scholarly journals Surgical Management of Lateral Ankle Instability in Athletes

2019 ◽  
Vol 54 (6) ◽  
pp. 639-649 ◽  
Author(s):  
Luis D. Camacho ◽  
Zachary T. Roward ◽  
Yu Deng ◽  
L. Daniel Latt
Keyword(s):  
Surgical Management ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Anatomic Reconstruction ◽  
Ankle Sprains ◽  
Functional Rehabilitation ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Initial Surgery ◽  
Lateral Ankle Ligaments

Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery.

scholarly journals An Updated Model of Chronic Ankle Instability

2019 ◽  
Vol 54 (6) ◽  
pp. 572-588 ◽  
Author(s):  
Jay Hertel ◽  
Revay O. Corbett
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Patient Specific ◽  
Ankle Sprains ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Persistent Symptoms ◽  
Behavioral Impairments ◽  
Lateral Ankle Ligaments ◽  
First Time

Lateral ankle sprains (LASs) are among the most common injuries incurred during participation in sport and physical activity, and it is estimated that up to 40% of individuals who experience a first-time LAS will develop chronic ankle instability (CAI). Chronic ankle instability is characterized by a patient's being more than 12 months removed from the initial LAS and exhibiting a propensity for recurrent ankle sprains, frequent episodes or perceptions of the ankle giving way, and persistent symptoms such as pain, swelling, limited motion, weakness, and diminished self-reported function. We present an updated model of CAI that aims to synthesize the current understanding of its causes and serves as a framework for the clinical assessment and rehabilitation of patients with LASs or CAI. Our goal was to describe how primary injury to the lateral ankle ligaments from an acute LAS may lead to a collection of interrelated pathomechanical, sensory-perceptual, and motor-behavioral impairments that influence a patient's clinical outcome. With an underpinning of the biopsychosocial model, the concepts of self-organization and perception-action cycles derived from dynamic systems theory and a patient-specific neurosignature, stemming from the Melzack neuromatrix of pain theory, are used to describe these interrelationships.

Talar Anchor Placement for Modified Brostrom Lateral Ankle Stabilization Procedure

2008 ◽  
Vol 98 (6) ◽  
pp. 473-476 ◽  
Author(s):  
Arush K. Angirasa ◽  
Michael J. Barrett
Keyword(s):  
Research Study ◽  
Ankle Instability ◽  
Suture Technique ◽  
Anatomic Reconstruction ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Lateral Ankle Instability ◽  
Stabilization Procedure ◽  
Lateral Ankle Ligaments ◽  
Modified Broström Procedure

The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor placement, suture technique, or both. In this research study, we propose placing a bone screw anchor into the lateral shoulder of the talus rather than the typical placement at the lateral malleolus for anatomic reconstruction of the lateral ankle ligaments. (J Am Podiatr Med Assoc 98(6): 473–476, 2008)

Reconstruction of the Lateral Ankle Ligaments Using an Inferior Extensor Retinaculum Flap

1997 ◽  
Vol 18 (11) ◽  
pp. 723-728 ◽  
Author(s):  
D. Saragaglia ◽  
F. Fontanel ◽  
E. Montbarbon ◽  
Y. Tourné ◽  
F. Picard ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
X Rays ◽  
Extensor Retinaculum ◽  
Sports Activity ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Functional Instability ◽  
Lateral Ankle Ligaments ◽  
Inferior Extensor Retinaculum

The aim of this study was to assess the results of 32 cases of chronic ankle instability. These were treated by ligament shortening and reinforced with an inferior extensor retinaculum flap. All patients complained of persistent functional instability unrelieved with proprioceptive exercises. Results were assessed clinically (pain, instability, recovery of sports activity, mobility) and radiologically (correction of laxity on stress x-rays). This enabled us to draw up a revision score on a scale of 100 points. We obtained a mean score of 86.7 points (45–100 points), and subjective results showed that 88% of the patients were satisfied with the surgery.

