Simultaneous ossicle resection and lateral ligament repair give excellent clinical results with an early return to physical activity in pediatric and adolescent patients with chronic lateral ankle instability and os subfibulare

Abstract

Purpose To elucidate surgical outcomes in pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare. Methods A retrospective chart review was conducted of pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare following simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active range of motion exercises for the ankle in our department between 2013 and 2017. Clinical outcomes were evaluated by comparing preoperative and final follow-up American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and Karlsson-Peterson ankle function scores. Intervals between surgery and return to physical education in school were determined. Results 31 feet of 15 male and 16 female patients were examined. Mean postoperative follow-up duration was 40.7 ± 12.7 (range 24-66) months. Mean AOFAS score increased significantly from 66.3 ± 2.5 (range 62-77) preoperatively to 96.5 ± 4.9 (range 87-100) at final follow-up (p < 0.001). Mean Karlsson-Peterson score increased significantly from 51.7 ± 4.0 (range 47-70) preoperatively to 95.3 ± 6.7 (range 80-100) at final follow-up (p < 0.001). Mean interval between surgery and return to physical education in school was 11.4 ± 1.6 (range 10-18) weeks. Conclusion Simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active ankle range of motion exercises may give excellent clinical outcomes with early return to physical activity for chronic lateral ankle instability with os subfibulare in pediatric/adolescent patients desiring an early return to physical activity. Level of evidence III.

[Retracted] Ligament Repair Method for Sports Dancers Based on Health Monitoring

“…Among them, a i +1 c is the i + l -th value in the c -th feature vector in the input, W l is the corresponding weight, b i is the value of the corresponding selector at the i th position, and L is the length of the receptive field [ 24 , 25 ]. When scanning over the input, one length is slided at a time, and a zero is added to the beginning and end of each feature vector of the input for padding, as shown in Figure 4 .…”

Treatment of Symptomatic Subfibular Ossicle by Excision and Modified Broström Procedure for Skeletally Immature Patients

“…Previous studies have suggested 2 possible theories for the ossicle. 2,8,16 The first is accessory bone, namely, a secondary ossification center at the tip of the fibula that has not fused with the metaphysis. The second is avulsion fracture of the lateral ankle ligament complex, mainly caused by a severe ankle sprain.…”

“…However, regardless of pathophysiology, children and adolescents with subfibular ossicles have higher rates of chronic lateral ankle instability (CLAI) and pain. 11,16 Conservative management is the primary strategy, such as brace immobilization, rest and functional exercise, [18][19][20]29 and surgical treatments are considered in patients with persistent symptoms. 16,24 However, the optimal surgical procedures are still under debate.…”

“…11,16 Conservative management is the primary strategy, such as brace immobilization, rest and functional exercise, [18][19][20]29 and surgical treatments are considered in patients with persistent symptoms. 16,24 However, the optimal surgical procedures are still under debate. Some studies have suggested that ossicle resection without lateral ligament reconstruction appears to be simple and effective in the treatment of posttraumatic functional instability.…”

“…1,13,14 Similar short-term outcomes were also observed in juvenile patients with symptomatic subfibular ossicles who had received treatment using the same procedure. 16,23 However, to date, the patient's physeal status before surgery and at final follow-up is still unclear, and it is necessary to clarify the physeal growth of the lateral ankle in skeletally immature patients undergoing this procedure.…”