Open Evaluation of the Peroneal Tendons Should Be Considered in Patients With Chronic Lateral Ankle Instability Undergoing Ankle Arthroscopy With Lateral Ankle Stabilization

Clair, Benjamin L.; Winder, Michelle; Neubauer, Elizabeth F.

doi:10.1053/j.jfas.2021.10.020

Cited by 4 publications

(3 citation statements)

References 19 publications

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“… 9 The fact that peroneal pathology is a common concomitant finding in CAI may provide reasoning as to why its presence does not impact long-term patient-reported outcomes. 4 …”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up

Scheinberg,

Sanchez,

Sankey

et al. 2024

Foot & Ankle Orthopaedics

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Background: Ankle sprains are a common musculoskeletal injury among the general population and often involve the lateral ligament complex. Although the majority of ankle sprains are treated successfully with nonsurgical conservative measures, an estimated 5% to 20% of ankle injuries ultimately develop chronic lateral ankle instability (CAI). Multiple surgical treatment modalities for the lateral ankle complex exist, such as anatomical and nonanatomical reconstruction. The current gold standard for primary surgical repair is the Broström-Gould procedure. This is the first article to provide PROMIS scores following BG and the largest study with 5-year outcomes for an open BG. Methods: This was a descriptive study of a retrospective cohort of patients undergoing a BG with a minimum follow-up of 5 years. Patient-reported outcome instruments collected postoperatively were PROMIS Pain, Physical Function, Depression, and FAAM. Further preoperative clinic characteristics were analyzed to correlate with the final outcome. The electronic medical record was queried for Current Procedural Terminology ( CPT) code 27698 (Broström-Gould) from January 2010 to June 2017. Surveys were conducted in the clinic and through phone interviews. Patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). The following preoperative variables were recorded: history of prior CAI procedures, history of major trauma, duration of symptoms, number of diagnosed ankle sprains, other collagen pathologies, generalized ligament laxity, participation in sports/activity level, peroneal subluxation, clinically diagnosed peroneus longus or brevis tendinopathy, deltoid ligament injury, anterior ankle impingement, and posterior ankle impingement. The PROMIS and Foot and Ankle Ability Measure (FAAM) scores were obtained with a combination of clinic and phone interviews. Data were aggregated in Microsoft Excel and entered in R (version 4.2.0) for statistical analysis. Results: Our results show that the minimum 5-year patient-reported PROMIS scores for patients following a Broström-Gould procedure are as follows: PROMIS physical function, 50.5; PROMIS pain interference, 48.2; and PROMIS depression, 38.2. This indicates, at a minimum, that patients 5 years removed from the procedure are within 1 SD of the general population in regard to PROMIS physical function and pain. Our patient-reported FAAM, activities of daily living, and FAAM sports scores were 59.6 and 13.0 respectively. Preoperative magnetic resonance imaging (MRI) findings were recorded. Arthroscopic examination was performed before lateral ligaments reconstruction for patients with intra-articular pathologies confirmed on MRI. Conclusion: The findings from our study offer evidence supporting the effectiveness of the Broström-Gould procedure to be associated with normal physical function, even 5 years after surgery. Furthermore, our research identified specific factors such as tobacco use, diabetes, and sports participation that independently correlated with reported outcome measures. These insights enable physicians to better manage patient expectations and tailor treatment strategies accordingly. Our study establishes a foundation for future prospective research endeavors that aim to leverage the PROMIS system for comprehensive outcome assessments. Level of Evidence: Level III, retrospective cohort study.

