Autograft versus allograft tenodesis for chronic ankle instability: a single-center retrospective comparative study

2020 ◽  
Author(s):  
Claudio Legnani ◽  
Enrico Borgo ◽  
Vittorio Macchi ◽  
Alberto Ventura
Keyword(s):  
Ankle Instability ◽  
Surgical Techniques ◽  
Chronic Ankle Instability ◽  
Foot And Ankle ◽  
Lateral Tenodesis ◽  
Peroneus Brevis ◽  
American Orthopaedic ◽  
Objective Outcomes ◽  
Retrospective Comparative Study ◽  
Autograft Group

Aim: To compare the outcomes of patients who underwent autograft tenodesis with those who underwent allograft tenodesis for the treatment of chronic mechanical ankle instability. Patients & methods: Ten patients who underwent allograft lateral tenodesis were compared with 15 patients who underwent lateral tenodesis using a split peroneus brevis tendon. Patients were followed up after an average time of 10.5 years. Results: No statistically significant differences concerning American Orthopaedic Foot and Ankle Society and Karlsson–Peterson scores were reported (p = n.s.). A reduced average radiographic anterior talar translation was observed in the autograft group compared with the allograft group (1.4 and 4.0 mm respectively, p < 0.001). Conclusion: Both surgical techniques significantly improved subjective and objective outcomes in patients suffering from chronic ankle instability compared with pre-operatory status. Autograft stabilization provided reduced post-operative anterior talar translation compared with allograft tenodesis.

scholarly journals Results of a survey of practices in chronic ankle instability in France

2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0000
Author(s):  
Ronny Lopes ◽  
Ali Ghorbani ◽  
Frederic Leiber Wackenheim ◽  
Guillaume Cordier ◽  
Thomas Amouyel
Keyword(s):  
Open Surgery ◽  
Ankle Instability ◽  
Surgical Techniques ◽  
Chronic Ankle Instability ◽  
Primary Objective ◽  
Accurate Assessment ◽  
Foot And Ankle ◽  
Associated Injuries ◽  
Therapeutic Choice ◽  
Secondary Objective

Background: After a failed conservative treatment, surgical techniques used to treat chronic ankle instability are being more and more evaluated and proficiency is increasing. Two main procedures are available: - Ligament repairs associated with tissue reinforcement - Ligament reconstructions more or less in anatomic position. Anatomic techniques have proven to be superior to non-anatomic techniques. These different surgical techniques performed arthroscopically have the main advantage to manage simultaneously associated injuries that are very common in chronic ankle instability. For some, it is the last and best diagnostic test through which a decision can be made between repair and reconstruction. Despite all this knowledge, the indications remain very heterogeneous and essentially depend on surgeons’ preference. The primary objective was of this study was make an accurate assessment of practices in France. The secondary objective was to identify situations in which the choice of surgical treatement appeared to be consensual or controversial and to try to identify the parameters that influence these choices. Methods: A survey of practices was conducted among foot and ankle surgeons in France from 3 different societies (SFA, AFCP, and GRECMIP). The survey consisted of 2 parts; the first part focused on the surgeon’s characteristics and the second part presented 3 clinical cases. A therapeutic choice was validated for each situation. Results: Two hundred and twenty-eight responses were recorded. The average age of surgeons was 46 years and they had been treating ankle instability for an average of 14 years. 67% performed this procedure less than 20 times a year and only 7% more than 50 times. More than half of them adapted to each situation (56%) while 44% always use the same technique. In 9% of cases because they are only proficient in one technique and in the other cases because they believe the technique always provides good results. 63% used the technique in open surgery, 21% under arthroscopy, 13% in minimally invasive surgery and in 7% of the cases an initial arthroscopy is performed before open surgery for stabilization. Conclusion: This survey reflected the heterogeneity of surgical practices in ankle instability and provided indications for areas of research in clinical situations with the least consensus.

