The complication was addressed with surgical excision of the knots. cOrthopedics, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, P.R. The American Orthopaedic Foot and Ankle Society (AOFAS) and Tegner scores were noted post-injury and during the 24-month follow-up. In contrast, clinical examination was 47.4% sensitive and 100% specific. Ankle traction was removed and a 4-cm incision was made, starting from the anterior margin of the fibula and ending downwards and posteriorly, approximately 1 cm distal from the tip of the lateral malleolus. Karlsson J, Bergsten T, Lansinger O, Peterson L. Long-term functional outcome after surgery of chronic ankle instability. About 30% of patients may develop chronic ankle instability (CAI), which significantly limits their professional or recreational activities. 1-3 For many individuals, ankle sprains lead to functional or mechanical impairments, resulting in the sensation of giving way and repeated bouts of instability.4 This clinical phenomena is known as chronic ankle instability (CAI). Bethesda, MD 20894, Web Policies Orthopaedics Department, Volos General Hospital, Volos, GRC, 3 Over the years, there have been several anatomic and non-anatomic techniques describing the reconstruction or repair of the lateral ankle ligaments. Chronic instability can lead to loose ankle ligaments, loss of joint cartilage, and tendon injury. Chronic Lateral Ankle Instability - Everything You Need To Know - Dr. Nabil Ebraheim 218,176 views Dec 14, 2016 Dr. Ebraheims animated educational video describing the condition of. The diagnosis of CAI relies on the understanding of anatomy and a thorough assessment of the patient. Inter-rater reliability for CFL tears was moderate on clinical examination (k = 0.514) and fair on MRI, in conjunction with ankle arthroscopy (k = 0.357). Nonsurgical treatment may include: Physical therapy. The remaining 30 patients (30/67 [44.78%], group B) developed mechanical instability with combined ATFL and CFL rupture. 5th Orthopaedics Department, Diagnostic and Therapeutic Centre of Athens - Hygeia, Athens, GRC, 2 They were recreational athletes or active military personnel. Mechanical stability was achieved in all cases. Group B (capsule ligamentous reconstruction): During the first two postoperative weeks, a below-knee cast was applied. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Up to 40% of individuals can develop chronic lateral ankle instability (CLAI) after a lateral ankle sprain. No postoperative ankle instability or relapsing ankle sprain was reported in either group. The anchors were in good position. The site is secure. The patient's parents were overly worried, and so she only began to partially weightbear at 2 months postoperatively. Recovery time after Lateral Ankle Instability Surgery Patients will remain non weight bearing for about two weeks in a cast. 4). These results indicate that simple excision of the fracture fragment is not an ideal way to treat LB injury; it is worth mentioning that we cannot just excise the APC, as the scar tissue connection cannot compensate for LB function. [17]. The operative procedure chosen depended on the fracture type. Approval for this study was obtained from the Institutional Review Board of the hospital where the study was conducted. Yoshimoto K, Noguchi M, Maruki H, Tominaga A, Ishibashi M, Okazaki K. Knee Surg Sports Traumatol Arthrosc. Get into a half-kneeling position on the floor with the ankle you are stretching in front Make sure your front foot flat on the floor and facing straight forward Shift your weight forward while keeping the heel firmly on the ground Keep the inner edge of the knee aligned with the big toe to prevent flaring in or outward Foot Ankle Int. This site needs JavaScript to work properly. Philadelphia, PA: Mosby Elsevier; 2007. Coughlin MJ, Mann RA, Saltzman CL. The injury of the calcaneocuboid ligaments. Am J Sports Med. Weber B fracture of the lateral malleolus with concomitant anterior talofibular ligament injury following an ankle supination injury. Method of checking LB stability. [18]. FOIA may email you for journal alerts and information, but is committed The VAS pain score was significantly reduced at the last follow-up compared with preoperatively (Table 2). A retrospective review was conducted on 67 patients diagnosed with CLAI in the Department of Sports Medicine, Xiangya Hospital, Central South University from January 2015 to January 2018, including 42 males and 25 females, aged from 17 to 41 years old, with disease course of (12.63.2) months. Normative data for the American Orthopedic Foot and Ankle Society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system. All participants were recreational athletes or active service military personnel. Yi G, Fu S, Yang J, Wang G, Liu Y, Guo X, Shi J, Zhang L. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Lacerations of the lateral . The objective of this study was to compare the difference of plantar pressure distribution between surgical treatment and conservative treatment for CAI. The oblique view clearly demonstrates the APC. Minimally invasive treatment of chronic ankle instability: a comprehensive review[J]. 