A modified all-inside arthroscopic remnant-preserving technique of lateral ankle ligament reconstruction: medium-term clinical and radiologic results comparable with open reconstruction

Zhang, Kaibin; Khan, Abdul Aleem; Dai, Hanhao; Li, Yang; Tao, Tianqi; Jiang, Yiqiu; Gui, Jian‐Fang

doi:10.1007/s00264-020-04773-w

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…In accordance with the previously published literature, this study demonstrated considerable clinical improvements in patients with CLAI after open and arthroscopic ATFL reconstruction, with no differences between the 2 procedures. Zhang et al 26 also demonstrated that the clinical outcomes did not differ substantially between patients treated with either arthroscopic or open reconstruction using AOFAS, visual analog scale, and Karlsson scores and talar tilt angle and anterior talar translation measurements. However, knowledge regarding the difference in cartilage condition between the 2 procedures is limited.…”

Section: Discussionmentioning

confidence: 95%

Evaluation of Open Versus Arthroscopic Anterior Talofibular Ligament Reconstruction for Chronic Lateral Ankle Instability With Talar and Subtalar Cartilage MRI T2 Mapping: A 3-Year Prospective Study

Hu,

Li,

et al. 2024

Am J Sports Med

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Background: Previous studies have examined patients with chronic lateral ankle instability (CLAI) undergoing open and arthroscopic anterior talofibular ligament (ATFL) reconstruction, reporting equivalent clinical results between the 2 procedures. However, data on the magnetic resonance imaging (MRI) outcomes on cartilage health after the 2 procedures are limited. Purpose: To compare the cartilage MRI T2 values of the talar and subtalar joints between patients with CLAI undergoing open and arthroscopic ATFL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective study was conducted on patients who underwent open or arthroscopic ATFL reconstruction between January 2018 and December 2019, with a mean follow-up duration of 3 years. MRI scans and American Orthopaedic Foot & Ankle Society (AOFAS) and Tegner score estimations were completed by patients ≤1 week before surgery, as a baseline measurement, and at a 3-year follow-up. A total of 21 healthy volunteers were included who underwent MRI at baseline. Cartilage health was evaluated using MRI T2 mapping. The talar and subtalar cartilage regions were segmented into 14 subregions. Results: At baseline, patients with CLAI had substantially higher T2 values in the medial anterior, medial center, medial posterior, and lateral center regions on the talus compared with the healthy controls ( P = .009, .003, .001, and .025, respectively). Remarkable increases in T2 values in the lateral posterior region on the talus were observed from baseline to follow-up in the open group ( P = .007). Furthermore, T2 values were considerably higher in the medial center, medial posterior, lateral posterior, and lateral posterior calcaneal facets of the posterior subtalar joint at follow-up in the arthroscopic group compared with the baseline values ( P = .025, .002, .006, and .044, respectively). No obvious differences in ΔT2 values were noted between the 2 groups at follow-up. The AOFAS and Tegner scores remarkably improved from baseline to follow-up for the 2 groups (open: 3.25 ± 0.58 vs 5.13 ± 0.81, P < .001; arthroscopic: 3.11 ± 0.90 vs 5.11 ± 1.08, P < .001), with no considerable difference between them. Conclusion: The elevated T2 values of cartilage could not be fully recovered after open or arthroscopic ATFL reconstruction. Both arthroscopic and open ATFL reconstruction displayed similar effects on cartilage health concerning ΔT2, but the arthroscopic group demonstrated more degenerative cartilage subregions than the open group.

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Section: Discussionmentioning

confidence: 95%

Evaluation of Open Versus Arthroscopic Anterior Talofibular Ligament Reconstruction for Chronic Lateral Ankle Instability With Talar and Subtalar Cartilage MRI T2 Mapping: A 3-Year Prospective Study

Hu,

Li,

et al. 2024

Am J Sports Med

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“…Second, the possibility that concomitant lesions, including OLTs or synovitis, may have affected clinical outcomes cannot be excluded. Nonetheless, correlations between osteochondral defects and postoperative ankle pain—more often caused by other intra‐articular pathologic conditions, including hypertrophic synovial thickening, synovitis, and soft tissue impingement—have been insufficiently evidenced by previous studies [29, 38]. Additionally, there were no patients with definite pathology related to peroneal tenosynovitis either clinically or on preoperative MRI.…”

Section: Discussionmentioning

confidence: 96%

Arthroscopic Broström–Gould repair has comparable radiological and clinical outcomes compared to traditional open Broström–Gould repair in high-demand patients

