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PURPOSE@#To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese, and/or with demand for highly intensive sports, and/or with poor-quality ligament remnants.@*METHODS@#A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament (ATFL) reconstruction with tensional remnant repair technique from January 2019 to August 2021. General data, including demographics, surgical time, and postoperative adverse events, were recorded. The American Orthopaedic Foot and Ankle Society score (AOFAS), foot and ankle ability measure (FAAM), visual analog scale (VAS), and anterior talar translation were measured preoperatively and at 6 weeks, 3 months, and 2 years postoperatively. Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL. Data were analyzed using SPSS 19.0. F test was used to analyze the pre- and postoperative VAS, FAAM, and AOFAS scores. The significance was set at p < 0.05.@*RESULTS@#There were 20 males and 10 females among the patients with a mean age of (30.71 ± 5.81) years. The average surgical time was (40.21 ± 8.59) min. No adverse events were observed after surgery. At 2 years postoperatively, the anterior talar translation test showed grade 0 laxity in all patients. VAS score significantly decreased from preoperatively to 6 weeks, 3 months, and 2 years postoperatively (p < 0.001). Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks, 3 months, and 2 years postoperatively was statistically significant (p < 0.001). At 3 months postoperatively, most patients (23/30) could return to their pre-injured activities of daily living status. At 2 years postoperatively, all patients were able to return to their pre-injured activities of daily living status, and almost every patient (18/19) who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal. The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL.@*CONCLUSION@#The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation, and allowed early return to pre-injured activities, which could be a reliable option for patients with chronic lateral ankle instability.
Subject(s)
Male , Female , Humans , Young Adult , Adult , Ankle Joint/surgery , Retrospective Studies , Activities of Daily Living , Ankle Injuries/surgery , Lateral Ligament, Ankle/surgery , Joint Instability/surgery , Ligaments , Obesity , Arthroscopy/methodsABSTRACT
OBJECTIVE@#To explore the clinical efficacy of reconstruction the anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon for the treatment of chronic lateral ankle instability.@*METHODS@#The clinical data of 42 patients with chronic lateral ankle instability treated by anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon from July 2016 to July 2019 was retrospectively analyzed. Including 30 males and 12 females, age ranged from 25 to 46 years old with an average of (37.6±12.4) years. There were 15 cases of left foot and 27 cases of right foot, the time from injury to operation was 3 to 12 months with a mean of (7.4±2.8) months. And 14 patients had tenderness in lateral collateral ligament area, 28 patients complained of multiple ankle sprains while walking on the flat ground. At 12 months after operation, the talar tilt angle and visual analogue scale(VAS)were observed, ankle joint varus stress and anterior drawer test were performed to check the mechanical stability of the ankle joint, American Orhopaedic Foot and Ankle Society(AOFAS) was used to score the ankle and hindfoot functions and evaluate the curative effect.@*RESULTS@#Forty patients were followed up for 12 to 48 months with an average of (28.3±10.0) months, 2 cases were lost. The VAS decreased from(4.50±0.93) scores before surgery to (1.10±0.30) scores at 12 months after surgery;the talar tilt angle was reduced from (12.26±1.13)° before operation to (4.60±0.45)° at 12 months after operation;the AOFAS score increased from (65.10±7.50)scores before surgery to (84.40±3.95) scores at 12 months after surgery;all the differences were statically significant(P<0.05). According to the AOFAS score, 27 cases got excellent results, 7 good, 5 fair, and 1 poor. One patient had the symptoms of sural nerve injury after operation, and the symptoms were relieved after oral Mecobalamin for 3 months. The remaining patients had no complications such as nerve injury, infection, and skin necrosis. There was no instability of ankle joint, and both ankle varus stress test and drawer test were negative.@*CONCLUSION@#Autologous peroneal brevis tendon with double bone channel pass through the tendon (modified Chrisman-Snook operation) can anatomically reconstruct the anterior talofibular ligament and the calcaneofibular ligament, restore the stability of the patient's ankle joint, reduce postoperative complications, and restore ankle joint function well.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Ankle , Ankle Joint/surgery , Joint Instability/surgery , Lateral Ligament, Ankle/surgery , Retrospective Studies , TendonsABSTRACT
Ankle sprains are commonly seen injuries among athletic and young population, and it is necessary to stabilize the patient ankle as soon as possible. Authors report the cost-effective option of using a modified Brostrom technique with one suture anchor in a limited resource setting. Case a 24- year-old male came to the orthopaedic clinic with chief complaint of left ankle pain for the past 2 weeks after jumping and landing in a twisted position. Patient also complained of unstable ankle after the fall. On physical examination, the ankle showed tenderness and instability when anterior drawer test was performed. The patient was diagnosed with lateral ankle instability. This case report describes a modification to the original Brostrom procedure using one suture anchor to anatomically reconstruct the lateral ankle ligaments in treating high demand patient who have lateral ankle instability. After six months follow up, the patient has shown significant improvement on his left ankle. Despite of all the modifications of Brostrom procedure, the use of more suture anchors or sophisticated technique such as arthroscopy might result in increasing cost. Reasonably good outcome can still be achieved with modified Brostrom procedure that utilizes minimal incision, simple steps, and single suture anchor. Due to its cost-effectiveness, authors believe that modified Brostrom technique with one suture anchor is an effective and practical treatment option for lateral ankle instability. Brostrom technique using suture anchors as shown here can provide similarly good outcomes compared with other more complex techniques.