23. So we summarize the following experience for reference: in type I and type II injuries the fracture fragment should be removed and reconstructed with a wire anchor; cannulated screws were used to fix the fracture in type III patients, and the LB reconstruction was performed with autograft or allograft tendons. The effect of landing heights and loads on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI) may be important but are still unclear. With myriad procedures described for chronic lateral ankle instability, there is little consensus on optimal treatment outcome or a truly "ideal" operation. All the authors declare that they have no conflict of interest. In contrast, the rationale for anatomic repair is to restore normal anatomy by imbrication of the lateral capsuloligamentous complex. However, both patients saw great improvement after intensive physiotherapy. Methods: MeSH More than half of these injuries occur after excessive ankle plantar-flexion and inversion during athletic activities or military training. . Patients were asked to rate their overall satisfaction with the surgical results as excellent, good, fair, or poor (Table 1). This study is limited by its retrospective nature. Epub 2016 Nov 14. Correspondence: Fengqi Zhang, Department of Foot and Ankle Surgery, The 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, P.R. The results of the current study are encouraging, but LB repair and reconstruction is very complex, and surgeons need to have substantial experience to successfully treat such injuries. 2022 Oct 20;17(1):459. doi: 10.1186/s13018-022-03354-4. Dimmick S, Kennedy D, Daunt N. Evaluation of thickness and appearance of anterior talofibular and calcaneofibular ligaments in normal versus abnormal ankles with MRI[J]. Treatment Non . The site is secure. When needed, we also performed osteophyte resection, loose body excision, scar tissue removal, and synovectomy. Failure after strict rehabilitation may be an indication for surgery. An official website of the United States government. sharing sensitive information, make sure youre on a federal We assessed 67 patients who were treated for chronic lateral ankle instability. Patients with LB lesions experience substantially more pain in the region of the LB with radiation of pain to the forefoot compared with patients with only lesions in the region of the ankle joint. Andermahr et al[14] suggested that lateral and stress radiographs with about 20 kp varus stress should be performed at the level of the calcaneocuboid joint, and then the calcaneocuboid angle should be measured. J Am Podiat Med Assoc 97:19-30, 2007; Tropp H, Odenick P, Gillquist J: Stabilometry . Rasmussen O. Sprained ankles, VI: surgical treatment of chronic ligament ruptures. The use of orthotics shows promise in the treatment of ankle instability, particularly in response to improving balance after injury 39 or fatigue, 40 when rearfoot motion is altered, 41 and in normal subjects. The lateral capsuloligamentous complex was divided. A modified Brostrm repair with transosseous fixation for chronic ankle instability: a midterm followup study in soldiers. Of the patients who underwent excision of the fracture fragment, the surgical result was rated as excellent by 1/32 (3.1%) patients, good by 11/32 (34.4%) patients, and fair by 20/32 (62.5%) patients. No postoperative residual swelling was identified. Tenodesis techniques are not recommended because of their suboptimal long-term results related to the modification of ankle and hindfoot biomechanics.Level of Evidence: Level V, expert opinion. Indeed, this modification resulted in reduced anterior talar displacement and a decreased talar internal rotation [25]. The procedure usually involves ankle arthroscopy along with tightening of the lateral ankle ligaments. This study aims to examine the results of a treatment algorithm based on the integrity of the CFL and to investigate the significance of clinical examination, imaging modalities, arthroscopy, and anatomic reconstruction in highly active patients with chronic ankle instability. [1,2] Especially in the active population, where lateral ankle sprain accounts for up to 20% of all sports-related injuries. Gribble PA, Bleakley CM, Caulfield BM, et al. The left foot was involved in 69 cases (61.6%), and the right in 43 cases (38.4%). Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3-11-Year Follow-up. Conversely, in "mechanical" instability, provocative tests are positive. Unable to load your collection due to an error, Unable to load your delegates due to an error. The patients' daily life may be seriously affected by ankle osteoarthritis and other irreversible damages, if the ATFL injury is not treated in time and drags on. J Athl Train 2002;37:45862. Chronic ankle instability. Edama M, Kageyama I, Kikumoto T, et al. Synovitis and scar tissue were more common in group A (p = 0.01) compared to group B. B: An uncommon mechanism of fracture, consisting of dorsiflexion and eversion, causing a compression-type lesion. Forty-three participants (21 CAI and 22 non-CAI) volunteered for this study. In the operating room, a specific surgeon performed provocative tests and standardized stress views. Fracture of the promontory of the calcaneus. The indications for treatment, nonoperative and operative treatment, as well as the biomechanical information available regarding these methods of treatment are considered. Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture. Objectives: Anterior talofibular ligament (ATFL) injury is one of the most common injuries in sports medicine, resulting in chronic lateral ankle instability (CLAI). Moreover, despite being originally designed for knee evaluation, Tegner Activity Level scoring system has also been used for the assessment of the ankle joint [15,16]. Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. The patients with signs of swelling in the region of the LB. Federal government websites often end in .gov or .mil. Cartilage defects were treated with debridement or microfracture technique. Fengqi Zhang designed the study; Yaning Sun, Yuchao Tang, Mingming Zhao, and Huijuan Wang inquired the EMR for variables of interest; Shiji Qin searched relevant literature and analyzed and interpreted the data; Yaning Sun and Huijuan Wang wrote the manuscript, and Fengqi Zhang approved the final version of the manuscript. Am J Sports Med 2017;45:2019. Arthroscopic treatment of lateral ankle ligament instability; Chronic lateral ankle instability; Modified Brostrm procedure; Suture tape augmentation for lateral ankle ligament instability. A modification described by Gould [17] proposed that additional mobilization and reattachment of the lateral portion of the extensor retinaculum to the fibula would offer greater talocrural and subtalar joint stability. Regardless, examination under anesthesia remains impractical since it can only be performed in the operating room before arthroscopy. Gerber JP, Williams GN, Scoville CR, et al. Brostrm L. Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI. [6] Furthermore, LB injury has rarely been studied and is not frequently considered, so diagnosis of LB injury is not as easy as diagnosis of lateral ligament injury. 2019 Jun;54(6):639-649. doi: 10.4085/1062-6050-348-18. . Foot Ankle Surg. 2015 Mar;20(1):59-69. doi: 10.1016/j.fcl.2014.10.002. Would you like email updates of new search results? Cohen's kappa coefficient was used to determine the inter-rater reliability between clinical examination and arthroscopy, as well as MRI and arthroscopy. J Bone Joint Surg Br 1991;73:8025. Horibe S, Shino K, Taga I, et al. Outcomes were assessed by comparison of pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale pain scores, Karlsson scores, and radiographic assessment. We searched the Cochrane Library, MEDLINE, and EMBASE. Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium- and Long-Term Functional Follow-Up. A common ankle sprain can lead to ankle instability, cartilage . However, as this is a retrospective study, the need for a superior level of evidence calls for the design of a prospective study with a higher number of participants and increased (more than 80%) statistical power. Over the next two weeks, patients were allowed to perform proprioception, resistance, and closed chain training exercises. Usually, the conservative treatment for acute injuries is successful, even if a chronic ankle instability persists in 5-20% of cases, defined by an instability lasting more than 6 months [3], [4]. Liu J, Chen M, Xu T, Tian Z, Xu L, Zhou Y. J Orthop Surg Res. Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Patients with an intact CFL were placed in group A while those with CFL tears in group B. Concomitant intra-articular pathologies, if present, were treated arthroscopically. The site is secure. Anterior talofibular ligament (ATFL) injury is one of the most common injuries in sports medicine, resulting in chronic lateral ankle instability (CLAI). Ankle sprain is often combined with LB damage. Clinical rating scale for postoperative ankle reconstruction. This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. Andermahr J, Helling HJ, Rehm KE, et al. [21]. The average age at the time of surgery was 31.9 (range, 1843) years. Statistical analyses were performed with statistical software (SPSS version16.0; SPSS, Inc, Chicago, IL). . Occasionally, a third anterocentral portal was also used. Keywords: These are either anatomic or non-anatomic. You may notice problems with Skeletal Radiol 1987;16:1146. Standing X-ray examination indicated normal joint space without stenosis, and the internal fixation was in good position. The LB is a major stabilizing factor for the lateral transverse tarsal joint (Chopart lateral joint line),[15] and so LB damage can result in laxity in the lateral part of the transverse tarsal joint; this can be demonstrated by the presence of a widened joint space in a roentgenogram performed while forcefully inverting the forefoot. A: Type I fracture: undisplaced fracture; B: Type II fractures: displaced fracture; C: Type III fractures: large displaced fragment that involved the calcaneocuboid joint; D: Schematic drawing of the type III surgery method. Twenty patients had tenderness and clinically detectable swelling at the point of the LB, but the degree of ankle pain was significantly reduced compared with preoperatively. Chronic ankle instability (CAI) has been defined as "repetitive bouts of lateral ankle instability resulting in numerous ankle sprains.". Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair. Du MZ, Su T, Jiang YF, Jiao C, Guo QW, Hu YL, Jiang D. Front Surg. Urits I, Hasegawa M, Orhurhu V, et al. The anatomic location of the lateral ankle ligament and the LB. Comparison of repeated measurements documented during preoperative assessment and 24-month postoperative review was performed using the paired samples Students t-test or Wilcoxon test (in case of violation of normality). 2020 Apr;12(2):505-514. doi: 10.1111/os.12651. : (anterior talofibular ligamentATFL)3~6ATFLATFL: 201512018167422517~41(12.63.2)2938ATFLXATFLATFL361224(American Orthopaedic Foot and Ankle SocietyAOFAS)(Karlsson ankle functionalKAF)(the Japanese Society for Surgery of the FootJSSF): 6752(77.6%)12(17.9%)II~III23(34.3%)IV5(7.5%)3(4.5%)212~24(15.643.17)64(95.5%)XAOFAS(94.786.37)(64.1712.43P<0.01)KAFJSSF(KAF91.0411.36 vs 59.7413.63P<0.01JSSF95.3210.21 vs 66.9214.38P<0.01): ATFL. Finally, the lateral portion of the inferior extensor retinaculum was tagged to the periosteum of the fibula with absorbable sutures (Figures (Figures2,2, ,3).3). 2017 Apr;38(4):405-411. doi: 10.1177/1071100716683348. Keywords: 2011 Nov;39(11):2381-8. doi: 10.1177/0363546511416069. Calcaneofibular ligament may act as a tensioner of peroneal tendons as revealed by a contactless three-dimensional scan system on cadavers. The minimally invasive ATFL reconstruction with partial peroneus brevis tendon has advantages of small trauma, good reconstruction a nd excellent clinical outcomes, thus, is a safe and effective method for the treatment of chronic lateral ankle instability. Stability of the fixation was evaluated with the anterior drawer and talar tilt tests. You may search for similar articles that contain these same keywords or you may . Doherty C, Delahunt E, Caulfield B, et al. We evaluated our outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS clinical rating system) [15] and Tegner activity level score [16]. The posterior talofibular ligament was intact in both groups. Postoperative follow-up was conducted for 12-24 (15.643.17) months. Non-Operative Treatment. In "functional" ankle instability, patients report a subjective feeling of "giving way" with provocative tests being negative. Surgical excision for anterior-process fractures of the calcaneus. Chronic Lateral Ankle Instability Full-text available Article Jan 2018 Dae-Wook Kim Ki-Sun Sung View Anatomic stabilization techniques provide superior results in terms of functional. During arthroscopy, osteophytes were encountered and resected in 14 patients in Group A and eight patients in group B. 2019 Dec 15;33(12):1503-1509. doi: 10.7507/1002-1892.201905072. Kennedy JG, Smyth NA, Fansa AM, et al. Ankle arthroscopy confirmed the presence of cartilaginous lesions, osteophytes, and loose bodies, as outlined previously by other imaging modalities and clinical examination. Do not disregard or avoid professional medical advice due to content published within Cureus. An epidemiological observational study of midtarsal joint sprain showed that the most frequent trauma mechanism was foot inversion (76% of cases), followed by plantar hyperflexion (21%), dorsal hyperflexion (2%), and foot eversion (1%)[6,18,2124] (Fig. Out of 67 patients, 58 were males and 9 were females. The CFL is the only ligament bridging the tibiotalar and subtalar joints. Orthopaedics and Trauma Department, Ministry of Defence Hospital Unit (MDHU) Northallerton, Northallerton, GBR, AOFAS, American Orthopaedic Foot and Ankle Society, Chronic Lateral Ankle Instability in Highly Active Patients: A Treatment Algorithm Based on the Arthroscopic Assessment of the Calcaneofibular Ligament, Monitoring Editor: Alexander Muacevic and John R Adler. The diagnosis of LB injury can be missed or delayed. The ankle should be in neutral or slight plantar flexion to help align ATFL and CFL. We used 95% confidence intervals. Foot Ankle Int 2017;38:76978. Some error has occurred while processing your request. The incision was then rinsed with saline and sutured. Int Orthop 34:991-996 30. Surgical management for chronic lateral ankle ligament instability is useful when patients have failed nonoperative modalities. Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Purpose: Treatment of chronic lateral ankle instability (CLAI) with poor remnant quality is challenging. Imaging studies, including plain radiographs, sonography, MRI, and arthroscopic examinations, are . Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. Its integrity is compromised when excessive stress is applied while the ankle is inverted and dorsiflexed. Following a lateral ankle sprain, 40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Anatomic repair can be performed when the quality of the damaged ligaments permits. Ankle arthroscopy was performed in all patients. With a history of ankle sprain, this patient presented with pain and ankle instability months after a precipitating injury as a result of tearing of the ligaments near the ankle bone at the outside aspect of the foot/ankle. The calcaneonavicular part of the LB is thicker (average diameter 3 mm) and longer (average length 15 mm) than the calcaneocuboidal part (2 mm in diameter and 9 mm in length)[8] (Fig. However, several factors may lead to chronic ankle instability with recurring ankle sprains: Inadequate primary treatment Incomplete healing of the ligaments Repetitive trauma with deteriorated tissue quality Sugimoto K, Takakura Y, Akiyama K, Kamei S, Kitada C, Kumai T. Surgical Considerations in the Treatment of Ankle Instability. Its high inter-rater reliability in conjunction with ankle arthroscopy corroborates that it is a highly efficient diagnostic tool for the assessment of chronic ankle instability. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. [15]. osteoarthritis subtalar joint pathologies Surgical treatment of lateral ankle instability syndrome A curvilinear incision was then made approximately 7 cm below the lateral malleolus and along the peroneal muscle. The pattern of lateral ankle ligamentous injury is well understood. An official website of the United States government. Patients returned for a clinical and radiologic follow-up evaluation at an average of 31 (range, 2435) months postoperatively. 2019 Jun;31(3):201-210. doi: 10.1007/s00064-019-0595-7. 2022 May 9;9:816669. doi: 10.3389/fsurg.2022.816669. Ankle sprain is a common type of sports injury that may cause chronic ankle instability in approximately20 30% of cases. All the patients had surgical indications and no obvious contraindications, and they were treated with arthroscopic debridement and double-bundle anatomical reconstruction of the AFTL's fibular enthesis under anesthesia. Therefore, the excellent postoperative outcome documented in both groups supports our hypothesis regarding the lower clinical significance of ATFL. In patients with ankle sprain, anterior talofibular ligament injury may cause avulsion fracture. . Also, patients were encouraged to start proprioception and manual resistance exercises, to focus on intrinsic muscle strengthening, and begin swimming. Postoperative stiffness developed in two patients in group A, with severe restriction of ankle dorsiflexion (greater than 15 degrees). The functionality is limited to basic scrolling. Lateral ligament reconstruction procedures for the ankle. This study aims to investigate the effect of double-bands anatomical reconstruction of the ATFL's fibular enthesis for the treatment of CLAI. The purpose of this meta-analysis was to compare different surgical techniques for management of chronic lateral ankle instability. Epub 2012 Aug 9. Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. A key point to surgical treatment of chronic lateral ankle instability is choosing a suitable surgical procedure. Disclosure Dr E. Ferkel discloses that he is a consultant and instructor for Arthrex and Ferring Pharmaceuticals. Keyword Highlighting Finally, as reports of LB injury are extremely rare, we cannot compare our method with methods used by other organizations. Repeated ankle sprains are a common cause of this syndrome. [Arthroscopic repair of chronic lateral ankle instability]. Sun, Yaning MDa; Wang, Huijuan MDb; Tang, Yuchao MDa; Qin, Shiji MDa; Zhao, Mingming MDc; Zhang, Fengqi MDa,*, aDepartment of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, bDepartment of Histology and Embryology, Hebei Medical University. [3]. 7). Data is temporarily unavailable. Failure after strict rehabilitation may be an indication for surgery. This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. Asia Pac J Sports Med Arthrosc Rehabil Technol. The stress upon it increases as the ankle moves into plantar-flexion and inversion, whereas the addition of internal rotation amplifies its risk for tear. [22]. Epub 2016 Nov 18. Treatment of Chronic Ankle Lateral Instability using Modified Brostrom Procedure Jae Hoon Ahn, M.D., Young-Geun Lee . High-intensity training with a bi-directional bicycle pedal improves performance in mechanically unstable ankles--a prospective randomized study of 19 subjects. Surgery of the Foot and Ankle. Foot Ankle Int 2000;21:996-1003. Return to play after modified Brostrm operation for chronic ankle instability in elite athletes. Normally with ankle sprain rehab, especially initially in your earlier rehab process, you'd be concerned with restoring mobility, particularly restoring end ranges of motion. [10]. Ankle sprains are common musculoskeletal injuries, especially among sportspersons and athletes. During this period, isometric and progressively active exercises commenced. These demands lead to a proportionately higher threshold for expectations. 81974338/the National Natural Science Foundation, xywm2015I34/the Xiangya-PKU Weiming Research Fund, 2017zzts238/the Fundamental Research Funds for the Central Universities of Central South University. Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Furthermore, ankle MRI offered valuable additional information about the severity of ligamentous and cartilaginous injuries [7]. APC = anterior process of the calcaneus. Adler H. Ligamentous injuries of the foot arch. [1] Chronic instability refers to a feeling of apprehension in the ankle, "giving way" and recurrent ankle sprains, persisting for a minimum of six months after the initial sprain. Of the LB reconstruction patients, the surgical result was rated as excellent by 6/7 (85.7%) patients, and poor by 1/7 (14.3%) patients. Objectives: For the investigation of cartilage lesions, bone bruising, and peroneal tendon tears, ankle MRI without contrast was performed on all participants [12]. The sensitivity and specificity of MRI in detecting CFL ruptures were 46.7% and 87%, respectively. government site. Arch Orthop Trauma Surg 1988;107:3268. Sammarco GJ, Idusuyi OB. Clipboard, Search History, and several other advanced features are temporarily unavailable. Patients with ATFL injury who show no significant recovery after 3-6 months of conservative treatment should consider surgical treatment as soon as possible to restore ankle stability and function. The periosteum was stripped off from the tip of the lateral malleolus with the assistance of a bone rongeur. Giving way is considered an uncontrolled or unpredictable excessive inversion of the ankle joints that occurs at heel strike or toe-off during walking or running. The .gov means its official. 2022 Nov 19;17(1):502. doi: 10.1186/s13018-022-03402-z. Two years after surgery, it improved to 96.6 6.84 in group A and 96.9 6.53 in group B, whereas the overall mean score was 96.9 6.54 (p < 0.001) (Table (Table11). In these cases, if instability is still present after a comprehensive nonoperative treatment, a surgical stabilization is required [5], [6], [7]. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Unable to load your collection due to an error, Unable to load your delegates due to an error. the display of certain parts of an article in other eReaders. Degan TJ, Morrey BF, Braun DP. The postoperative results in group A indicated that arthroscopic treatment alone sufficed for the management of patients with functional instability. Mild syndesmotic attenuation was evident in three patients in group A and four patients in group B, whereas deltoid ligament injury was prevalent in three patients in group A and two patients in group B. In the present study, the LB was examined as described by Gellman[18] (Fig. AOFAS scores measured during the 24-month follow-up demonstrated that most patients reported minor to no limitations regarding their fitness status (p < 0.001). Patients were given a comprehensive physiotherapy program and were discharged on the day of surgery with instructions to ambulate with partial weight-bearing. Seven patients sought professional help for their instability elsewhere before our consultation. Knee Surg Sports Traumatol Arthrosc, 2000,8:173-9. Foot Ankle Int 2007;28:10414. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. We assessed 67 highly active patients with chronic lateral ankle instability. Due to the CFL injuries occurring with the ankle in dorsiflexion, we elected to apply a below-knee cast with the ankle in a mildly plantar-flexed and valgus position for two weeks. The aim of the present study was to evaluate clinical results and complications of anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation in the treatment of such patients. Careers. By continuing to use this website you are giving consent to cookies being used. The purpose of this study was to determine the type and frequency of associated injuries and conditions in military patients with chronic lateral ankle instability. Proprioception is essential for neuromuscular control in relation to sport injury and performance. Purpose Treatment of chronic lateral ankle instability (CLAI) with poor remnant quality is challenging. Accessibility 5). The medial component was comprised with the lateral calcaneonavicular ligament, which extends medially and anteriorly, and attached on the dorsolateral side of the navicular. Treatment of chronic lateral ankle instability: a modified Brostrm technique using three suture anchors. Foot Ankle Int 1999;20:97103. Curr Pain Headache Rep, 2020, 24(3): 8. A long-term clinical and radiological follow-up. This test was performed with the ankle held plantar-flexed at 15 degrees. Diagnostic arthroscopy followed, where the integrity of the CFL was assessed. Patients who underwent LB repair or reconstruction had an excellent or good outcome regarding patient subjective self-assessment, pain scores, Karlsson scores, and AOFAS scores at final follow-up. Anat Anzeiger Off Organ Anat Gesellschaft, 2018, 216: 69- 74. Your message has been successfully sent to your colleague. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Clin Orthop Relat Res 1999;2128. They underwent ankle arthroscopy followed by modified Brostrm-Gould reconstruction (Figure (Figure44). Baumhauer JF, OBrien T. Surgical considerations in the treatment of ankle instability. official website and that any information you provide is encrypted 3. [4]. Conversely, the purpose of non-anatomic reconstruction is to regain stability through various tenodesis techniques. Postoperatively, some patients still had clinically detectable signs (discoloration, tenderness, and swelling) at the point of the LB. Orthopaedics Department, Medical School, University of Patras, Patras, GRC, 4 2017 Mar;38(3):324-330. doi: 10.1177/1071100716674997. In patients with CFL tear, our algorithm mandated further treatment. The peroneal tendons and sural nerve were to be protected at the posterior end of the incision. This study aimed to report our institution's experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury. However, as patients with ankle sprain may have concurrent LB injury, the LB is often overlooked while the ankle joint is being examined. The rationale of anatomic reconstruction is to restore anatomy with direct repair of the identified ruptures and imbrication of the lateral ligaments. Cao S, Wang C, Ma X, Wang X, Huang J, Zhang C. Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: a comparative study with surgical findings and timings of scans. The latter improved to 6.2 2.15 two years after surgery (p = 0.009). The Kolmogorov-Smirnov test was utilized for normality analysis of the quantitative variables. These findings agree with other studies citing that MRI has limitations in diagnosing CFL injuries [29,30]. 2022 Nov;108(7):103159. doi: 10.1016/j.otsr.2021.103159. Foot Ankle Clin. Yuan C, Wang Z, Zhu G, Wang C, Ma X, Wang X. Biomed Res Int. These methods offer good results even in very active groups such as athletes and military personnel. Orthop Traumatol Surg Res. PMC Of the 67 patients, 29 left ankles and 38 right ankles were included in this study. Outpatient follow-up was conducted at 3, 6, 12, and 24 months postoperatively. Patients typically suffer from pain, recurrent ankle sprains and swelling of the ankle. At 14 days postoperatively, the sutures were removed, and plaster fixation was applied for 4 weeks. Chronic lateral ankle pain is recurring pain on the outer side of the ankle often develops after an injury such as a sprained ankle. Ankle instability and arthroscopic lateral ligament repair. Six patients from each group developed postoperative synovitis that necessitated treatment with secondary arthroscopic synovectomy. modify the keyword list to augment your search. Our proposed algorithm offers a reliable method for accurate evaluation and successful treatment of chronic lateral ankle instability. One patient from group A developed superficial peroneal nerve intermediate branch entrapment. It also helped identify synovitis and scar tissue that could not be viewed by MRI scans [6]. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, March 2018 - Volume 97 - Issue 9 - p e0028, Diagnosis and treatment of chronic lateral ankle instability with ligamentum bifurcatum injury: An observational study, Articles in Google Scholar by Yaning Sun, MD, Other articles in this journal by Yaning Sun, MD, C5 palsy after C5/6/7 posterior foraminal decompression: A case report. Richie, DH: Effects of foot orthoses on patients with chronic ankle instability. Stress ultrasound provides an ideal and immediate evaluation of the ligament integrity in the office. It is the weakest ligament of the lateral ligament complex (LLC) and the first to be injured in ankle sprains [8]. [15] (Fig. Several operative options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Morphological features of the anterior talofibular ligament by the number of fiber bundles[J]. Preoperative color Doppler ultrasonography and magnetic resonance examination were performed to observe ATFL injury. [A comparative study of all-arthroscopic technique and modified open Brostrm technique in repair of anterior talofibular ligament with anchors]. Highlight selected keywords in the article text. Epub 2019 Mar 27. J Bone Joint Surg Am 1982;64:51924. Clinicians should closely examine the LB in cases of CLAI, and should surgically repair or reconstruct the LB when necessary. Over 80 surgical procedures have been described for chronic lateral ankle instability, and the procedures can be . Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture. Ths A, Odagiri H, Elkam M, Lopes R, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Boniface O, Guillo S, Bauer T; French Arthroscopic Society. Patients suffered from repeated sprains which leaded to pain, swelling and obvious ankle relaxation. The lateral component was comprised with the medial calcaneocuboid ligament, which extends anteriorly and anchored on the dorsomedial aspect of the cuboid. Data were expressed as mean SD for quantitative variables and as frequencies and percentages for qualitative variables. and transmitted securely. During a sprain, the ligaments in your ankle may have been stretched or torn, and when they healed it resulted in weaker and "stretched out" ligaments. For more information, please refer to our Privacy Policy. Li X, Lin TJ, Busconi BD. Foot Ankle Int 1998;19:65360. The authors are grateful to K. Liu and L. Zhang of the Department of Orthopedics, and to X. DEFINITION Lateral ligament injuries of the ankle are treated conservatively with good results in most cases. Surgical management of chronic lateral ankle instability: a meta-analysis. Accessibility 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. Stability of the ankle joint: analysis of the function and traumatology of the ankle ligaments. In such cases, if we only repair the ankle joint and ignore the LB lesions, patients will still experience postoperative tenderness and swelling in the region of the LB. Radiologic examinations were performed preoperatively and during final follow-up. MRI is most useful for chronic ankle instability. Radiology 1956;67:38690. doi: 10.1016/j.otsr.2016.06.026. 