Reconstruction of the Lateral Ankle Ligaments with Allograft in Patients with Chronic Ankle Instability

2006 ◽  
Vol 11 (3) ◽  
pp. 597-605 ◽  
Author(s):  
Alessandro Caprio ◽  
Francesco Oliva ◽  
Fabio Treia ◽  
Nicola Maffulli
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Lateral Ankle Ligaments

scholarly journals Chronic lateral ankle instability: a current concepts review

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
Ziyaad Mayet ◽  
Paulo NF Ferrao ◽  
Nikiforos Ρ Saragas ◽  
Richard Paterson ◽  
Sebastian KM Magobotha ◽  
...  
Keyword(s):  
Ankle Instability ◽  
Osteochondral Lesions ◽  
Mechanical Instability ◽  
Functional Rehabilitation ◽  
Level Of Evidence ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Chronic Lateral Ankle Instability ◽  
Lateral Ankle Instability ◽  
Lateral Ankle Ligaments

ABSTRACT Injuries to the lateral ankle ligaments are quite common, with a reported incidence of up to 22% of all sports injuries, and 85% of all ankle sprains. Most of these are effectively managed using nonoperative measures in the acute setting. Approximately 20% of patients will, however, develop chronic lateral ankle instability (CLAI). Although the anatomy and biomechanics are well documented, more recently, the concepts of the lateral talofibular calcaneal ligament (LTFCL) and microinstability have been described. For those who develop CLAI, a full assessment is mandatory to not only search for correctable risk factors (malalignment), but also to differentiate between functional and mechanical instability. Associated injuries need to be excluded, such as osteochondral lesions of the talus. Rotational ankle instability is a new concept that needs to be considered. Patients who present with CLAI are initially managed conservatively in the form of functional rehabilitation. This management is especially effective in patients with functional instability. Surgery is generally indicated after failed conservative management in patients with objective mechanical instability. The elite athlete is a relative indication to performing surgery early. The choice of surgical procedure is made on an individualised basis, although open anatomical procedures remain the gold standard. Non-anatomical procedures are no longer recommended. Newer minimally invasive and endoscopic techniques show promise in experienced hands but there is only limited evidence to support its use at present. The use of a suture tape as an augment is reserved for specific indications and should not be used routinely. Level of evidence: Level 5 Keywords: chronic lateral ankle instability, ATFL, CFL, functional rehabilitation, Broström, surgical procedures for lateral ankle ligaments

scholarly journals Evaluating and Differentiating Ankle Instability

2019 ◽  
Vol 54 (6) ◽  
pp. 617-627 ◽  
Author(s):  
Phillip A. Gribble
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
High Rate ◽  
Diagnostic Tools ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
The Status ◽  
History Of ◽  
Ankle Complex

Given the prevalence of lateral ankle sprains during physical activity and the high rate of reinjury and chronic ankle instability, clinicians should be cognizant of the need to expand the evaluation of ankle instability beyond the acute time point. Physical assessments of the injured ankle should be similar, regardless of whether this is the initial lateral ankle sprain or the patient has experienced multiple sprains. To this point, a thorough injury history of the affected ankle provides important information during the clinical examination. The physical examination should assess the talocrural and subtalar joints, and clinicians should be aware of efficacious diagnostic tools that provide information about the status of injured structures. As patients progress into the subacute and return-to-activity phases after injury, comprehensive assessments of lateral ankle-complex instability will identify any disease and patient-oriented outcome deficits that resemble chronic ankle instability, which should be addressed with appropriate interventions to minimize the risk of developing long-term, recurrent ankle instability.

scholarly journals Gait Kinematics After Taping in Participants With Chronic Ankle Instability

2014 ◽  
Vol 49 (3) ◽  
pp. 322-330 ◽  
Author(s):  
Lisa Chinn ◽  
Jay Dicharry ◽  
Joseph M. Hart ◽  
Susan Saliba ◽  
Robert Wilder ◽  
...  
Keyword(s):  
Confidence Intervals ◽  
Gait Cycle ◽  
Sagittal Plane ◽  
Ankle Instability ◽  
Knee Kinematics ◽  
Chronic Ankle Instability ◽  
Mean Difference ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
Gait Kinematics