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Objective:To compare the clinical efficacy of rehabilitation training at different stages on patients with anterior talofibular ligament injury after conservative treatment. Methods:From October 2017 to October 2018, 58 patients with anterior talofibular ligament injury were divided into six-week rehabilitation group (n = 29) and twelve-week rehabilitation group (n = 29), according to the time they began rehabilitation after injury. Visual Analogue Score (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot function scoring system were used to evaluate ankle function before rehabilitation, and two weeks, four weeks and eight weeks after rehabilitation, respectively. Results:Two weeks, four weeks and eight weeks after rehabilitation, the scores of VAS and AOFAS improved in both groups (|t| > 4.137, P < 0.001), the scores of VAS were lower (|t| > 3.110, P < 0.01), and the scores of AOFAS were higher (|t| > 3.016, P < 0.01) in the six-week rehabilitation group than in the twelve-week rehabilitation group. Conclusion:It is suggested to begin rehabilitation within six weeks for patients with anterior talofibular ligament injury after conservative treatment.
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Introducción La inestabilidad crónica lateral del tobillo es una patología frecuente en las personas que sufren esguinces. El tratamiento inicial es conservador y de no funcionar se recomienda el tratamiento quirúrgico; la técnica descrita por Broström y modificada por Gould es la más utilizada, efectiva y reportada en la actualidad. Con el advenimiento de la cirugía artroscópica, uno de los autores (JBGG) ha desarrollado una técnica mínimamente invasiva que se ha utilizado en la unidad de pie desde hace 8 años. Este trabajo evalúa los resultados funcionales, de dolor y cicatrización de los pacientes tratados con la técnica Artroscópica y la técnica de Broström-Gould abierta. Materiales & Métodos Se evaluaron un total de 111 pacientes, 50 con la técnica abierta y 61 con técnica artroscópica, operados por inestabilidad lateral crónica del tobillo entre enero de 2004 y diciembre de 2011. Se utilizo la escala AOFAS de tobillo y retropié para la medición del dolor, función y alineación, y la escala EVA para la medición del dolor. Resultados El promedio de puntuación final de la escala AOFAS fue de 90 puntos y la inestabilidad se revirtió en el 96% de los casos, para ambos grupo de pacientes. El dolor fue aliviado eficientemente por ambas técnicas. No se observaron diferencias estadísticamente significativas entre los grupos del estudio. Discusión La reparación artroscópica de la inestabilidad crónica lateral del tobillo fue tan efectiva para restablecer la función, estabilidad y eliminar el dolor del tobillo como la técnica abierta y puede tener una menor posibilidad de complicaciones relacionadas con las heridas.