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“… 9 The fact that peroneal pathology is a common concomitant finding in CAI may provide reasoning as to why its presence does not impact long-term patient-reported outcomes. 4 …”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up

Scheinberg,

Sanchez,

Sankey

et al. 2024

Foot & Ankle Orthopaedics

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“…While these types of tears may be seen in any age group, they often result from degeneration or repetitive microtrauma with subsequent tendon thinning, which progresses to a tear propagating from the level of the retromalleolar groove [24]. Less commonly, peroneus brevis tears result from acute athletic injuries and contribute to chronic lateral ankle instability [25,26]. Given the relatively high rate of these tears in patients with lateral ankle pain, it is particularly important to assess the diagnostic accuracy of US and MRI in these cases.…”

Section: Peroneus Brevis Tearmentioning

confidence: 99%

Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation

Melville,

Taljanovic,

Gimber

et al. 2024

JCM

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Suspected peroneal tendinopathy, tears, and subluxation are often confirmed preoperatively using magnetic resonance imaging (MRI) or diagnostic ultrasound (US). No study has directly compared the accuracy of these tests for the diagnosis of peroneal tendon pathology. The purpose of this study is to directly compare MRI and US to intraoperative findings in patients who underwent surgery for suspected peroneal pathology to determine the imaging diagnostic accuracy. Operative records and diagnostic images for 21 consecutive patients who had both MRI and US prior to surgery for suspected peroneal tendinopathy, tears, or subluxation were retrospectively reviewed. The results of this review are compared with the intraoperative findings to yield the sensitivity and specificity for each imaging modality. For the diagnosis of peroneal tendon tears, US was found to have a sensitivity of 88% and specificity of 100%, compared to 100% sensitivity and specificity for MRI. In the diagnosis of peroneal tendinopathy, both US and MRI had a sensitivity and specificity of 100%. In diagnosing peroneal subluxation, US was 100% sensitive compared to 66% for MRI, and both were 100% specific. In conclusion, US was found to be more effective in diagnosing peroneal subluxation and MRI was slightly more accurate in the diagnosis of peroneal tendon tears.

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“…Operative options include anatomic repair, anatomic reconstruction with autograft or allograft, and tenodesis procedures [ 7 ]. Ankle arthroscopy can be used as an approach for anatomic repair (Corte Real 2009) or reconstruction and to identify and treat associated intra-articular conditions [ 8 ]. Tenodesis techniques are not recommended due to suboptimal long-term results [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of arthroscopic technique for anterior talofibular and calcaneofibular ligament reconstruction versus open modified brostrom-gould procedure in chronic lateral ankle instability management

Hong,

Kong,

Zhang

et al. 2024

J Orthop Surg Res

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Background Chronic Lateral Ankle Instability (CLAI) is a common condition treated using either Anterior Talofibular and Calcaneofibular Ligament (ATFL and CFL) reconstruction or Modified Brostrom Procedure (MBP). However, the comparative efficacy of these approaches is not well-studied. Methods In this study, clinical data were retrospectively collected from 101 patients diagnosed with CLAI who underwent either ATFL and CFL reconstruction (n = 51) or the MBP (n = 50). Patients were comparable in terms of age, sex, Body Mass Index (BMI), post-injury duration, preoperative American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, Visual Analog Score (VAS), Anterior Talar Translation, and Talar Tilt Angle. Results The post-operative measures showed no significant differences in AOFAS Score, Karlsson Score, and VAS between both treatment groups. However, patients who underwent ATFL and CFL reconstruction showed significantly lower follow-up Anterior Talar Translation (mean = 4.1667 ± 1.3991 mm) and Talar Tilt Angle (mean = 5.0549 ± 1.6173°) compared to those who underwent MBP. Further, patients treated with ATFL and CFL reconstruction experienced a significantly longer postoperative recovery time (median = 6 weeks) compared to MBP (median = 3 weeks). Conclusions Although both therapeutic techniques were generally effective in treating CLAI, the ATFL and CFL reconstruction approach delivered superior control of Anterior Talar Translation and Talar Tilt Angle. However, its longer recovery time merits further study to optimize the balance between therapeutic efficacy and recovery speed.

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Open Evaluation of the Peroneal Tendons Should Be Considered in Patients With Chronic Lateral Ankle Instability Undergoing Ankle Arthroscopy With Lateral Ankle Stabilization

Cited by 4 publications

References 19 publications

Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up

Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up

Comparison of Ultrasound and MRI with Intraoperative Findings in the Diagnosis of Peroneal Tendinopathy, Tears, and Subluxation

Comparative analysis of arthroscopic technique for anterior talofibular and calcaneofibular ligament reconstruction versus open modified brostrom-gould procedure in chronic lateral ankle instability management

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