Does the Association of Microfractures for the Treatment of Osteochondral Lesions of the Talus Affect the Outcome Following Arthroscopic Treatment for Chronic Ankle Instability?

2021 ◽  
Vol 111 (1) ◽  
Author(s):  
Claudio Legnani ◽  
Enrico Borgo ◽  
Vittorio Macchi ◽  
Alberto Ventura
Keyword(s):  
Surgical Procedure ◽  
Ankle Instability ◽  
Osteochondral Lesion ◽  
Chronic Ankle Instability ◽  
Activity Level ◽  
Arthroscopic Treatment ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Significant Difference ◽  
American Orthopaedic

Background The purpose of the present study was to retrospectively compare the outcomes of patients who underwent arthroscopic thermal capsular shrinkage with those who underwent both arthroscopic thermal capsular shrinkage and arthroscopic osteochondral lesion (OCL) treatment with microfractures. Our hypothesis was that the simultaneous treatment does not negatively affect the outcome of the combined surgical procedure by influencing the postoperative rehabilitation protocol and does not significantly differ from capsular shrinkage alone in terms of subjective and objective outcomes. Methods Seventy-six patients with chronic ankle instability were treated at our department from 2004 to 2012 and reviewed retrospectively. Forty-two patients underwent arthroscopic thermal-assisted capsular shrinkage (group A), and 34 patients underwent combined arthroscopic capsular shrinkage and microfractures for OCL lesions of the talus (group B). All patients underwent a four-step surgical procedure including synovectomy, debridement, capsular shrinkage, and bracing and nonweightbearing for 21 days. In patients with OCL lesions, microfractures of the OCL were associated. Clinical assessment included objective examination, the American Orthopaedic Foot and Ankle Society ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and Sefton articular stability scale. Results The median follow-up was 6 years (range, 2–9 years). The median postoperative visual analogue scale score, American Orthopaedic Foot and Ankle Society score, and Tegner score were improved from the preoperative level for both groups (P &lt; .001). No significant difference was found between the two groups for the subjective scores and satisfaction rate (P = not significant). Similarly, no significant difference regarding the incidence of range-of-motion restriction was reported between the two groups (P = not significant). Conclusions The association of microfractures for the treatment of osteochondral lesions does not affect the outcome following arthroscopic treatment for chronic ankle instability up to 6 years from surgery.

Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

2021 ◽  
pp. 036354652110080
Author(s):  
Sung Hyun Lee ◽  
Hyung Gyu Cho ◽  
Je Heon Yang
Keyword(s):  
Clinical Outcomes ◽  
Ankle Instability ◽  
Surgical Techniques ◽  
Chronic Ankle Instability ◽  
Anterior Talofibular Ligament ◽  
Extensor Retinaculum ◽  
Level Of Evidence ◽  
Group A ◽  
The Mean ◽  
Inferior Extensor Retinaculum

Background: Although several arthroscopic surgical techniques for the treatment of chronic ankle instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Purpose: To compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI between 2016 and 2018. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into 2 groups according to the surgical technique used for CAI: arthroscopic ATFL repair (group A; n = 37) and arthroscopic ATFL repair with additional IER augmentation (group R; n = 45). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). Results: Out of 101 patients, 19 (18.5%) were excluded per the exclusion criteria, and 82 were evaluated. We identified 6 retears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL retear on MRI (8.1% [3/37] in group A and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement >3 mm as compared with the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups ( P < .001). However, there were no significant differences in the clinical results and radiologic findings between the groups. Conclusion: The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.

scholarly journals The Effect of Peroneal Muscle Strength on Functional Outcomes After the Modified Broström Procedure for Chronic Ankle Instability

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0019
Author(s):  
Byung-Ki Cho ◽  
Seung-myung Choi
Keyword(s):  
Muscle Strength ◽  
Functional Outcomes ◽  
Ankle Instability ◽  
Peak Torque ◽  
Chronic Ankle Instability ◽  
Functional Evaluation ◽  
Foot And Ankle ◽  
Patient Reported ◽  
Functional Outcome Measures ◽  
Modified Broström Procedure

