Ligament stabilization improved clinical and radiographic outcomes for individuals with chronic ankle instability and medial ankle osteoarthritis

Abstract

Purpose Chronic ankle instability with a long symptom duration is often accompanied by medial compartment ankle osteoarthritis (OA). However, the outcomes of individuals after ligament stabilization have rarely been reported. The radiographic and clinical outcomes after ligament stabilization in individuals with chronic ankle instability and medial compartment OA were investigated. Methods The study investigated 27 ankles with chronic ankle instability and medial compartment OA that underwent lateral ankle ligament reconstruction from 2007 to 2015 with a follow-up period of at least 1 year. Ligament stabilization was performed via either the modified Broström procedure (MBP) or lateral ankle reconstruction (LAR) using semitendinosus tendon allografts. ResultsThe median instability duration was 60 (range 12-480) months, and the median follow-up period was 39 (range 12-108) months. The preoperative Takakura ankle OA stage was predominantly stage I (20 patients (74.1%)), followed by stage II (five patients (18.5%)). Ankle MRI (20 ankles) revealed medial cartilage denudation in three cases (15%), cartilage thinning in nine cases (45%), osteophyte formation in ten cases (50%), and loose body formation in six cases (30%). According to the arthroscopic results, the modified Outerbridge grade was two in nine cases and four in ten cases, so these grades were the most common (37.5% and 41.7%, respectively). The MBP was performed in 14 patients, and LAR was performed in 13 patients (52% and 48%, respectively); the bone marrow stimulation procedure was performed in 15 patients (55%). The visual analogue scale score decreased from 6.0 (SD 1.6) preoperatively to 1.8 (SD 1.6) postoperatively (p = 0.000). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score improved from 61.9 (SD 14.2) to 89.7 (SD 6.2), and the Karlsson-Peterson score improved from 54.7 (SD 13.9) to 88.3 (SD 9.0) (p = 0.000). There were no serious complications, and all patients were satisfied. Conclusions Ligament stabilization with arthroscopic procedures for individuals with chronic ankle instability and medial ankle OA yielded significant functional outcomes with high patient satisfaction, even without radiographic improvement. Level of evidence IV.

Autologous Matrix-Induced Chondrogenesis With Lateral Ligament Stabilization for Osteochondral Lesions of the Talus in Patients With Ankle Instability

“…Patients with ankle instability often present with concurrent OLT, with a reported incidence of up to 60% to 95%. 30,33 In a recently published study, Kim et al 20 showed that patients with chronic ankle instability and medial ankle osteoarthritis significantly benefit from LLS, with AOFAS scores increasing from 61.9 ± 14.2 to 89.7 ± 6.2 (P < .001) postoperatively. Conversely, Jiang et al 19 investigated whether concurrent arthroscopic OLT treatment with abrasion, curettage, drilling, or microfracture has an adverse effect on the clinical outcome of LLS in patients with chronic ankle instability, as it might compromise the rehabilitation protocol.…”

Clinical significance of the anteromedial talus osteophyte in anteromedial ankle impingement in chronic lateral ankle instability

“…Osteophytes form around the ankle when the joint is unstable for an extended period of time [ 21 ]. Walsh et al performed arthroscopic treatment only for anterior ankle impingement and discovered that up to 84% had recurrence of osteophytes on imaging during the 5-year follow-up, which is thought to be associated with failure to restore ankle stability [ 6 ]. Yang et al, on the other hand, used ankle arthroscopy to stabilize the ankle joint with modified Broström repair of lateral ankle ligaments and to resect the anterior ankle osteophytes concurrently, and there was no osteophytes recurrence at a mean 3-year follow-up [ 26 ].…”

“…The anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) make up the lateral ankle ligament complex, which is one of the most critical structures for maintaining lateral ankle stability [ 4 , 5 ]. The majority of CLAI patients who follow conservative treatment may effectively manage their instability; however, for those who do not respond to conservative treatment, lateral ankle ligament complex repair/reconstruction is frequently recommended [ 6 ]. It is worth mentioning that the ATFL is the most commonly injured ligament structure, and in some cases, the only one [ 7 , 8 ].…”

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

“…This study was approved by the Peking University Third Hospital Medical Science Research Ethics Committee (IRB00006761‐M2019035). CLAI with mechanical instability was diagnosed clinically when the patient met all of the following criteria [11, 18, 25]: (1) A traumatic history of at least one significant ankle sprain; (2) persistent clinical symptoms including pain, swelling, ‘giving way’ sense, feeling of instability or recurrent sprain for at least 3 months; (3) physical examinations, including ankle anterior drawer test and varus stress test, confirmed grade III joint laxity; (4) radiographic findings with attenuated, scarred, wavy or defective lateral ankle ligaments on MRI. Respective anatomic reconstruction and MBG procedure were performed based on the quality of the ligament remnant.…”

“…Acute ankle sprain, as one of the most common sports‐related injury, usually calls for conservative treatment first [2]. However, 10–30% of patient developed chronic lateral ankle instability (CLAI), which requires ankle stabilisation surgery to improve ankle function and slow down development of ankle osteoarthritis [18, 21, 27].…”