The Effect of an Ossicle of the Lateral Malleolus on Ligament Reconstruction of Chronic Lateral Ankle Instability

Sixty-one patients underwent a primary ankle lateral ligament reconstruction for chronic instability between 1989 and 1996. In addition to the ligament reconstruction, all patients had evaluation of the peroneal retinaculum, peroneal tendon inspection by routine opening of the tendon sheath, and ankle joint inspection by arthrotomy. A retrospective review of the clinical history, physical exam, MRI examination, and intraoperative findings was conducted on these 61 patients. The purpose was to determine the type and frequency of associated injuries found at surgery and during the preoperative evaluation. At surgery no patients were found to have isolated lateral ligament injury. Fifteen different associated injuries were noted. The injuries found most often by direct inspection included: peroneal tenosynovitis, 47/61 patients (77%); anterolateral impingement lesion, 41/61 (67%); attenuated peroneal retinaculum, 33/61 (54%); and ankle synovitis, 30/61 (49%). Other less common but significant associated injuries included: intra-articular loose body, 16/61 (26%); peroneus brevis tear, 15/61 (25%); talus osteochondral lesion, 14/61 (23%); medial ankle tendon tenosynovitis, 3/61 (5%). The findings of this study indicate there is a high frequency of associated injuries in patients with chronic lateral ankle instability. Peroneal tendon and retinacular pathology, as well as anterolateral impingement lesions, occur most often. A high index of suspicion for possible associated injuries may result in more consistent outcomes with nonoperative and operative treatment of patients with chronic lateral ankle instability.

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Chronic Lateral Ankle Instability

The American Journal of Sports Medicine ◽

10.1177/0363546508319050 ◽

2008 ◽

Vol 36 (11) ◽

pp. 2167-2172 ◽

Cited By ~ 121

Author(s):

Woo Jin Choi ◽

Jin Woo Lee ◽

Seung Hwan Han ◽

Bom Soo Kim ◽

Su Keon Lee

Keyword(s):

Logistic Regression ◽

Confidence Interval ◽

Odds Ratio ◽

Ligament Reconstruction ◽

Ankle Instability ◽

Multivariate Logistic Regression ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

Background There has been no attempt to correlate the type and number of intra-articular lesions with the results of ligament reconstruction for chronic lateral ankle instability. Hypothesis Certain intra-articular lesions affect the clinical outcome of ligament reconstruction. Study Design Case series; Level of evidence, 4. Methods Sixty-five ankles from 64 patients underwent a modified Broström operation for chronic lateral ankle instability with a mean follow-up of 28.7 months (range, 12–67). The results were assessed according to the Karlsson-Peterson Ankle Score. The type of intra-articular lesions and the association of clinical outcome were investigated using Pearson's correlation coefficient and multivariate logistic regression analysis. Results The average Karlsson-Peterson Ankle Score was improved from 53 ± 14.63 preoperatively to 85.21 ±11.97 at final follow-up ( P < .001). Five different intra-articular lesions were described in 63 ankles (96.9%), and the ankle score negatively correlated with the number of lesions ( r = −.604; P < .001). Multivariate logistic regression showed that syndesmosis widening (odds ratio, 11.1; 95% confidence interval: 2.2–55.4; P = .003), osteochondral lesions of the talus (odds ratio, 8.5; 95% confidence interval: 1.7–42.3; P = .008), and ossicles (odds ratio, 4.5; 95% confidence interval: 1.0–20.2; P = .046) are significant predictors of unsatisfactory results after ligament reconstruction. Conclusion Arthroscopic diagnosis and treatment of intra-articular lesions associated with chronic lateral ankle instability is a safe and effective method. The presence of any combination of associated intra-articular lesions can result in a poor outcome.