Category: Sports Introduction/Purpose: Although the peroneal muscle is known to be a major dynamic lateral stabilizer of the ankle, few informations are available regarding the changes of muscle strength and relationship with the outcomes after lateral ligaments repair surgery. The purpose of this study was to identify the effects of peroneal strength on the validated functional outcome measures after the modified Broström procedure(MBP) for chronic ankle instability. Methods: Forty-one patients (41 ankles) underwent MBP using suture anchors were eligible and followed up to 2 years postoperatively. Functional evaluation consisted of the Foot and Ankle Outcome Score(FAOS), Foot and Ankle Ability Measure(FAAM). The changes of peroneal strength were evaluated using isokinetic dynamometer. Differences in the functional outcomes between the 3 groups divided according to recovery rate of peroneal strength were analysed. Results: Peak torque and total work for eversion in 60º/sec angular velocity significantly improved from a mean 8.1 Nm, 5.2 Nm preoperatively to 11.4 Nm, 6.9 Nm at postoperative 2 years, respectively (P < .001, P = .038). Deficit ratio of peak torque for eversion significantly improved from a mean 38.6% to 17.4%, and a significant side to side difference was found (P = .011). There were no significant differences in FAOS, FAAM, and measurements of stress radiograph between the 3 groups. Conclusion: Although restoration of peroneal strength postoperatively was about 82.6% of unaffected ankle, patient-reported function in daily and sport activities were satisfactorily improved. Postoperative isokinetic strength of the peroneus demonstrated no statistically significant effects on the functional outcomes after MBP.

scholarly journals Abnormalities of foot and ankle alignment in individuals with chronic ankle instability: a systematic review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Takumi Kobayashi ◽  
Yuta Koshino ◽  
Takahiro Miki
Keyword(s):  
Systematic Review ◽  
Internal Rotation ◽  
Methodological Quality ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Control Group ◽  
Foot And Ankle ◽  
Anterior Displacement ◽  
Foot Posture

Abstract Background To prevent recurrent ankle sprain, it is important to clarify the pathology of chronic ankle instability (CAI). An association has been reported between CAI and abnormalities of foot posture and ankle alignment. There is no consensus on the types of these abnormalities that occur in individuals with CAI. The objective of this systematic review is to clarify the relevance of abnormality of foot posture and ankle alignment for CAI. Methods A systematic computerized literature search was performed of the PubMed, CINAHL, SPORTDiscus, Web of Science, and the Cochrane Register of Clinical Trials databases. The selected studies either compared CAI patients with a control group or CAI ankles with contralateral healthy ankles and specifically reported foot posture and alignment of the ankle in the outcomes. They were written in English and published prior to June 2021. The methodological quality of the included studies was evaluated using a 16-question index. Data were extracted independently by two reviewers, and the certainty of evidence was assessed using GRADE approach. Results Sixteen studies including 872 patients of high to low methodological quality were included. These showed there was significant anterior displacement and internal rotation of the talus in CAI ankles (low evidence), but there was no consensus on fibular alignment or foot posture. Conclusions This review showed there was significant anterior displacement and internal rotation of the talus in CAI ankles but found no consensus on the characteristics of fibular and foot alignment. Further investigations are required to clarify the characteristic foot and ankle malalignment in CAI to facilitate the development of efficient interventions.

scholarly journals Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability

2017 ◽  
Vol 11 (1) ◽  
pp. 617-632 ◽  
Author(s):  
Jorge Pablo Batista ◽  
Jorge Javier del Vecchio ◽  
Luciano Patthauer ◽  
Manuel Ocampo
Keyword(s):  
Ankle Instability ◽  
Medical Condition ◽  
Surgical Techniques ◽  
Clinical Success Rate ◽  
Chronic Ankle Instability ◽  
Tilt Test ◽  
Lateral Ligament ◽  
Return To Sports ◽  
Ligament Repair

