Concomitant Syndesmotic Instability and Medial Ankle Instability Are Risk Factors for Unsatisfactory Outcomes in Patients With Chronic Ankle Instability

Kim, Jin Su; Young, Ki Won; Cho, Hun Ki; Lim, Seok Min; Park, Young Uk; Lee, Kyung Tai

doi:10.1016/j.arthro.2015.02.021

Cited by 15 publications

(22 citation statements)

References 29 publications

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“…cReferences 2, 4, 6 –9, 12, 13, 15 –17, 19, 20, 25, 28, 35, 40 –45, 51, 57, 58, 64, 67, 69, 72, 73, 76, 77, 79 –81, 85, 86, 96, 98, 109 –111, 114, 117 –119, 132, 136, 142, 144 –146, 154, 156, 164, 166, 168, 170, 174, 179, 180, 185, 191, 194, 196 –…”

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confidence: 99%

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Song

Liu

Sun

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered. Purpose: To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI. Study Design: A consensus statement of the Chinese Society of Sports Medicine. Methods: A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized. Results: A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded. Conclusion: This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.

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confidence: 99%

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Song

Liu

Sun

et al. 2019

Orthopaedic Journal of Sports Medicine

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Section: Discussionmentioning

confidence: 93%

“…5,6,43 Ankle instability in these 2 groups is predominantly mechanical because of anatomical defects such as arthrokinematic changes, ligamentous tear, and/or degenerative pathological laxity. 26,27,34 However, there may also be an element of functional instability that was not measured in this study. 14 The ultimate goal of surgery for treatment of CAI is to restore normal hindfoot biomechanics, 42 and the anatomic MBG procedure remains the gold standard.…”

Section: Discussionmentioning

confidence: 94%

“…A power analysis was performed based on prior research performed on the use of the LARS ligament, with documented recurrence rates and range of values for FAOS and TAS. 26 With an SD of 5 points for the total FAOS, 19 patients were required in each group to achieve a power of 80% with 95% significance. If 1 point is regarded as clinically important, then to detect a significant difference between the mean TAS, 20 patients were required in each group.…”

Section: Methodsmentioning

confidence: 99%

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Ligament Augmentation Reconstruction System (LARS) for Ankle Lateral Ligament Reconstruction in Higher-Risk Patients: A 5-Year Prospective Cohort Study

Porter

Trajkovska

Georgousopoulou

2022

Orthopaedic Journal of Sports Medicine

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Background: The modified Broström-Gould (MBG) procedure is the gold standard for patients with chronic ankle instability (CAI), but it is relatively contraindicated for patients with higher body weight or generalized ligamentous laxity (GLL). The use of the ligament augmentation reconstruction system (LARS) is an alternative. Hypothesis: It was hypothesized that clinical outcomes would be similar in patients with increased body weight (>90 kg) or GLL, relative to controls. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 66 patients satisfying the inclusion criteria were invited to participate and were divided into 3 groups: controls (no risk factors for inferior clinical outcome), patients with body weight >90 kg, and patients with GLL (Beighton score, ≥5 of 9). All patients underwent imbrication of the lateral collateral ligament complex augmented with the LARS. Primary outcomes of interest were Tegner activity scale (TAS) and Foot and Ankle Outcome Score (FAOS) subscale scores. Secondary outcomes were recurrence of ankle instability, the need for further surgery, and/or complications. Patients were reviewed at 2 and 5 years postoperatively, and outcomes between groups were compared using repeated-measures analysis of variance. Results: Complete data were available for 63 patients (21 patients in each group). TAS improved in all groups from preoperatively to 2 years and 5 years postoperatively ( P < .001 for all). Relative to the controls, the TAS scores were lower in the >90-kg group at 2 years and 5 years ( P < .001 for both periods), while the GLL group had similar scores to controls at both postoperative periods. Both the >90-kg and the GLL groups showed no significant difference in improvement on any FAOS subscale scores relative to the controls, at both 2 and 5 years postoperatively. There were no recurrences, repeat surgeries, or major complications. Conclusion: Relative to controls, patients with body weight >90 kg or GLL had similar FAOSs, and TAS scores were lower in the >90-kg group, at 2 and 5 years, after the use of the LARS to augment lateral collateral ligament imbrication for CAI. Use of the LARS in this manner is a viable option in patients for whom the MBG procedure is relatively contraindicated.

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“…Mechanical instability may occur following certain anatomical defects such as ligamentous tear, synovial irritation, arthrokinematic changes, or degenerative pathological laxity. 32-34 Functional instability means the occurrence of recurrent ankle instability and the sensation of joint instability due to the contributions of two factors: proprioceptive and neuromuscular deficits. 35 …”

Section: Aetiology and Classificationmentioning

confidence: 99%

Acute ankle sprain: conservative or surgical approach?

Al-Mohrej

Alkenani

2016

EFORT Open Reviews

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Ankle sprains fall into two main categories: acute ankle sprains and chronic ankle instability, which are among the most common recurrent injuries during occupational activities, athletic events, training and army service.Acute ankle sprain is usually managed conservatively and functional rehabilitation failure by conservative treatment leads to development of chronic ankle instability, which most often requires surgical intervention.Enhancing the in-depth knowledge of the ankle anatomy, biomechanics and pathology helps greatly in deciding the management options.

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Concomitant Syndesmotic Instability and Medial Ankle Instability Are Risk Factors for Unsatisfactory Outcomes in Patients With Chronic Ankle Instability

Cited by 15 publications

References 29 publications

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Ligament Augmentation Reconstruction System (LARS) for Ankle Lateral Ligament Reconstruction in Higher-Risk Patients: A 5-Year Prospective Cohort Study

Acute ankle sprain: conservative or surgical approach?

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