A new method of anterior talofibular ligament reconstruction: Arthroscopically artificial ligament reconstruction with tensional remnant-repair / 中华创伤杂志(英文版)

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.

Recovery of proprioception after lateral ankle sprain / 中国康复理论与实践

ObjectiveTo observe the recovery of proprioception of the affected ankle over time after lateral ankle sprain accepting routine rehabilitation. MethodsFrom June, 2020 to June, 2022, 18 patients with lateral ankle sprain in Kunshan Rehabilitation Hospital underwent routine rehabilitation for twelve weeks. They were measured active and passive position sense of bilateral ankles using an isokinetic dynamometer before treatment, and four, eight and twelve weeks after treatment, respectively. ResultsThe active presentation difference of affected ankle reduced after treatment (F = 22.533, P < 0.001), but it was more than that of the healthy ankle at the same time (t > 4.419, P < 0.001). No significant improvement was found in passive presentation difference of affected ankle after treatment (F = 1.175, P > 0.05), and it was not significantly different from those of the healthy ankle at the same time (|t| < 0.646, P > 0.05). ConclusionProprioception of affected ankle has been impaired after lateral ankle sprain, and it can be recovered after rehabilitation, but cannot achieve the healthy level even after three months of training. Passive position sense as an index of proprioception needs more researches.

Platelet-rich plasma on ankle sprains – efficacy on pain reduction and shorter return to play: A systematic review of available randomized control trials

Background@#The role of platelet-rich plasma (PRP) has been widely studied, but only recently did trials emerge that probed into its potential role in ankle sprains. With the limited available literature, most of the trials results showed that it might have a role in faster healing and pain reduction. @*Objectives@#The purpose of this review is to summarize available studies on ankle sprains in order to identify if there is good initial evidence of its role on return to play (RTP) among active individuals as well as pain reduction. It is also to identify if results were consistent among studies. @*Methodology@#A systematic search of available literature in online databases was done to compare results about outcome measures on pain score and RTP. Included studies are those with a population of 18 years and above treated with PRP with or without post-procedural immobilization. Outcome scorings that assessed pain as a parameter was also included. @*Results@#Three randomized controlled trials and two prospective studies were identified. Results showed an average of 8 weeks to RTP (p-value - 0.006) with decreased pain in ankle sprains treated with PRP and functional therapy. @*Limitation@#Only one randomized controlled trial (RCT) compared PRP with a placebo and a small population of all studies made available. More comparable RCTs are needed to strengthen results of the studies. @*Conclusion@#The use of PRP on ankle sprains may have a potential role in shorter time to RTP and pain reduction.

Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT / 北京大学学报(医学版)

OBJECTIVE@#To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle.@*METHODS@#From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement.@*RESULTS@#Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (P=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency.@*CONCLUSION@#Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.

The Effect of Ankle Brace on Biomechanics of the Lower Extremity During Landing: A Systematic Review and Meta Analysis / 医用生物力学

Objective To examine the effects of ankle brace on biomechanics of the lower extremity during landing, so as to provide a theoretic support to choose ankle brace for people with different sports levels. Methods The key words (ankle brace OR ankle braces OR ankle bracing OR ankle support) AND (landing OR land OR jump OR hopped OR hopping) AND (biomechanics OR kinematics OR kinetics OR electromyography OR neuromuscular) in Chinese and English were searched from different electronic databases (CNKI, Web of Science, EBSCO, PubMed and other databases), for a period of Jan. 2000 to Dec. 2020. Cochrane was used to evaluate the quality of eligible studies. For meta analysis, subgroup analysis was used to assess the impact of ankle braces on ankle biomechanics.Results Thirteen studies with a total of 222 participants were included for mata analysis in this study. The semi-rigid ankle brace reduced the peak of ankle inversion by 25.8% compared with the elastic ankle brace (SMD=-0.562, P<0.001). Moreover, the elastic ankle brace reduced ankle plant flexion during landing among athletes (SMD=-3.42, P=-0.021). As for collagiate students, both elastic ankle and semi-rigid ankle decreased the ankle inversion (elastic ankle brace: 35.4%, SMD=-1.000, P=-0.013; semi-rigid ankle brace: 31.11%, SMD=-0.881, P<0.001) and ankle plant flexion (elastic ankle brace:23.30%, SMD=-1.381, P<0.001;semi-rigid ankle brace: 36.33%, SMD=-1.605, P<0.001).Conclusions Both ankle braces can prevent ankle sprain for athletes (basketball, volleyball, running) who experience training more than 5 years. The elastic ankle brace can limit the inversion and plantar flexion, while the semi-rigid ankle brace can merely decrease the ankle inversion. Therefore, athletes are more suitable for the elastic ankle brace. As for collegiate students without training history, both ankle brace can decrease the ankle inversion and plantar flexion. The elastic ankle brace has greater restriction on inversion, while the semi-rigid ankle brace has more restriction on plantar flexion. Therefore, the elastic ankle brace should be utilized if collegiate students have calcaneofibular ligament injury, while the semi-rigid ankle brace is more suitable for collegiate students who have a history of anterior talofibular ligament injury.