Objectives:Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury.Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela.Several open and arthroscopic surgical techniques have been described to treat this medical condition.Material and Methods:Of the 22 patients who were treated; 18 males and 4 females, and aged from 17-42 years (mean 28 years).All patients presented a history of more than three ankle sprains in the last two years and presented positive anterior drawer and talar tilt test of the ankle in the physical examination.We perform an anterior arthroscopy of the ankle in order to treat asociated disease and then we performed“All inside¨lateral ligament repair through two portals (anteromedial and anterolateral) using an anchor knotless suture.Results:Clinical outcome evaluations were performed at a mean follow up of 25 months. (R: 17-31).Overall results has been shown by means of the American Orthopaedic Foot and Ankle Society (AOFAS). Mean AOFAS scores improved from 63 points (range 52–77) preoperatively to 90 points (range 73–100) at final follow up.No recurrences of ankle instability were found in the cases presented.Conclusion:Several surgical procedures have been described during the last years in order to treat chronic ankle instability.¨All inside¨lateral ligament reconstruction presents lower local morbidity than open procedures with few complications. Moreover, it is a reproductible technique, with high clinical success rate, few complications and relatively quick return to sports activities. A high knowledge of the anatomic landmarks should be essential to avoid unwated injuries.

The effect of combined mechanism ankle support on postural control of patients with chronic ankle instability

2016 ◽  
Vol 41 (1) ◽  
pp. 58-64 ◽  
Author(s):  
Mohammad Hadadi ◽  
Ismaeil Ebrahimi ◽  
Mohammad Ebrahim Mousavi ◽  
Gholamreza Aminian ◽  
Ali Esteki ◽  
...  
Keyword(s):  
Postural Control ◽  
Postural Sway ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Foot And Ankle ◽  
Balance Performance ◽  
Balance Test ◽  
Combined Mechanism ◽  
Ankle Support ◽  
Healthy Participants

Background:Chronic ankle instability is associated with neuromechanical changes and poor postural stability. Despite variety of mechanisms of foot and ankle orthoses, almost none apply comprehensive mechanisms to improve postural control in all subgroups of chronic ankle instability patients.Objectives:The purpose of this study was to investigate the effect of an ankle support implementing combined mechanisms to improve postural control in chronic ankle instability patients.Study design:Cross-sectional study.Methods:An ankle support with combined mechanism was designed based on most effective action mechanisms of foot and ankle orthoses. The effect of this orthosis on postural control was evaluated in 20 participants with chronic ankle instability and 20 matched healthy participants. The single-limb stance balance test was measured in both groups with and without the new orthosis using a force platform.Results:The results showed that application of combined mechanism ankle support significantly improved all postural sway parameters in chronic ankle instability patients. There were no differences in means of investigated parameters with and without the orthosis in the healthy group. No statistically significant differences were found in postural sway between chronic ankle instability patients and healthy participants after applying the combined mechanism ankle support.Conclusion:The combined mechanism ankle support is effective in improving static postural control of chronic ankle instability patients to close to the postural sway of healthy individual. the orthosis had no adverse effects on balance performance of healthy individuals.Clinical relevanceApplication of the combined mechanism ankle support for patients with chronic ankle instability is effective in improving static balance. This may be helpful in reduction of recurrence of ankle sprain although further research about dynamic conditions is needed.

scholarly journals Predicting Manual Therapy Treatment Success in Patients With Chronic Ankle Instability: Improving Self-Reported Function

2017 ◽  
Vol 52 (4) ◽  
pp. 325-331 ◽  
Author(s):  
Erik A. Wikstrom ◽  
Patrick O. McKeon
Keyword(s):  
Ankle Instability ◽  
Weight Bearing ◽  
Treatment Success ◽  
Chronic Ankle Instability ◽  
Response Analysis ◽  
Controlled Clinical Trial ◽  
Foot And Ankle ◽  
Minimally Clinically Important Difference ◽  
Medicine Research ◽  
Ability Measure