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454 Brace Brace: Modified Brsotrom-Gould Procedure with and Without Internal Brace for the Treatment of Chronic Lateral Ankle Instability

British Journal of Surgery ◽

10.1093/bjs/znab134.282 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J McGuigan ◽

A Pillai ◽

A Hall

Keyword(s):

Clinical Outcomes ◽

Ligament Reconstruction ◽

Ankle Instability ◽

Nonoperative Treatment ◽

Lateral Ligament ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability ◽

Significant Difference ◽

Internal Brace

Abstract Introduction The most common ankle injury is a sprain. Surgical management is only indicated when nonoperative treatment fails. Modified Broström-Gould (MBG) is the gold standard surgical technique. MBG technique may be augmented with an internal brace. This study aims to compare the clinical outcomes of MBG with and without internal brace for the treatment of chronic lateral ankle instability using validated patient recorded outcome measures. Method Retrospective analysis of patients that underwent lateral ankle ligament reconstruction between January 2012 and June 2019 were reviewed at and asked to complete the Manchester oxford foot and ankle questionnaire (MOXFQ). 29 patients (30 ankles) underwent lateral ligament reconstruction between these dates and completed the questionnaire, 20 patients (21 ankles) without internal brace and 9 patients with internal brace. Results The group with internal brace displayed significantly better results in the MOXFQ summary index score (20.49 ± 13.15 vs 43.53 ± 34.72, P = 0.014) and standing/walking subscale (15.48 ± 13.00 vs 45.92 ± 36.60, P = 0.023) compared to group without internal brace. There was no significant difference between Pain and Social interactions subscales. Conclusions Our results show that the addition of an internal brace to the MBG procedure for the management of chronic lateral ankle instability improves clinical outcomes.

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Minimally invasive ligament reconstruction in patients with chronic lateral ankle instability

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.05.041 ◽

2016 ◽

Vol 22 (2) ◽

pp. 22

Author(s):

L. Manzi ◽

M. Grassi ◽

C. Maccario ◽

F.G. Usuelli

Keyword(s):

Minimally Invasive ◽

Ligament Reconstruction ◽

Ankle Instability ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00204 ◽

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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Modified Incision for Brostrom Lateral Ligament Reconstruction of the Ankle

Journal of Orthopaedic Surgery ◽

10.1177/230949900901700216 ◽

2009 ◽

Vol 17 (2) ◽

pp. 199-201 ◽

Cited By ~ 1

Author(s):

Ravindra H Mahajan ◽

Rakesh B Dalal

Keyword(s):

Wound Healing ◽

Ligament Reconstruction ◽

Ankle Instability ◽

Lateral Malleolus ◽

Lateral Ligament ◽

Neurological Damage ◽

Distal Fibula ◽

Lateral Ankle ◽

Lateral Ankle Instability ◽

Wound Healing Problems

Purpose. To describe a modified incision for the Brostrom procedure to correct lateral ankle instability. Methods. 14 men and 12 women aged 23 to 38 (mean, 27) years with lateral ankle instability underwent the Brostrom procedure with a modified incision to repair both the anterior talofibular and calcaneofibular ligaments, without endangering the sural or superficial peroneal nerves. The incision ran longitudinally over the distal fibula extending 2.5 cm distal to the tip of the lateral malleolus. Results. There were no instances of wound healing problems, neurological damage, and repair failure. Surgical exposure of all patients was graded as excellent. Conclusion. The modified incision enables easy repair without endangering the sural and superficial peroneal nerves. Access to the peroneal tendons is allowed if necessary.

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The anterior talo-fibular ligament reconstruction in surgical treatment of chronic lateral ankle instability

International Orthopaedics ◽

10.1007/s00264-010-0995-7 ◽

2010 ◽

Vol 34 (7) ◽

pp. 991-996 ◽

Cited By ~ 20

Author(s):

Tomáš Trč ◽

Milan Handl ◽

Vojtech Havlas

Keyword(s):

Surgical Treatment ◽

Ligament Reconstruction ◽

Ankle Instability ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Lateral Ankle Instability

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Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211004099 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712110040

Author(s):

Ji Hye Choi ◽

Kug Jin Choi ◽

Chin Youb Chung ◽

Moon Seok Park ◽

Ki Hyuk Sung ◽

...

Keyword(s):

Standard Deviation ◽

Tilt Angle ◽

Ankle Instability ◽

Interobserver Reliability ◽

Initial Presentation ◽

Lateral Ankle ◽

Chronic Lateral Ankle Instability ◽

Stress Radiographs ◽

Lateral Ankle Instability

Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.

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