Quantitative Study on Kinematics of Ankle Rotating-Traction-Poking Manipulation for Treating Acute Lateral Ankle Sprain / 医用生物力学

Objective To quantify operation characteristics of the ankle rotating-traction-poking manipulation (RTPM) for treating acute lateral ankle sprain by using motion capture technology, so as to provide objective references for standardized operation of RTPM and its education inheritance. Methods A professional physiotherapist performed the RTPM on 60 volunteers with acute lateral ankle sprain. Motion capture system was used to acquire effective kinematic data during the RTPM, so as to make analysis and summarize rules. Results The average time of ankle rotating for six circles was 11.36 s and the average time of ankle traction and poking was 3.42 s. The average displacement of ankle traction was 36.94 mm and the average displacement of ankle poking was 22.44 mm. The average angle of ankle traction was 23.27°, and the average angle of ankle poking was 22.76°. During the RTPM for treating acute lateral ankle sprain, the average linear velocity of ankle rotating was 58.28 mm/s, and the average linear velocity of ankle traction and poking was 23.81 mm/s. The linear acceleration of ankle rotating was 0.43 mm/s2, and the linear acceleration of ankle traction and poking was 0.54 mm/s2. Conclusions The RTPM can be applied in clinical practice. During the RTMP, the principle of gentleness, rhythmicity and continuity should be followed. Under the premise of following physiological characteristics of ankle joint, treatment of the sprained ankle should be carried out with slow and uniform speed continuously.

Anatomical reconstruction of lateral ligament complex with singletunnel pullout stutrue fixation for chronic lateral ankle instability / 中国骨伤

OBJECTIVE@#To explore clinical effects of single-tunnel pullout structure fixation and anatomical reconstruction of lateral ligament complex in treating chronic lateral ankle instability.@*METHODS@#From January 2016 to December 2018, clinical data of 23 patients with chronic lateral malleolus instability who underwent anatomical reconstruction of lateral malleolus ligament complex with single-tunnel pullout structure fixation, were retrospectively studied. Among them, including 7 males and 16 females, aged from 17 to 33 years old with an avergae of (26.0±4.3) years old;16 patients classified to grage 0, and 7 patients classified to gradeⅠaccording to Kellgren-Lawrence(K-L) grading;the time of sprain ranged form 2 to 15 with an average of (5.7±2.9) times;the time from injury to operation ranged to 4 to 18 months with an average of (9.0±3.3) months. The range of movement of operative and uninjured ankle joints were measured at 24 months after opertaion, visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate ankle joint function and improvement of pain, K-L grading and MRI scoring of osteoarthritis of ankle (MSOA) were used to evaluate degree of cartilage degeneration of ankle joint.@*RESULTS@#All patients were followed up from 24 to 48 months with an average of (33.4±6.7) months. All the anterior talofibular ligaments and calcaneofibular ligaments were dissected and reconstructed by single-tunnel pullout structure fixation. The range of motion of dorsiflexion, plantarflexion, varus, and valgus on the operative side of ankle joint were smaller than those on the healthy side. There were no statistically differences in dorsiflexion and eversion between operative side and healthy side of ankle joint (@*CONCLUSION@#Treatment of chronic lateral ankle instability with reconstruction of lateral ligament complex with single-tunnel pullout structure fixation could provide better tendon and bone healing conditions, improve surgical safety and could achieve satisfactory clinical outcomes.