Context:  Therapeutic modalities that stimulate sensory receptors around the foot-ankle complex improve chronic ankle instability (CAI)–associated impairments. However, not all patients have equal responses to these modalities. Identifying predictors of treatment success could improve clinician efficiency when treating patients with CAI. Objective:  To conduct a response analysis on existing data to identify predictors of improved self-reported function in patients with CAI. Design:  Secondary analysis of a randomized controlled clinical trial. Setting:  Sports medicine research laboratories. Patients or Other Participants:  Fifty-nine patients with CAI, which was defined in accordance with the International Ankle Consortium recommendations. Intervention(s):  Participants were randomized into 3 treatment groups (plantar massage [PM], ankle-joint mobilization [AJM], or calf stretching [CS]) that received six 5-minute treatments over 2 weeks. Main Outcome Measure(s):  Treatment success, defined as a patient exceeding the minimally clinically important difference of the Foot and Ankle Ability Measure–Sport (FAAM–S). Results:  Patients with ≤5 recurrent sprains and ≤82.73% on the Foot and Ankle Ability Measure had a 98% probability of having a meaningful FAAM–S improvement after AJM. As well, ≥5 balance errors demonstrated 98% probability of meaningful FAAM–S improvements from AJM. Patients &lt;22 years old and with ≤9.9 cm of dorsiflexion had a 99% probability of a meaningful FAAM–S improvement after PM. Also, those who made ≥2 single-limb–stance errors had a 98% probability of a meaningful FAAM–S improvement from PM. Patients with ≤53.1% on the FAAM–S had an 83% probability of a meaningful FAAM–S improvement after CS. Conclusions:  Each sensory-targeted ankle-rehabilitation strategy resulted in a unique combination of predictors of success for patients with CAI. Specific indicators of success with AJM were deficits in self-reported function, single-limb balance, and &lt;5 previous sprains. Age, weight-bearing–dorsiflexion restrictions, and single-limb balance deficits identified patients with CAI who will respond well to PM. Assessing self-reported sport-related function can identify CAI patients who will respond positively to CS.

Chronic Lateral Ankle Instability: Results of Anatomic Repair with Polyester Tape Augmentation

2020 ◽  
Vol 22 (1) ◽  
pp. 27-33
Author(s):  
Islam Sarhan ◽  
Islam Mubark ◽  
Ahmed Waly
Keyword(s):  
Ankle Sprain ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
High Rate ◽  
Anatomic Reconstruction ◽  
Foot And Ankle ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Anatomic Repair ◽  
Lateral Ankle Instability

Background. Ankle sprains are one of the most common injuries in both athletes and the general population. A major problem accompanying ankle injury is the high rate of recurrence, with about 20% of acute ankle sprain patients developing chronic ankle instability. Unlike acute ankle sprain, chronic ankle instability usually needs surgical intervention. Various anatomic reconstruction techniques using the ruptured ends of the ligaments to restore stability have gained popularity. The purpose of this study was to evaluate the functional results of the treatment of chronic lateral ankle instability with anatomic repair of the injured ligaments and reinforcement with polyester tape. Material and methods. A prospective study of 30 consecutive patients who underwent anatomic reconstruction of the lateral ligaments using transosseous suturing and augmentation using a polyester tape done at a single centre by a single surgeon from 2016 to 2017. All patients were assessed preoperatively and postoperatively at 6 weeks, 3, 6 and 12 months. The American Orthopaedic Foot and Ankle Score (AOFAS) and Free Online Foot and Ankle Ability Measure (FAAM) were recorded and used for results analysis. Results. At 12 months’ follow-up, the AOFAS had improved from mean 52.47 ± 2.06 to 91.0 ± 6.03 (p< 0.001) .The FAAM mean score had improved from mean 55.21± 1.9 to 90.43 ± 4.02 Conclusion. The ankle ligament reconstruction with additional polyester tape augmentation is an effective technique in treating chronic ankle instability with a satisfactory surgical outcome.

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