Operative treatment of lateral ligament instability

Shakked, Rachel; Karnovsky, Sydney C.; Drakos, Mark C.

doi:10.1007/s12178-017-9391-x

Cited by 43 publications

(28 citation statements)

References 101 publications

(93 reference statements)

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“…6,10 Therefore, ankle stress radiographs, including those in the varus stress and anterior drawer views, are widely used to evaluate the degree of lateral ankle instability and to define surgical indication, although the criteria for surgical indication or cutoff values are variable. 2,5,13 Interobserver Reliability and Consistency of Ankle Stress Radiographs Lohrer et al 11 reported values for the reliability of ankle stress radiographs that were comparable to our results, and this modality is considered relevant for clinical use. The study suggested that further studies should address the consistency and accuracy of obtaining multiple ankle stress radiographs of the same patients to improve the clinical relevance of ankle stress radiographs.…”

Section: Clinical Utility Of Ankle Stress Radiographssupporting

confidence: 87%

Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

Choi

Chung

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient’s ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph.

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Section: Clinical Utility Of Ankle Stress Radiographssupporting

confidence: 87%

Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

Choi

Chung

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…However, it is now evident that the long-term effects of surgical treatment is similar to functional treatment in cases of acute ankle sprain and the majority of cases do not need surgery to resolve the complaints (level 1)[ 161 - 163 ]. Currently, non-operative functional treatment is the preferred method and surgery is only reserved for acute cases of unstable syndesmotic injuries, associated ankle fractures, chronic cases of refractory ankle instability (defined by varus tilt > 10° or > 5° compared to the contralateral side or 10 mm of anterior translation or 5 mm more than the contralateral side)[ 164 ], and in cases not responding to an adequate exercise-based rehabilitation[ 33 ]. However, treatment decisions should be individualized.…”

Section: Treatment and Rehabilitationmentioning

confidence: 99%

“…The modified Broström procedure is commonly used and comprises the direct anatomic repair of torn lateral ligaments together with reinforcement of the inferior extensor retinaculum[ 166 ]. This procedure has a success rate of > 90%[ 164 ]. Arthroscopic surgery may be preferred in order to treat or rule out a concomitant intra-articular lesion, avoid unnecessary exposure to a more invasive approach, and expedite recovery and return to play in the athletic population (level 1)[ 10 , 36 , 162 ].…”

Section: Treatment and Rehabilitationmentioning

confidence: 99%

Acute ankle sprain in athletes: Clinical aspects and algorithmic approach

Halabchi

Hassabi

2020

WJO

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Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.

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“…The current surgical treatment of CLAI is mainly divided into anatomical repair of the ligament and strengthening of the lateral ligament. In open surgery, the Broström procedure with direct ATFL repair and Broström‐Gould procedure combined with extensor retinaculum suture to strengthen the lateral ligament of the ankle are considered the gold standard procedures for the treatment of CLAI. The above surgical procedures are performed for treatment of CLAI in traditional open surgery.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium‐ and Long‐Term Functional Follow‐Up

Feng

Sun

Wang

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium-and long-term follow-up.Methods: From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles, 25 right ankles) aged between 21 and 56 years, with an average age of 32.17 AE 6.35 years, presenting with CLAI, was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07 AE 13.29 months. All patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair of ATFL, with the fixation of one to two anchors. Pre-and post-operative visual analogue scales (VAS), the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation. Results:The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average of 51.25 AE 11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve, blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77 AE 1.36 days. All patients were followed for 24 to 45 months, averaging 33.16 AE 10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow-up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12 AE 0.13, the AOFAS score increased to 92.53 AE 4.87, and the KAFS score increased to 93.36 AE 6.15. All the follow-up indexes were significantly different from those before surgery.Conclusion: Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable medium-and long-term effect.

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Operative treatment of lateral ligament instability

Cited by 43 publications

References 101 publications

Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

Consistency and Reliability of Ankle Stress Radiography in Patients With Chronic Lateral Ankle Instability

Acute ankle sprain in athletes: Clinical aspects and algorithmic approach

Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium‐ and Long‐Term Functional Follow‐Up

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