Background Chronic lateral ankle instability is a common condition in people with inversion sprains. Initial treatment is conservative, and if that does not work a surgical approach is recommended, such as that described by Broström and later modified by Gould, and is the most used and effective. With the advent of arthroscopic surgery, one of the authors (JBGG) has recently developed a minimally invasive technique that has been used in the Surgical Foot and Ankle Unit of Imbanaco Medical Centre for 8 years. Therefore, this work aims to determine functional outcomes of patients treated with the arthroscopic technique compared with the open technique of Broström-Gould. Methods A total of 111 patients were evaluated, including 50 with the open method, and 61 with arthroscopic surgery technique for chronic lateral ankle instability between January 2004 and December 2011. The American orthopaedic foot and ankle score (AOFAS) scale for ankle and hindfoot was used for measuring pain, function, and alignment, and a visual analogue scale (VAS) was used to assess the pain. Results The final AOFAS score was 90 points, and instability was reversed in 96% of cases, for both groups of patients. The pain was relieved efficiently by both techniques. There were no statistically significant differences between the study groups. Discussion Arthroscopic repair of chronic lateral ankle instability is an effective tool to restore the function and stability, as well as eliminate ankle pain, and is comparable in effectiveness with the conventional technique. Additionally, there is a lower chance of complications related to wounds.
Subject(s)
Humans , Lateral Ligament, Ankle , Arthroscopy , Joint Instability , LigamentsABSTRACT
Objective To compare Magnetic Resonance Imaging(MRI) and stress radiography in diagnosing chronic anterior talofibular ligament (ATFL) injury.Methods Among 45 patients undergoing ankle arthroseopy between October 2016 and December 2016,39 patients were included in this study.The ankle arthroscopy was used as the gold standard for diagnosing the chronic ATFL injury.The sensitivity,speciality and accuary of MRI and stress radiography were calculated according to the arthroscopic findings.Results The ankle arthroscopy revealed ATFL injury in 30 cases and intact ATFL in 9 cases,while MRI results found ATFL injury in 28 cases and intact ATFL in 11 cases with thesensitivity,speciality and accuary of 90.0％,88.9％ and 89.7％ respectively.The stress radiography results revealed ATFL injury in 21 cases and intact ATFL in 18 cases,with the sensitivity,speciality and accuary of 63.3％,77.8％ and 66.7％.Conclusion MRI was more reliable in diagnosing chronic ATFL injury compared with the stress radiography.
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Objective To discuss the clinical effects of arthroscopy combined with Brostrom repair in the treatment for chronic ankle instability talofibular ligament injury.Methods From January 2012 to June 2015,42 cases of chronic ankle instability in our hospital were performed modified Brostrom repair.All the cases were evaluated by AOFAS scoring system.Results All the patients were followed up for 9 to 17 months,an average of (12.7±3.5)months.At the last follow-up,all cases could participate in normal daily running training mission.Activity levels of 2 cases with cartilage injury had a decline than before.The others were able to attend the confrontational training.Postoperative AOFAS score(88.4±4.9) increased compared with preoperative score (43.3±7.8),the difference was significant(P<0.05).ConclusionThe curative effect of arthroscopy combined with Brostrom repair in treatment of chronic ankle instability talofibular ligament injury is satifactory.It can be helpful to the wounded rapid rehabilitation and good for the popularization and application in basic-level hospitals.
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Objective To investigate the surgical methods and short-term effects of Internal-braceTM technology combined with modified Brostrom procedure for treatment of chronic ankle instability.Methods A retrospective case series study was made on 17 patients with chronic ankle instability treated using the Internal-braceTM technology combined with modified Brostrom procedure from May 2015 to April 2016.There were 10 males and 7 females,at age of 24 and 36 years (mean,31.8 years).A left ankle injury occurred in 6 patients and a right ankle injury in 11 patients.Operation time,postoperative complications and incision healing was documented after operation.Ankle stability was tested using the anterior drawer test and lateral stress test,and ankle range of motion was detected.American orthopedic foot and ankle society (AOFAS) score was used for postoperative efficacy evaluation.Results Operation time was 45 to 84 minutes (mean,64.5 minutes).None of the patients revealed neurological deficits after operation.All incisions healed by the first intension.Full weight bearing was started two weeks after operation.All patients were followed up for mean 3.5 months (range,1-6 months).At the final follow-up,both anterior drawer test and lateral stress test were negative.All patients had a normal range of motion of the ankle after operation.AOFAS score was increased from preoperative (36.2 ± 13.4)points to (91.2 ± 6.7) points at the final follow-up (P ＜ 0.01).According to the AOFAS score,the results were excellent in 15 patients and good in 2 patients,with the good rate of 100％.Conclusion For chronic ankle instability,Internal-braceTM technology comnbined with modified Brostrom procedure benefits wound healing and functional recovery,reduces incidence of complications and exhibits satisfactory short-term outcome.