Stable ankle after modified brostrom technique using one anchor with double suture at Sanglah Hospital: a case report

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.

T2-mapping quantitative imaging technique based on sequence optimization in the ankle talus osteochondral injury / 中国组织工程研究

BACKGROUND: At present, DWI, DTI, T1-mapping, T2-mapping, and T2*-mapping are commonly used in cartilage functional imaging sequences in both scientific research and clinic. T2-mapping is often used for the quantitative analysis of cartilage, but it was obviously limited due to the long scanning time and poor experience of the patient.OBJECTIVE: To quantitatively evaluate the talar cartilage injury degree of chronic lateral ankle instability patients by sequence optimized T2-mapping quantitative imaging technique. METHODS: Totally 53 cases of chronic ankle instability(case group) and 46 healthy subjects(control group) were from the Second Affiliated Hospital of Inner Mongolia Medical University. They underwent conventional Magnetic Resonance Imaging and optimal T2-mapping quantitative imaging scanning. The total talar cartilage was divided into six compartments: internal anterior, internal medial, internal posterior, lateral anterior, lateral center and lateral posterior. Six T2 values were totally taken as each partition had one T2 value. The experiment was approved by the Ethics Committee of Inner Mongolia Medical University. RESULTS AND CONCLUSION: The T2 values of internal anterior, internal medial, internal posterior areas of case group were higher than those of control group(P 0.05). The results showed that the talus cartilage injury mainly occurred in the internal talus in patients with chronic lateral ankle instability. The cartilage damage degree could be quantitatively evaluated by magnetic resonance T2-mapping imaging technique. It is possible that T2-mapping based on sequence optimization can be used in functional image routine scan.

Return to Play after Modified Broström Operation for Chronic Ankle Instability in Elite Athletes

BACKGROUND: This study assessed the average time to return to training and official game participation after modified Broström operation (MBO) in elite athletes. METHODS: Sixty athletes diagnosed with lateral ankle instability underwent MBO from October 2011 to December 2013. Their average age was 19.3 years, and the average follow-up time was 28.8 months. We measured the time sequence of three phases of rehabilitation: start of personal training, start of team training, and start of the first official game after recovery. Patients were divided into an early return to play (RTP) group and late RTP group. The groups were compared to identify possible risk factors affecting the RTP time. RESULTS: The mean length of time to return to personal training was 1.9 months, return to team training was 2.9 months, and return to competitive play was 3.9 months. There were no significant differences of any variables including age, sex, body mass index, level of sports, grade of instability, presence of os subfibulare, and preoperative functional score between the early RTP and late RTP groups. CONCLUSIONS: The RTP was 83.3% at 4 months after lateral ankle ligament repair and 100% at 8 months postoperatively. The results provide reference data for orthopedic surgeons in evaluating surgical results and informing patients about expectations after surgery in terms of performance level and timing of return to sports.

Arthroscopic Modified Broström Operation for Lateral Ankle Instability / 대한정형외과학회잡지

Lateral ankle sprain is the most common ankle injuries. Patients who fail conservative treatments are candidates for modified Broström operation (MBO). Traditionally, the primary surgical treatment performed is the open MBO. Recently, there has been an evolution in the arthroscopic treatment of lateral ankle injury. Several reports reveal biomechanically equivalent results of arthroscopic vs . open MBO when using matched cadaver pairs. Also there was no difference in the clinical or radiologic outcomes between the arthroscopic and open MBO in randomized controlled trial. Therefore, arthroscopic MBO is reasonable and good alternative treatment for lateral ankle injury. Actually new techniques of arthroscopic treatment for ankle injury is introduced about arthroscopic syndesmotic repair and arthroscopic deltoid repair. Arthroscopic techniques for ankle injuries seem to develop further in the future.