Context: Chronic ankle instability is characterized by repetitive lateral ankle sprains. Prophylactic ankle taping is a common intervention used to reduce the risk of ankle sprains. However, little research has been conducted to evaluate the effect ankle taping has on gait kinematics. Objective: To investigate the effect of taping on ankle and knee kinematics during walking and jogging in participants with chronic ankle instability. Design: Controlled laboratory study. Setting: Motion analysis laboratory. Patients or Participants: A total of 15 individuals (8 men, 7 women; age = 26.9 ± 6.8 years, height = 171.7 ± 6.3 cm, mass = 73.5 ± 10.7 kg) with self-reported chronic ankle instability volunteered. They had an average of 5.3 ± 3.1 incidences of ankle sprain. Intervention(s): Participants walked and jogged in shoes on a treadmill while untaped and taped. The tape technique was a traditional preventive taping procedure. Conditions were randomized. Main Outcome Measure(s): Frontal-plane and sagittal-plane ankle and sagittal-plane knee kinematics were recorded throughout the entire gait cycle. Group means and 90% confidence intervals were calculated, plotted, and inspected for percentages of the gait cycle in which the confidence intervals did not overlap. Results: During walking, participants were less plantar flexed from 64% to 69% of the gait cycle (mean difference = 5.73° ± 0.54°) and less inverted from 51% to 61% (mean difference = 4.34° ± 0.65°) and 76% to 81% (mean difference = 5.55° ± 0.54°) of the gait cycle when taped. During jogging, participants were less dorsiflexed from 12% to 21% (mean difference = 4.91° ± 0.18°) and less inverted from 47% to 58% (mean difference = 6.52° ± 0.12°) of the gait cycle when taped. No sagittal-plane knee kinematic differences were found. Conclusions: In those with chronic ankle instability, taping resulted in a more neutral ankle position during walking and jogging in shoes on a treadmill. This change in foot positioning and the mechanical properties of the tape may explain the protective aspect of taping in preventing lateral ankle sprains.

scholarly journals Systematic Review of Postural Control and Lateral Ankle Instability, Part I: Can Deficits Be Detected With Instrumented Testing?

2008 ◽  
Vol 43 (3) ◽  
pp. 293-304 ◽  
Author(s):  
Patrick O. McKeon ◽  
Jay Hertel
Keyword(s):  
Postural Control ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Effect Sizes ◽  
Ankle Sprains ◽  
Lateral Ankle Sprain ◽  
Lateral Ankle ◽  
Increased Risk ◽  
Clinical Questions

Abstract Objective: To answer the following clinical questions: (1) Is poor postural control associated with increased risk of a lateral ankle sprain? (2) Is postural control adversely affected after acute lateral ankle sprain? (3) Is postural control adversely affected in those with chronic ankle instability? Data Sources: PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway. Study Selection: Only studies assessing postural control measures in participants on a stable force plate performing the modified Romberg test were included. To be included, a study had to address at least 1 of the 3 clinical questions stated above and provide adequate results for calculation of effect sizes or odds ratios where applicable. Data Extraction: We calculated odds ratios with 95% confidence intervals for studies assessing postural control as a risk factor for lateral ankle sprains. Effect sizes were estimated with the Cohen d and associated 95% confidence intervals for comparisons of postural control performance between healthy and injured groups, or healthy and injured limbs, respectively. Data Synthesis: Poor postural control is most likely associated with an increased risk of sustaining an acute ankle sprain. Postural control is impaired after acute lateral ankle sprain, with deficits identified in both the injured and uninjured sides compared with controls. Although chronic ankle instability has been purported to be associated with altered postural control, these impairments have not been detected consistently with the use of traditional instrumented measures. Conclusions: Instrumented postural control testing on stable force plates is better at identifying deficits that are associated with an increased risk of ankle sprain and that occur after acute ankle sprains than at detecting deficits related to chronic ankle instability.

scholarly journals There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ashish Shah ◽  
Brent Cone ◽  
Cesar de Cesar Netto ◽  
Ibukunoluwa Araoye ◽  
Parke Hudson ◽  
...  
Keyword(s):  
Single Incision ◽  
Ankle Instability ◽  
Demographic Data ◽  
Lateral Ligament ◽  
Complication Rates ◽  
Ligament Repair ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Significant Difference ◽  
Lateral Ankle Ligaments

Category: Ankle Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair. Methods: This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test. Results: Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively. Conclusion: Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.

Patient with an Ankle Sprain

2016 ◽  
Author(s):  
Andrea Trescot
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Ankle Sprain ◽  
Ankle Instability ◽  
Age Groups ◽  
Pain Syndrome ◽  
The Elderly ◽  
Chronic Ankle Instability ◽  
Ankle Sprains ◽  
Lateral Ankle ◽  
High Ankle Sprain

Ankle sprains are a very common injury, suffered by approximately 25,000 patients per year, and affect all age groups, including children, athletes, and the elderly. The recognition of the type of ankle sprain (medial, lateral, syndesmotic) affects early and late management of ankle sprains. Also discussed are the acute diagnosis and treatment of ankle sprains, as well as the consequences of chronic ankle instability, which may include serious conditions such as complex regional pain syndrome and chronic ankle instability. Surgical and nonsurgical treatment, evaluation, prognosis, and prevention are also discussed. Key words: ankle pain, ankle sprain, chronic ankle instability, complex regional pain syndrome, cryoneuroablation, high ankle sprain, lateral ankle sprain, medial ankle sprain, 

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