8th Edition. The "giving way" usually happens while walking or doing other activities, but it can also happen while standing still. Several methods of conservative treatment, such as peroneal muscle strengthening, ankle bracing that blocks subtalar joint inversion, and application of small lateral heel wedges, have been described. treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter study. Individuals who participate in activities that involve the ankle, such as ballet and gymnastics or . Both arthroscopic and non-arthroscopic techniques used for repairing have yielded good results. Orthop Traumatol Surg Res 2016;102:65761. Online ahead of print. . Between weeks 6 and 12, closed chain as well as passive and active range of motion exercises were added to the rehabilitation program. [2] In preoperative assessment, a detailed history was taken and a thorough clinical examination was performed. Failure after strict rehabilitation may be an indication of surgery. Orthop Trauma Surg 1982;99:1837. Int Orthop, 34 (7) (2010), pp. Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient's level of activity. The LB is a double ligament with a common origin on the lateral aspect of the anterior process of the calcaneus (APC). [23]. We therefore recommend a treatment algorithm for chronic ankle instability depending on arthroscopic findings regarding the integrity of CFL. Conservative management is the mainstay of treatment in chronic lateral ankle instability. Strength of the kappa coefficients was interpreted in the following manner: 0.01 to 0.20: slight; 0.21 to 0.40: fair; 0.41 to 0.60: moderate; 0.61 to 0.80: substantial; 0.81 to 1.00: near perfect. Please try after some time. Finally, between the third and sixth postoperative month, patients would gradually start sports specific exercises. These three issues need to all be considered as part of a triad of chronic ankle instability issues. Recurrent inversion injuries caused pain, swelling, stiffness, and a feeling of giving way, thus preventing participants from participating in sports as well as the physical aspects of military training exercises. If the injury does not improve with bracing and therapy over time, the best treatment is surgical ligament repair. Our proposed algorithm offered a reliable pathway for accurate evaluation and successful treatment of chronic lateral ankle instability in high-demand groups. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains[J]. Injuries of the hindfoot. Disclaimer, National Library of Medicine Nielsen S, Agnholt J, Christensen H. Radiologic findings in lesions of the ligamentum bifurcatum of the midfoot. LB = ligamentum bifurcatum. The paired t test and Wilcoxon signed-rank test were used to determine the differences. Conversely, we postulated that the CFL was the primary restraint for lateral ankle instability and that reconstruction of the lateral capsuloligamentous complex should be offered only to CFL-deficient patients. Two Mitek G-II anchors (Mitek Products Inc., Norwood, MA, USA) were then inserted into the bare bone area accommodating the reattachment of the CFL to the lateral malleolus. Of the 112 cases of CLAI plus concurrent LB injury, 62 patients (55.4%) were men, and 50 (44.6%) were women. http://creativecommons.org/licenses/by-nc-nd/4.0, Received in revised form February 7, 2018. Consent was obtained or waived by all participants in this study. Abbreviations: AOFAS = American Orthopaedic Foot and Ankle Society, APC = anterior process of the calcaneus, CLAI = chronic lateral ankle instability, LB = ligamentum bifurcatum, VAS = visual analog scale pain scores. This site needs JavaScript to work properly. As part of our routine, the lateral ankle ligaments were evaluated. Search for Similar Articles Both scores were calculated preoperatively and two years postoperatively. [24]. Weng PW, Chen CY, Tsuang YH, Sun JS, Lee CH, Cheng CK. Gellman M. Fracture of the anterior process of the calcaneus. sharing sensitive information, make sure youre on a federal Both the anterior ankle drawer test and the varus stress test were positive. Anatomic repair using a modification of the Brostrm procedure is the preferred technique for initial surgery. Preoperative Lymphocyte-to-Monocyte Ratio Can Indicate the Outcomes in Repair of I-III Degree Injury of Lateral Ankle Ligament. The integrity of the CFL was evaluated clinically with the talar tilt test. Chronic ankle instability (medial and lateral). The APC is seen on the lateral view, but is projected over the talus. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. LB = ligamentum bifurcatum. HHS Vulnerability Disclosure, Help We found that many patients with ankle instability also had Chopart lateral joint instability. and transmitted securely. Would you like email updates of new search results? DVT (deep vein thrombosis) prophylaxis was prescribed until the cast was removed. Lindner HO, Kaufner HK. Postoperatively, most patients recovered very well. Open anatomic reconstruction is an effective method of stabilization. Hence, to fully support this observation, a double-blinded clinical study must be designed. 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