Ligament Repair in Chronic Lateral Ankle Instability: Efficacy and Technique of Broström Procedures / 대한족부족관절학회지

Chronic lateral ankle instability occurs in 10% to 20% of individuals after acute ankle sprain. The management of chronic lateral ankle instability is traditionally conservative treatment in the acute phase. On the other hand, surgical intervention is considered if conservative treatment fails and the symptoms are ongoing. This review focuses on the surgical approaches to treatment of chronic lateral ankle instability, including Broström surgical techniques, with a review of the traditional procedure and newer techniques.

Anatomical Landmarks for Lateral Ankle Ligament Reconstruction—a Cadaveric Study / 中国运动医学杂志

Purpose To clarify the morphological parameter and describe the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks through precisely anatomical explore of human cadaveric ankles,so as to provide anatomical evidences for the reconstruction of lateral ankle ligaments.Methods Nineteen ankle specimens were dissected to isolate the lateral ankle ligaments and measure the morphological parameters such as length,width,thickness and the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.Results The average length of anterior talofibular ligaments (ATFL) was 23.1 ± 2.98 mm,among which 8 were single-banded(42.1％)and 11 were double-banded(57.9％).The average distance from the fibular origination of ATFL to the anterior tubercle of fibula(AA)was 17.1 ± 3.00 mm,to the fibular obscure tubercle(AO)was 5.1 ± 1.69 mm,to the tip of the fibula(AT)was 14.1 ± 2.86 mm.The distances from the talus insertion of ATFL to the superior and inferior talus articular surface were 11.4 ± 2.25 mm and 18.4 ± 2.30 mm respectively,to the anterior lateral talus chondral surface was 4.8 ± 1.42 mm.The average length of calcaneofibular ligament(CFL)was 31.4 ± 3.55 mm.The average distance of the fibular origination from ATFL to CFL was 6.4 ± 2.55 mm.The average angle between ATFL and CFL was 116.6 ± 12.69°.The distance from the calcaneus insertion of CFL to the peroneal tubercle(CP)was 15.4 ± 2.86 mm,to the posterior superior border of calcaneus(CC)was 13.9 ± 2.46 mm,to the subtalar joint surface was 15.2 ± 3.21 mm.The coefficient variation assessing the anatomical reliability of different bony landmarks were as follows:ATFL fibular origination AA(17.54％) ＜AT(20.28％) ＜ AO(33.14％),CFL calcaneus insertion CC(17.70％)＜CP(18.57％)＜CS(21.1％).Conclusion Certain variations exist in the morphological parameters and the distances from the insertion of the lateral ankle ligaments to the adjacent bony landmarks.It provides anatomical evidence for lateral ankle ligament reconstruction in treating chronic ankle instability.

The Effect of a Proximal and Distal Tibiofibular Joint Manipulation on Dorsiflexion and Balance in Individuals with a History of Lateral Ankle Sprain

PURPOSE: This study aimed to evaluate the changes in dorsiflexion and balance following proximal and distal tibiofibular joint manipulation in individuals with a history of lateral ankle sprain (LAS). METHODS: Fifteen participants with a history of unilateral LAS, exhibiting a restriction in ankle dorsiflexion were included in this study. LAS ankle received a manipulation to the proximal and distal tibiofibular joint, while the opposite control ankle received no manipulation intervention. The outcome measures included ankle dorsiflexion and balance. Ankle dorsiflexion was measured using weight-bearing lunge test. Static and dynamic balances were measured using the overall, anterioposterior, and mediolateral balance index via the biodex balance system. Measurements were obtained prior to and following manipulation. RESULTS: This study showed that ankle dorsiflexion and dynamic balance were improved following the manipulation compared to those prior to the manipulation (p0.05). CONCLUSION: The joint manipulation technique applied to the ankle of those with a history of LAS appears to improve ankle dorsiflexion and dynamic balance. This suggest that a manipulation to the proximal and distal tibiofibular joint could be provided as preliminary data regarding the prophylactic effects of recurrent LAS.