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Objective To evaluate the angle between the anterior talofibular ligament (ATFL) and posterior talofibular ligament (PTFL) in patients with mechanical ankle instability,so as to find out a new indirect diagnosis method for the chronic ATFL lesion.Methods One hundred subjects were included in this study,among which 50 patients with mechanical ankle instability were assigned to group A and 50 counterparts without it were selected into group B All patients were taken MR Images and the ATFL and PTFL angle at the axial plane was evaluated.The difference between two groups was evaluated.Results The ATFL and PTFL angle increased significantly in group A when compared to group B (82.1° ± 8.0° v.s,74.4° ± 5.9°,P＜0.01).The area under receiver operating characteristic curve (ROC)was 0.874 (P＜0.01),indicating great significance in diagnosing the chronic ATFL tear.Moreover,the angle was 79 degree,showing high sensitivity (0.88) and specificity (0.64) of diagnosing ATFL tear.Conclusion The ATFL and PTFL angle increases significantly in patients with the mechanical instability.Moreover,the possibility of ATFL tear increases when the ATFL and PTFL angle is greater than 79 degree.
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Objective To clarify the diagnostic value of oblique axial scan parallel to the course of the anterior talofibular ligament in magnetic resonance imaging of anterior talofibular ligament in patients with chronic ankle instability. Methods 96 patients with ankle injury who were admitted into our hospital form June 2010 to March 2015 were examed with oblique axial scan beside the routine axial magnetic res-onance imaging examination. The grade of the anterior talofibular ligament injury and confirmed full-length views of the anterior talofibular lig-ament were analyzed by two musculoskeletal radiologists ( with more than 5 years experience) , and associated lesions were also checked. Re-sults The full-length view of the anterior talofibular ligament was checked in 69 patients (71. 8%) through the routine axial view and it was checked in 93 patients (96. 9%) through the oblique axial scan view. Anterior talofibular ligament injury was checked in 71 patients through the oblique axial scan, which was 19 patients more than that through the routine axial. Conclusion An additional oblique axial scan is use-ful in evaluation of anterior talofiibular ligament in patients with ankle injury.
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Inversion injury of the lateral ankle ligaments is very common. Few studies, however, have focused on avulsion fracture of the lateral ankle ligaments. A fracture producing a small fragment usually avulsed from lateral malleolus and may be easily misdiagnosed as a sprain because the fragment is superimposed on the lateral malleolus and goes undetected on early radiographs, especially in skeletally immature patients. We present a case of isolated avulsion fracture of the talar attachment of the anterior talofibular ligament in 13-year-old male patient. Diagnosis was confirmed by computed tomography and avulsed fragment was fixed to original talar footprint with suture anchors. A high level of suspicion must be maintained to obtain an accurate diagnosis of avulsion fracture in inversion ankle injury because of the high incidence in children and to prevent recurrent instability.
Subject(s)
Adolescent , Animals , Child , Humans , Male , Ankle , Ankle Injuries , Incidence , Ligaments , Sprains and Strains , Suture AnchorsABSTRACT
The fibularis tertius muscle (FTM) in man has been developed over time to acquire subsequent bipedal gait. The FTM functions as a crucial contributor in dorsiflexion and eversion, postulated over the years as a stabilizer of the talocrural joint, avoiding forced investment and protecting the anterior talofibular ligament. The literature describes that FTM is absent in 10 percent of cases, with no data on Chilean population. A study of surface anatomy in 168 young subjects, 60 percent female and 40 percent male students at the Universidad de Talca, Chile, with a mean age of 20.6 +/- 1.68 years, was conducted. The presence of FTM was identified following the implementation of a clinical assessment protocol that determines the presence of muscle on the basis of a progression called F1, F2, and F3. The FTM was present in 49.11 percent of cases. On the right side, 20 percent (n = 37) of the subjects presented the FTM in F2 and 30 percent (n = 50) in F3. On the left side, 1 percent (n = 2) showed the muscle in F1, 21 percent (n = 35) in F2, and 26 percent (n = 44) in F3. Our results contrast with the high prevalence of FTM in the literature and suggest studies of association with lesions of the talocrural region.
