Morphology of Anterior Talofibular Ligament After Arthroscopic Lateral Ankle Ligament Repair

Hagio, Tomonobu; Yoshimura, Ichiro; Kanazawa, Kazuki; Minokawa, So; Yamamoto, Takuya

doi:10.1177/1071100720920610

Cited by 8 publications

(9 citation statements)

References 46 publications

(59 reference statements)

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“…26 Assessing the anterior drawer and talar tilt laxity, which were deemed pathological when a "nonstop" was discovered, was the basis of the physical examination of the ankle instability. 6,26 We excluded 33 ankles (32 patients) for the following reasons: (1) inadequate (less than 1 year) follow-up after surgery (16 ankles); (2) ankle osteoarthritis diagnosed by plain radiographs, stage 2 or higher according to the Takakura classification 20 (3 ankles); (3) previous ankle surgery (3 ankles); (4) neuromuscular disorders (1 ankle); (5) pre-or postoperative hindfoot alignment view was not obtained (10 ankles). Finally, 63 ankles of 62 patients were included, and 3 patients were <15 years old.…”

Section: Methodsmentioning

confidence: 99%

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Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

et al. 2023

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Background: Hindfoot varus deformity is a known risk factor for chronic lateral ankle instability (CLAI). The impact of this deformity on clinical results following arthroscopic lateral ankle ligament repair (ALLR) for CLAI has not been studied. Methods: Sixty-three ankles from 62 patients who received ALLR for CLAI were retrospectively examined. Preoperative plain radiographs were used to measure tibial articular surface (TAS) angles, and long axial hindfoot alignment radiographs were used to measure tibiocalcaneal angles (TCAs) pre- and postoperatively. Results included ratings on the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and recurrent ankle instability (respraining of the operated ankle following surgery). Results: Recurrent ankle instability, defined as incidence of any new ankle sprain after surgery reported in the follow-up period, occurred in 13 ankles. The TAS angles of these patients were significantly low, and their preoperative TCA was significantly high. Multivariate analysis showed that preoperative TCA was an independent risk factor for recurrent ankle instability. The threshold values for preoperative TCA for recurrent instability were determined via the receiver operating characteristic curve analysis to be 3.4 degrees. Patients were assigned to a low- or high-TCA group based on the reported average TCA (2.7 degrees) of healthy patients. In the high-TCA group, recurrent instability was significantly more frequent, and the scores on the pain subscale of the postoperative SAFE-Q were significantly lower. Conclusion: Hindfoot varus alignment was associated with pooreroutcomes after ALLR. Level of Evidence: Level III, retrospective comparative study.

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Section: Methodsmentioning

confidence: 99%

“…26 Assessing the anterior drawer and talar tilt laxity, which were deemed pathological when a “nonstop” was discovered, was the basis of the physical examination of the ankle instability. 6,26…”

Section: Methodsmentioning

confidence: 99%

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

et al. 2023

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Section: Introductionmentioning

confidence: 99%

“…For these cases, surgical treatment is recommended to restore the stability of the ankle, improve the symptoms, and prevent subsequent disorders, including osteoarthritis. 13,16,32,37,40,56 There are 2 gold standard surgical procedures for chronic lateral ankle instability: anatomical repair, such as the Broström procedure, and anatomical reconstruction using graft tendons. Anatomical reconstruction is recommended for patients in whom prior surgery has failed, who have a high body mass index, or who have insufficient remnant anterior talofibular ligaments (ATFL).…”

Section: Introductionmentioning

confidence: 99%

Effects of the Ankle Flexion Angle During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft

et al. 2022

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Background: This study aimed to evaluate the effects of the ankle flexion angle during anterior talofibular ligament (ATFL) reconstruction on ankle kinematics, laxity, and in situ force of a graft. Methods: Twelve cadaveric ankles were evaluated using a 6–degrees of freedom robotic system to apply passive plantar flexion and dorsiflexion motions and multidirectional loads. A repeated measures experiment was designed using the intact ATFL, transected ATFL, and reconstructed ATFL. During ATFL reconstruction (ATFLR), the graft was fixed at a neutral position (ATFLR 0 degrees), 15 degrees of plantar flexion (ATFLR PF15 degrees), and 30 degrees of plantar flexion (ATFLR PF30 degrees) with a constant initial tension of 10 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ force of the ATFL and reconstructed grafts were calculated using the principle of superposition. Results: The in situ forces of the reconstructed grafts in ATFLR 0 degrees and ATFLR PF 15 degrees were significantly higher than those of intact ankles. The ankle kinematics and laxity produced by ATFLR PF 30 degrees were not significantly different from those of intact ankles. The in situ force on the ATFL was 19.0 N at 30 degrees of plantar flexion. In situ forces of 41.0, 33.7, and 21.9 N were observed at 30 degrees of plantar flexion in ATFLR 0, 15, and 30 degrees, respectively. Conclusion: ATFL reconstruction with the peroneus longus (PL) tendon was performed with the graft at 30 degrees of plantar flexion resulted in ankle kinematics, laxity, and in situ forces similar to those of intact ankles. ATFL reconstructions performed with the graft fixed at 0 and 15 degrees of the plantar flexion resulted in higher in situ forces on the reconstructed graft. Clinical Relevance: Fixing the ATFL tendon graft at 30 degrees of plantar flexion results in an in situ force closest to that of an intact ankle and avoids the excessive tension on the reconstructed graft.

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“…11,14 However, approximately 20% of patients develop chronic lateral ankle instability (CLAI), leading to repeated sprains and, in some cases, the development of osteoarthritis. 7,9,17,21,25,30 Surgical treatment is indicated for athletes whose performance is adversely affected by CLAI and patients who experience severe instability in the conduct of daily activities. Anatomic open repair of the anterior talofibular ligament (ATFL) has long been the standard procedure, 4 but the recent development of effective devices and increasing demand for minimally invasive surgery have led to the more frequent use of arthroscopic ankle lateral ligament repair (ALLR).…”

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confidence: 99%

Effect of Accelerated Rehabilitation on Early Return to Sport After Arthroscopic Ankle Lateral Ligament Repair

Teramoto

Murahashi

Takahashi

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, studies have described postoperative cast immobilization and the avoidance of weightbearing for a certain period. Accelerated rehabilitation may be helpful for an early return to sport. Purpose: To investigate clinical outcomes of ALLR and accelerated rehabilitation with a minimum duration of postoperative ankle immobilization and proactive early weightbearing. Study Design: Case series; Level of evidence, 4. Methods: This study investigated 23 ankles of 22 patients (11 men, 11 women; mean age, 38.7 years) who underwent ALLR for chronic lateral ankle instability. Postoperative management included the avoidance of weightbearing until postoperative day 3, after which full weightbearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. The following were evaluated: pre- and postoperative instability and pain symptoms, ankle range of motion, anterior drawer distance on stress radiograph, anterior translation measured with a capacitance-type strain sensor, the Ankle-Hindfoot Scale from the Japanese Society for Surgery of the Foot, and the SAFE-Q (Self-Administered Foot Evaluation Questionnaire). Results: Two male patients dropped out and were excluded from analysis. Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in range of motion. There were significant pre- to postoperative improvements in talar tilt angle (from 12.2°-5.6°, P < .01), anterior drawer distance (8.2-4.4 mm, P < .01), and anterior translation (10.5-4.6 mm, P < .01) as well as the Ankle-Hindfoot Scale score (68.8-96.8, P < .01) and all subscales of the SAFE-Q ( P ≤ .01 for all). Complete return to sport was achieved by 75% of the patients at 8 weeks postoperatively. Conclusion: When accelerated rehabilitation with proactive weightbearing exercises was implemented from postoperative day 3 without ankle immobilization after ALLR, there were significant improvements in objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.

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Morphology of Anterior Talofibular Ligament After Arthroscopic Lateral Ankle Ligament Repair

Cited by 8 publications

References 46 publications

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

Hindfoot Alignment and Ankle Stability Following Arthroscopic Lateral Ankle Ligament Repair

Effects of the Ankle Flexion Angle During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft

Effect of Accelerated Rehabilitation on Early Return to Sport After Arthroscopic Ankle Lateral Ligament Repair

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