Surgical Outcomes of Arthroscopic Modified Brostrom Procedure in Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: To evaluate the result of arthroscopic modified Brostrom procedure with suture anchor for chronic lateral ankle instability. MATERIALS AND METHODS: Fifty-two patients with chronic lateral ankle instability were analyzed, who underwent arthroscopic modified Brostrom procedure between December 2010 and May 2012. Clinical evaluation was performed using AOFAS scroring and Sefton grading system. RESULTS: The average AOFAS hind foot score increased from preoperative 61.9 to 88.8 at the last follow up. There were 35 excellent, 9 good, 4 fair, 4 poor results according to Sefton grading system. For one patient, lateral ankle instability recurred. CONCLUSION: Arthroscopic modified Brostrom procedure is considered to be an effective and satisfactory technique.

Intra-articular Lesions in Chronic Lateral Ankle Instability: Comparison of Arthroscopy with Magnetic Resonance Imaging Findings

BACKGROUND: Chronic lateral ankle instability often accompanies intra-articular lesions, and arthroscopy is often useful in diagnosis and treatment of intra-articular lesions. METHODS: Preoperative magnetic resonance imaging (MRI) examinations and arthroscopic findings were reviewed retrospectively and compared in 65 patients who underwent surgery for chronic lateral ankle instability from January 2006 to January 2010. MR images obtained were assessed by two radiologists, and the inter- and intra-observer reliability was calculated. American Orthopedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores were evaluated. RESULTS: Abnormalities of the anterior talofibular ligament (ATFL) were found in all 65 (100%) cases. In arthroscopy examinations, 33 (51%) cases had talar cartilage lesions, and 3 (5%) cases had 'tram-track' cartilage lesion. Additionally, 39 (60%) cases of synovitis, 9 (14%) cases of anterior impingement syndrome caused by osteophyte, 14 (22%) cases of impingement syndrome caused by fibrotic band and tissue were found. Sensitivity of MRI examination for each abnormality was: ATFL, 60%; osteochondral lesion of talus (OLT), 46%; syndesmosis injury, 21%; synovitis, 21%; anterior impingement syndrome caused by osteophyte, 22%. Paired intra-observer reliability was measured by a kappa statistic of 0.787 (95% confidence interval [CI], 0.641 to 0.864) for ATFL injury, 0.818 (95% CI, 0.743 to 0.908) for OLT, 0.713 (95% CI, 0.605 to 0.821) for synovitis, and 0.739 (95% CI, 0.642 to 0.817) for impingement. Paired inter-observer reliability was measured by a kappa statistic of 0.381 (95% CI, 0.241 to 0.463) for ATFL injury, 0.613 (95% CI, 0.541 to 0.721) for OLT, 0.324 (95% CI, 0.217 to 0.441) for synovitis, and 0.394 (95% CI, 0.249 to 0.471) for impingement. Mean AOFAS score increased from 64.5 to 87.92 (p < 0.001) when there was no intra-articular lesion, from 61.07 to 89.04 (p < 0.001) in patients who had one intra-articular lesion, and from 61.12 to 87.6 (p < 0.001) in patients who had more than two intra-articular lesions. CONCLUSIONS: Although intra-articular lesion in patients with chronic lateral ankle instability is usually diagnosed with MRI, its sensitivity and inter-observer reliability are low. Therefore, arthroscopic examination is strongly recommended because it improved patients' residual symptoms and significantly increased patient satisfaction.

Anatomic Reconstruction of the Lateral Ankle Instability Using the Semitendinosus Allograft Tendon and Interference Screws / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcome of the anatomic reconstruction of the lateral ankle instability using the semitendinosus allograft tendon and the interference screws. MATERIALS AND METHODS: This study is based on the 12 feet of lateral ankle instability that had been treated with anatomic reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) using the semitendinosus allograft tendon and the interference screws. The majority of patients were young and physically active. We evaluated the patients' VAS pain scores, AOFAS scores and Karlsson-Peterson ankle scores for the 11 feet involved with at least 12 months follow up, both pre- and post-operative. In addition, we evaluated patient satisfaction. We measured the talar tilt angles and the talar anterior translations from ankle stress views. RESULTS: The average age at surgery was 25.9 years old (19-57 years); patients had symptoms of recurrent sprain for average 31.4 months before surgery. The average follow up period was 14 months. For reconstruction, we used 4.0mm thick allograft semitendinosus tendon and interference screws. VAS pain scores decreased from 6.0 to 1.1 (p<0.05) and AOFAS scores improved from 70.4 to 90.4 postoperatively (p<0.05). Karlsson-Peterson ankle scores improved significantly from 54.6 to 92.4 (p<0.05). Radiographic talar tilt decreased from 15.7degrees to 3.2degrees postoperatively (p<0.05). Eighy-two percent of the patients were satisfied with the results and the patients had returned to their jobs by 3.7 months after surgery. CONCLUSION: Anatomic reconstruction of the ATFL and the CFL in the lateral ankle instability patients using the semitendinosus tendon and the interference screws is an ideal surgical option especially for young athletes with high grade instabilities.