El músculo fibular tercero (MFT) es un músculo que en el hombre se ha desarrollado paulatinamente, al adquirir la posición bípeda y posteriormente la marcha. Dentro de las funciones del MFT destaca su contribución en la flexión dorsal y eversión, postulándose que actuaría como estabilizador de la articulación talocrural, al evitar la inversión forzada y proteger al ligamento talofibular anterior. La literatura describe que el MFT se encuentra ausente en un 10 por ciento de los casos, no existiendo datos de la población chilena. Se realizó un estudio de anatomía de superficie en 168 sujetos jóvenes, el 60 por ciento de sexo femenino y 40 por ciento de sexo masculino, estudiantes de la Universidad de Talca, Chile, con edad promedio de 20,6 +/- 1,68 años. La presencia del MFT se identificó tras la aplicación de un protocolo de evaluación clínica que determina la presencia del músculo en base a una progresión denominada F1, F2, F3. El MFT estuvo presente en el 49,11 por ciento de los casos. En el lado derecho el 20 por ciento (n=37) de los sujetos presenta el MFT en F2 y un 30 por ciento (n=50) en F3. En el lado izquierdo un 1 por ciento (n=2) exhibe el músculo en F1, 21 por ciento (n=35) en F2 y un 26 por ciento(n=44) en F3. Nuestros resultados contrastan con la alta prevalencia del MFT descrita en la literatura y se sugiere la realización de estudios de asociación con las lesiones de la región talocrural.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Muscle, Skeletal/anatomy & histology , Foot/anatomy & histology , Metatarsus/anatomy & histology , Fibula/anatomy & histology , Tendons/anatomy & histologyABSTRACT
The purpose of this study was to investigate the arthro-sonographic appearance of the chronic anterior talofibular ligament (ATFL) injury. Twenty-nine patient, who were identified to have partial or complete ATFL tears by conventional ultrasonography were included. Intraarticular injection of 5 mL of fluid (2.5 cc lidocaine+2.5 saline) was performed under ultrasound-guidance, which was followed by arthrosonography. Among 23 patients with partial tear which was detected by the conventional ultrasonography, 11 patients were identified to have complete tear by the arthrosonography. Among 6 patients with complete tear was detected by conventional ultrasonography, all of them identified to have complete tear by the arthrosonography. Arthrosonography is helpful in evaluation the configuration of ATFL complete tear and detecting complete tear by making them appear larger and apparent after instillation of fluid.
Subject(s)
Humans , Injections, Intra-Articular , LigamentsABSTRACT
The lateral ankle ligaments consisted of the anterior talofibular, posterior talofibular and calcaneofibular ligaments. This study was to investigate the dimensions and anatomic variations of these ligaments and correlate with MR images. Sixty seven ankles of Korean adults were used. Among these 37 ankles were only disseted and 30 ankles were dissected after getting MR images. The anterior talofibular ligament consisted of two bands in 72.4%. The length and thickness of this ligament were 20.9mm and 1.8mm, respectively. The widths were 7.0 mm in the upper band and 4.7 mm in the lower band. The talofibular ligament appeared as a hypointense thick band or several lines in MR images. This ligament was observed in 100% of the axial MR sections and 82.8% of the coronal sections. The posterior talofibular ligament showed single thick band in 53.2% while others showed as two bands. The length, width, thickness and the angle between the horizontal plane and the posterior talofibular ligament were 21.8 mm, 7.3 mm, 3.4 mm and 22.6degrees, respectively. In coronal MR images this ligament appeared as a hypointense and heterogeneous thick band between the lateral malleolus and the talus. All anterior and posterior talofibular ligaments were observed in axial MR images with at least one same MR plane showing the two ligaments together. The length, width and thickness of the calcaneofibular ligament were 25.3 mm, 5.2 mm and 2.3 mm, respectively. It was composed of two bands in 8.5%. The angles to the coronal and sagittal planes and this ligament were 20.7degrees(range 5degrees~60degrees) and 27.0degrees(range 7degrees~50degrees), respectively. The calcaneofibular ligament was seen as a hypointense short line or dot depending on the cut plane. It was observed in 72.4% of the axial MR images and in 75.9% of the coronal images but was better imaged in the coronal planes.