journals Talar Osteonecrosis after Subchondroplasty for Acute Lateral Ligament Injuries: A Small Case Series

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0004
Author(s):  
Ian Foran ◽  
Daniel D. Bohl ◽  
Anand M. Vora ◽  
Nasima Mehraban ◽  
Kamran S. Hamid ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Magnetic Resonance ◽  
Case Series ◽  
Magnetic Resonance Images ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Ankle Sprains ◽  
X Rays ◽  
Bone Marrow Lesions ◽  
Radiology Reports

Category: Ankle; Sports; Trauma Introduction/Purpose: Non-operative treatment is regarded as the standard of care for the management of acute, uncomplicated lateral ankle sprains. As diagnostic and treatment options evolve, there is intermittently renewed interest in early surgical treatment of these acute injuries. Wider availability of magnetic resonance imaging (MRI) has made advanced imaging of acute ankle sprains more commonplace. One entity commonly seen on MRI is the ‘bone marrow lesion’ (BML). Recently, a procedure termed ‘Subchondroplasty’ (Zimmer, Warsaw, Indiana) has been developed to address chronic bone marrow lesions that have failed conservative management. We present a series of five cases referred from outside institutions in which patients developed rapid osteonecrosis of their tali after undergoing acute lateral ligament reconstruction with talar Subchondroplasty. Methods: We retrospectively evaluated the charts and available imaging of five patients who had developed osteonecrosis after undergoing a Subchondroplasty procedure in the setting of acute lateral ligament injury at outside institutions. Outside radiology reports, x-rays and magnetic resonance images, clinic notes, and operative reports were collected and analyzed. Patient demographics, comorbidities, and secondary interventions (after the index procedure) were recorded. Results: Average patient age was 23 (range 16-31). All patients were healthy. The patients were taken care of by different outside providers. All patients had pre-operative MRI demonstrating ATFL signal changes and bony edema within the talus in a distribution expected after ankle sprain. All patients were taken to the OR within 4 weeks of injury. Three underwent isolated talar Subchondroplasty; two underwent Subchondroplasty and an open Broström procedure. Within 6 months, radiographs and MRI in all patients demonstrated diffuse sclerosis of the tali, and diffuse talar hyperintensity on MRI scans, consistent with osteonecrosis. Two patients additionally had talar fragmentation and collapse. Currently, one patient has subsequently undergone total ankle replacement, two have had arthroscopy with bone marrow stimulation, and two are considering arthrodesis. Conclusion: We present 5 cases from outside institutions in which patients with acute ankle sprains and associated acute talar bone marrow lesions developed osteonecrosis after Subchondroplasty with or without lateral ligament repair. Although Subchondroplasty was likely not well-indicated in these acute cases, it raises a question of whether Subchondroplasty may be harmful to the talar blood supply. There is currently a lack of evidence to support Subchondroplasty for use in the foot and ankle. Practitioners should exercise caution when performing Subchondroplasy for the talus.

Joint Pressure, Volume and Alignment in Development of AOA: Indications for Orthobiologics and Surgeons

2019 ◽  
Author(s):  
Craig J Hubbard
Keyword(s):  
Lower Limb ◽  
Ankle Instability ◽  
Surgical Techniques ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Medical Outcomes ◽  
Class Actions ◽  
Before And After ◽  
Human Costs ◽  
Rehabilitation Need

To fix and prevent, not ‘manage’ Osteoarthritis OA in the lower limb, should be the collective ‘Holy Grail’ with or without Orthobiologics OB. Lateral Ankle Sprain LAS, Chronic Ankle Instability CAI and Ankle Osteoarthritis AOA create asymmetry which alters the biomechanics of the entire lower limb, so by better addressing AOA, we can probably do more than just impact the multi-billion dollar annual costs of AOA. It would seem we have advanced, if not futuristic Surgical techniques and Orthobiologic technology, so what is missing? The short answer is Medical Intent MI. Devices and methods used in rehabilitation need MI intent to enable and stimulate repair. The world is changing and Morals Ethics and the human costs, are being counted. CTE concussion is just the tip of the iceberg for cumulative trauma injuries, in cost and prevalence, and class actions seek to defend and enforce people’s rights to safety, either in the workplace, as in professional sport, or in medical outcomes. The significant yet hidden role of the subtalar joint as a ‘Safety Valve’ was first noted by Albert Ferguson in 1972, yet today the contradictions in rehabilitation and injury prevention devices that restrict the STJ, remain commonplace. It is also necessary to consider what has changed inside the synovial capsule before and after lateral ligament injury, such as pressure, joint alignment and space, so we can better understand and design for restoration of homeostasis. This paper will examine factors, causes and interventions that may be inadvertently restricting or preventing Orthobiologics effectiveness in the human ankle from a Translational Medicine perspective and an engineering bias.

scholarly journals Peroneus brevis tendon injury in chronic ankle instability.

2021 ◽  
Vol 15 (1) ◽  
pp. 37-42
Author(s):  
Rhavi Soares Daniel ◽  
Joaquim Maluf Neto ◽  
Auro Mitsuo Okamoto ◽  
Carlos Andrade
Keyword(s):  
Ankle Instability ◽  
Epidemiological Data ◽  
Tendon Injury ◽  
Chronic Ankle Instability ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Aofas Score ◽  
Level Of Evidence ◽  
Lateral Ligament Injury ◽  
Peroneus Brevis

Objective: To compare the surgical outcome of patients with chronic lateral ligament injury of the ankle, with and without an associated peroneus brevis tendon injury. Methods: This retrospective comparative study was based on epidemiological analysis and the American Orthopedic Foot and Ankle Society (AOFAS) scores of patients diagnosed with chronic ankle instability who were treated surgically with the Broström-Gould technique. The medical records of 50 patients treated in an orthopedics service between January 2012 and January 2020 were analyzed. The patients were divided into two groups: those with and without a peroneus brevis tendon injury. The following data were also collected: sex, age, comorbidities, and AOFAS score in the pre- and postoperative period (between 90-120 days), as well as other epidemiological data. Results: Sixteen patients (32%), whose mean age was 43 years and 76% of whom were female, presented with a peroneus brevis tendon injury. The right side (54%) was more commonly affected. The main comorbidities were obesity (14%), slight pes cavus (12%), diabetes mellitus (4%) and depression (4%). The mean improvement in AOFAS score was 41 points. There was a marginal difference in final AOFAS score (p=0.03) between the groups. Conclusion: The Broström-Gould Technique proved effective for treating chronic lateral ligament injury regardless of an associated peroneus brevis tendon injury. However, the final postoperative results were significantly worse in patients with a peroneus brevis tendon injury than in those without one. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

Sign in / Sign up

Export Citation Format

Share Document