Reliability of MRI Findings of Peroneal Tendinopathy in Patients with Lateral Chronic Ankle Instability

BACKGROUND: Patients with chronic lateral ankle instability also have peroneal tendinopathy often. However, preoperative MRIs of these patients are vague in many cases. Our study was performed to see the reliability of MRI findings of peroneal tendinopathy in patients with chronic lateral ankle instability. METHODS: MRI images for 82 patients who had chronic lateral ankle instability, and had received surgical treatment between March 2006 and November 2009 were compared with impressions from operating rooms. The mean age of patients was 36.4 years (range, 15 to 64 years), 82 ankles were studied, and patients with rheumatoid diseases were excluded from the study. RESULTS: Of the 82 cases, 26 were true positives, 38 true negatives, 13 false positives and 5 false negatives. Of 39 cases of peroneal tendinopathy diagnosed from MRI, 14 had peroneal tendon partial tears, 15 tenosynovitis, 3 dislocations, 17 low-lying muscle bellies, and 6 peroneus quartus muscles. Of 31 cases of peroneal tendinopathy observed in surgery 11 had peroneal tendon partial tears, 4 tenosynovitis, 5 dislocations, 12 low-lying muscle belliess, and 1 peroneus quartus muscle. Sensitivity and specificity of peroneal tendinopathy were 83.9% and 74.5%, respectively. Positive predictive value was 66.7%. Negative predictive value was 88.4%. Accuracy rate was 78.0%. CONCLUSIONS: MRI is a useful diagnostic tool for detecting peroneal tendinopathy in patients with chronic lateral ankle instability. However, MRI is vague in many cases. Therefore, a thorough delicate physical examination and careful observation is needed.

Common Foot and Ankle Disease

Participation of the population in sports activity is increasing. The life expectancy is also on the rise. In addition, the average initial age of women who wear heels is decreasing. For this reason, the incidence of foot disease such as ankle instability, foot deformity, and degenerative joint disease is becoming increasingly common. There is a wide spectrum of foot disease. Common foot disease that can be treated from outpatient base will be discussed in this review.

Chronic Lateral Ankle Instability: Efficacy of Combination of Ankle Arthroscopic Exploration and Modified Brostrom Operation / 대한족부족관절학회지

PURPOSE: To evaluate the efficacy of the arthroscopic exploration combined with modified Brostrom operation (MBO) for the treatment of chronic lateral ankle instability (CAI). MATERIALS AND METHODS: Sixty patients who diagnosed a CAI were performed MBO. We divided to 2 groups, whether simultaneously inspected by arthroscopy (group B) or not (group A). The both group's results were compared according to American Orthopedic Foot and Ankle Society Ankle-hindfoot score (AOFAS), functional ankle score and visual analog scale (VAS) at preoperative and final follow-up period. RESULTS: There were no significant differences of AOFAS, functional ankle score and VAS between both groups at final follow-up. However, in group A, 2 cases associated with medial ankle instability and syndesmotic injuries were did not diagnosed preoperatively, showed poor prognosis. In group B, one case had a permanent peroneal nerve symptom. The match rate of intra-articular lesions between preoperative diagnosis and postoperative arthroscopic diagnosis was 30% in group B. CONCLUSION: Combination of arthroscopic exploration and MBO is effective strategy for intra-operatively discrimination of intra-articular associated lesions for CAI.