Ankle and Subtalar Joint Kinematics Following Lateral Ligament Repair-Implications for Early Surgical Treatment

Pereira, Hélder; D’Hooghe, Pieter; Anderson, Nicholas; Fuld, Richard; Kelley, Judas; Baldini, Todd; Hunt, Kenneth J.

doi:10.1016/j.arthro.2017.08.106

Cited by 3 publications

(2 citation statements)

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“…Overall, after a combined ATFL-CFL rupture, combined ATFL-CFL reconstruction better restored normal motion than isolated ATFL reconstruction, especially for frontal-plane ROM and AA. This is in contrast with the study of Pereira et al 22 in which no significant differences were found in the kinematics after both isolated and combined ligament reconstruction. However, in Pereira et al's study 22 the cadaveric specimens were subjected to an inversion of 20°, which is more challenging than the normal and trapdoor gait that were investigated in this study.…”

Section: Discussioncontrasting

confidence: 99%

“…This is in contrast with the study of Pereira et al 22 in which no significant differences were found in the kinematics after both isolated and combined ligament reconstruction. However, in Pereira et al's study 22 the cadaveric specimens were subjected to an inversion of 20°, which is more challenging than the normal and trapdoor gait that were investigated in this study. Although surgeons think that combined reconstruction may benefit patients, CFL reconstruction surgery is not always considered, given its location underneath the peroneal tendons, close to the sural nerve.…”

Section: Discussioncontrasting

confidence: 99%

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Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures

et al. 2019

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Background: Altered kinematics and persisting ankle instability have been associated with degenerative changes and osteochondral lesions. Purpose: To study the effect of ligament reconstruction surgery with suture tape augmentation (isolated anterior talofibular ligament [ATFL] vs combined ATFL and calcaneofibular ligament [CFL]) after lateral ligament ruptures (combined ATFL and CFL) on foot-ankle kinematics during simulated gait. Study Design: Controlled laboratory study. Methods: Five fresh-frozen cadaveric specimens were tested in a custom-built gait simulator in 5 different conditions: intact, ATFL rupture, ATFL-CFL rupture, ATFL-CFL reconstruction, and ATFL reconstruction. For each condition, range of motion (ROM) and the average angle (AA) in the hindfoot and midfoot joints were calculated during the stance phase of normal and inverted gait. Results: Ligament ruptures mainly changed ROM in the hindfoot and the AA in the hindfoot and midfoot and influenced the kinematics in all 3 movement directions. Combined ligament reconstruction was able to restore ROM in inversion-eversion in 4 of the 5 joints and ROM in internal-external rotation and dorsiflexion-plantarflexion in 3 of the 5 joints. It was also able to restore the AA in inversion-eversion in 2 of the 5 joints, the AA in internal-external rotation in all joints, and the AA in dorsiflexion-plantarflexion in 1 of the joints. Isolated ATFL reconstruction was able to restore ROM in inversion-eversion and internal-external rotation in 3 of the 5 joints and ROM in dorsiflexion-plantarflexion in 2 of the 5 joints. Isolated reconstruction was also able to restore the AA in inversion-eversion and dorsiflexion-plantarflexion in 2 of the joints and the AA in internal-external rotation in 3 of the joints. Both isolated reconstruction and combined reconstruction were most successful in restoring motion in the tibiocalcaneal and talonavicular joints and least successful in restoring motion in the talocalcaneal joint. However, combined reconstruction was still better at restoring motion in the talocalcaneal joint than isolated reconstruction (1/3 for ROM and 1/3 for the AA with isolated reconstruction compared to 1/3 for ROM and 2/3 for the AA with combined reconstruction). Conclusion: Combined ATFL-CFL reconstruction showed better restored motion immediately after surgery than isolated ATFL reconstruction after a combined ATFL-CFL rupture. Clinical Relevance: This study shows that ligament reconstruction with suture tape augmentation is able to partially restore kinematics in the hindfoot and midfoot at the time of surgery. In clinical applications, where the classic Broström-Gould technique is followed by augmentation with suture tape, this procedure may protect the repaired ligament during healing by limiting excessive ROM after a ligament rupture.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 99%

Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures

et al. 2019

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Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement

Pereira

Vuurberg

Spennacchio

et al. 2018

Advances in Experimental Medicine and Biology

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Ankle sprain is amongst the most frequent musculoskeletal injuries, particularly during sports activities. Chronic ankle instability (CAI) resulting from an ankle sprain might have severe long-lasting consequences on the ankle joint. Despite the fact that most patients will respond favourably to appropriate conservative treatment, around 20% will develop symptomatic CAI with sense of giving away and recurrent sprains leading to functional impairment. "Classical" surgical repair by Brostrom-like surgery in one of its many modifications has achieved good results over the years. Recently, major advances in surgical techniques have enabled arthroscopic repair of ankle instability with favourable outcome while also enabling the treatment of other concomitant lesions: loose bodies, osteochondral defects (OCDs) or ankle impingement. Moreover, when the tissue remnant does not permit a repair technique, anatomic reconstruction by means of using a free graft has been developed. In many cases, OCDs occur as a consequence of CAI. However, traumatic and non-traumatic aetiologies have been described. There is no evidence favouring any surgical treatment over another concerning OCDs. Considering lower cost and limited aggression, microfracture is still the most frequent surgical approach. Herein, the authors describe their algorithm in the treatment of these conditions. Similarly, anterior or posterior impingement might be linked with CAI. These are clinical syndromes based on clinical diagnosis which are currently managed arthroscopically upon failure of conservative treatment.

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Concurrent Pathology and Ankle Instability

Pereira

D’Hooghe

Hunt

et al. 2021

Lateral Ankle Instability

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Ankle and Subtalar Joint Kinematics Following Lateral Ligament Repair-Implications for Early Surgical Treatment

Cited by 3 publications

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Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures

Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures

Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement

Concurrent Pathology and Ankle Instability

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