Baek

Kim

Jeong

2022

Knee Surg Sports Traumatol Arthrosc

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Purpose This study sought to conirm whether traditional open Broström-Gould repair and arthroscopic Broström-Gould repair for chronic ankle instability (CAI) would produce comparable radiological and clinical outcomes in high-demand patients. Methods This retrospective case-cohort study included high-demand patients, as determined by a pre-injury Tegner Activity Level ≥ 6, who underwent Broström-Gould repair and were followed up for ≥ 2 years. Patients were divided into the arthroscopic Broström-Gould repair group (AS Group) and the open Broström-Gould repair group (Open Group). Perioperative radiological assessments were performed. The Tegner Activity Levels, Foot and Ankle Outcome Scores (FAOSs), Karlsson and Peterson (K-P) scores, and American Orthopaedic Foot and Ankle Society ankle-hindfoot (AOFAS) scores were evaluated clinically. Results A total of 65 patients (31 from the AS Group and 34 from the Open Group) were included in the study. There were no diferences in age, sex, body mass index, preoperative anterior talar translation, talar tilt, signal-to-noise ratio, FAOS, K-P score, or AOFAS score between the two groups (n.s.). The preinjury median Tegner Activity Level was 7 and unchanged at the inal follow-up in both groups. Postoperative stress radiographs showed improvement; however, the groups did not difer signiicantly. The FAOS, K-P scores, and AOFAS scores improved in each group (P < 0.001). However, the clinical scores did not difer between the groups (all n.s.). Conclusions Traditional open and arthroscopic Broström-Gould repair for CAI in high-demand patients had comparable radiological and clinical outcomes. Clinically, arthroscopic Broström-Gould repair may represent a viable surgical alternative to open Broström-Gould repair in high-demand patients. Level of evidence Level III.

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“…In the reconstruction group, only 3 patients had mild ROM limitations while achieving good joint stability. Several studies have highlighted the potential risk of ligament reconstruction restricting ROM and negatively affecting the patient’s feelings and clinical outcomes [23, 42]. Li et al found that 25% of patients undergoing anatomic reconstruction surgery reported a tight feeling of the reconstructed ligaments [23].…”

Section: Discussionmentioning

confidence: 99%

“…Compared to the open procedure, arthroscopic lateral ankle ligament stabilisation could theoretically reduce the surgical invasiveness and accelerate postoperative recovery. Till now, several articles have reported the superiority of arthroscopic repair and reconstruction technique in functional outcomes and complications [4, 12, 42]. The comparison in return‐to‐activities and mid‐ to long‐term outcomes between arthroscopic and open anatomic reconstruction is needed in the future.…”

Section: Discussionmentioning

confidence: 99%

Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability

Zhu

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo compare the return‐to‐activity and long‐term clinical outcomes between anatomic lateral ligament reconstruction using the autologous gracilis tendon and modified Broström‐Gould (MBG) procedure in chronic lateral ankle instability (CLAI). It was hypothesised that there was no difference between the two techniques. MethodsFrom 2013 to 2018, 30 CLAI patients with grade III joint instability confirmed by anterior drawer test underwent anatomic reconstruction of lateral ankle ligament with the autologous gracilis tendon (reconstruction group) in our institute. Another 30 patients undergoing MBG procedure (MBG group) were matched in a 1:1 ratio based on demographic parameters. The post‐operative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner activity score, Karlsson–Peterson score, surgical complications, return‐to‐activities and work were retrospectively evaluated and compared between the two groups. ResultsAll subjective scores significantly improved after the operation (all with p < 0.001) without difference between the two groups (all n.s.). The MBG group showed a significantly higher proportion of postoperative sprain recurrence than the reconstruction group (26.7% vs. 0, p = 0.002). The reconstruction group showed a significantly longer period to start walking with full weight‐bearing (10.5 ± 6.9 vs. 7.0 ± 3.1 weeks, p = 0.015), jogging (17.1 ± 8.9 vs. 12.7 ± 6.9 weeks, p = 0.043) and return‐to‐work (13.5 ± 12.6 vs. 8.0 ± 4.7 weeks, p = 0.039) than the MBG group. ConclusionsBoth anatomic reconstruction using the autologous gracilis tendon and MBG procedure could equally achieved reliable long‐term clinical outcomes and the tendon reconstruction showed a relatively lower incidence of postoperative sprain recurrence but delayed recovery to walking, jogging and return‐to‐work. The MBG procedure was still the first choice with rapid recovery but the tendon reconstruction was recommended for patients with higher strength demand. Level of evidenceIII.

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A modified all-inside arthroscopic remnant-preserving technique of lateral ankle ligament reconstruction: medium-term clinical and radiologic results comparable with open reconstruction

Cited by 8 publications

References 28 publications

Evaluation of Open Versus Arthroscopic Anterior Talofibular Ligament Reconstruction for Chronic Lateral Ankle Instability With Talar and Subtalar Cartilage MRI T2 Mapping: A 3-Year Prospective Study

Evaluation of Open Versus Arthroscopic Anterior Talofibular Ligament Reconstruction for Chronic Lateral Ankle Instability With Talar and Subtalar Cartilage MRI T2 Mapping: A 3-Year Prospective Study

Arthroscopic Broström–Gould repair has comparable radiological and clinical outcomes compared to traditional open Broström–Gould repair in high-demand patients

Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability

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