Sindesmosis tibioperonea: diagnóstico, métodos de fijación y artroscopia

Introducción: Las lesiones de la sindesmosis tibioperonea son frecuentes tanto de forma aislada o asociadas a fracturas del maléolo posterior. El diagnóstico clínico es corroborado mediante estudios imagenológicos. Los métodos de fijación pueden ser rígidos o dinámicos. Objetivo: Actualizar aspectos sobre las lesiones de la sindesmosis tibioperonea en cuanto al diagnóstico, métodos de fijación y el empleo de la vía artroscópica. Método: La búsqueda y análisis de la información se realizó en un periodo de 61 días (1 de octubre al 30 de noviembre de 2022) y se emplearon las siguientes palabras: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. A partir de la información obtenida se realizó una revisión bibliográfica de un total de 258 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote. Desarrollo: Se hizo referencia a las maniobras clínicas para el diagnóstico y las clasificaciones tomográficas en caso de fractura asociada del maléolo posterior. Se mencionaron los métodos de fijación rígidos y dinámicos, donde se describieron las características de cada uno basado en varios factores. Se expusieron las ventajas de la vía artroscópica tanto para el diagnóstico como para el tratamiento. Conclusiones: Las lesiones de la sindesmosis tibioperonea distal son frecuentes. Los estudios tomográficos ofrecen ventajas al determinar la extensión de la fractura del maléolo posterior. La vía artroscópica ofrece múltiples ventajas diagnósticas y terapéuticas.

Introduction: Tibioperoneal syndesmosis injuries are frequent both in isolation or associated with posterior malleolus fractures. Clinical diagnosis is confirmed on imaging studies. Fixation methods might be rigid or dynamic as well. Objective: Provide new aspects related to tibioperoneal syndesmosis injuries in terms of diagnosis, fixation methods and the use of arthroscopic procedure. Method: Search and analysis of information needed were carried out in a period of 61 days (from October 1 to November 30, 2022) and the following words were used: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. Based on the information obtained, a bibliographic review of the total of 258 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search engine and reference manager EndNote. Development: It was expressed in the study aspects related to clinical management used in diagnostic and classification on the types of CT scan for fracture associated with posterior malleolar fracture. The rigid and dynamic fixation methods and its characteristics were mentioned as well. The arthroscopic approaches and its advantages for both diagnosis and treatment were presented. Conclusions: Distal tibioperoneal syndesmosis injuries are frequent ankle injury. Tomographic studies offer some advantages for determining how large the posterior malleolus fracture is. The arthroscopic approach offers multiple diagnostic and therapeutic advantages too.

Introdução: As lesões da sindesmose tibiofibular são frequentes isoladamente ou associadas a fraturas do maléolo posterior. O diagnóstico clínico é confirmado por exames de imagem. Os métodos de fixação podem ser rígidos ou dinâmicos. Objetivo: Atualizar aspectos das lesões da sindesmose tibiofibular quanto ao diagnóstico, métodos de fixação e uso da abordagem artroscópica. Método: A busca e análise das informações foi realizada em um período de 61 dias (1º de outubro a 30 de novembro de 2022) e foram utilizadas as seguintes palavras: syndesmosis injury, ankle syndesmosis instability, syndesmosis instability AND tight rope ankle instability, posterior maleolar fracture. Com base nas informações obtidas, foi realizada uma revisão bibliográfica de um total de 258 artigos publicados nas bases de dados PubMed, Hinari, SciELO e Medline, utilizando o gerenciador de busca e Gerenciador de referências do EndNote. Desenvolvimento: Foi feita referência a manobras clínicas para diagnóstico e classificações tomográficas em caso de fractura associada do maléolo posterior. Foram citados métodos de fixação rígidos e dinâmicos, onde foram descritas as características de cada um com base em vários fatores. As vantagens da abordagem artroscópica tanto para o diagnóstico quanto para o tratamento foram discutidas. Conclusões: As lesões da sindesmose tibiofibular distal são frequentes. Os estudos tomográficos oferecem vantagens na determinação da extensão da fratura do maléolo posterior. A abordagem artroscópica oferece múltiplas vantagens diagnósticas e terapêuticas.

Knot-free anchor repair of anterior talofibular ligament under total ankle arthroscopy / 中国骨伤

OBJECTIVE@#To explore clinical effect of repairing anterior talofibular ligament with knot-free anchors under total ankle arthroscopy in treating chronic lateral ankle instability.@*METHODS@#From April 2018 to August 2021, 24 patients with chronic lateral ankle instability were treated with knot-free anchors under total ankle arthroscopy to repair anterior talofibular ligament, including 16 males and 8 females, aged from 22 to 42 years old with an average of(28.6±5.8) years old;the time from injury to opertaion ranged from 6 to 10 months with an average of(7.7±1.3) months. Preoperative and postoperative American Orhopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), talar tilt, anterior talar translation(ATT) were recorded and compared.@*RESULTS@#All patients were followed up from 10 to 12 months with an average of (10.2±1.14) months. Incision were healed at stageⅠ, and no infection, nerve injury and lateral ankle instability occurred. AOFAS score improved from(52.79±8.96) before opertaion to (93.00± 4.01) at 6 months after operation, 23 patients got excellent result and 1 good;VAS decreased from (5.50±0.98) before opertaion to (1.04±0.80) at 6 months after operation(P<0.05);talar tilt decreased from(9.16±2.09)° to (3.10±1.72)° at 3 months after operation(P<0.05);ATT decreased from(8.80±2.55) mm to (2.98±1.97) mm at 3 months after operation(P<0.05). Twenty-four patients drawer test and varus-valgus rotation wer negative.@*CONCLUSION@#Repairing anterior talofibular ligament with knot-free anchors under total ankle arthroscopy for the treatment of chronic lateral ankle instability has advantages of less trauma, less complications safe and reliable, and good recovery of ankle joint function.

Outcome of Arthroscopic Bone Marrow Stimulation in Osteochondritis Dissecans of the Talus in a Tertiary Care Hospital

Introduction: Osteochondritis dissecans of the talus is a rarecondition that can create challenges for both the patient andthe treating surgeon. Arthroscopic bone marrow stimulation(i.e. microfracture, drilling) is a well-accepted and proventechnique to allow fibrocartilage differentiation and therebyprovide infill at the site of a cartilage defect in several joints,including the ankle. The aim of our study was to examine therole of arthroscopic bone marrow stimulation techniques as ameans of treatment for osteochondral lesions of the talus.Material and methods: Thirty two ankles were identifiedbetween January 2012 and January 2020 with talus OCD thatunderwent arthroscopic bone marrow stimulation. Each lesionwas classified according to the Berndt and Harty classification.Study patients were evaluated at 6 weeks, 3 months, 6 months,12 months, and annually after surgery. Assessments via avisual analogue scale (VAS) for pain during daily activitiesand sport activity and the American Orthopaedic Foot & AnkleSociety (AOFAS) scoring system were obtained at each visit.Result: There were 25 men and 4 women of average age 35years (range 17–50) and mean body mass index (BMI) 22 kg/m2 (range 20–34) at the time of surgery. Quantitative MRImeasurements on 3D FSPGR Sequence showed that meanarea of the lesions were 0.801 ± 0.505 cm2. Mean AOFASscores improved from 66 points (range 53–77) preoperativelyto 90 points (range 83–100) at final follow-up (p<0.05) andmean Visual Analogue Scale (VAS) scores from 6 points(range 5–8) to 2 points (range 0–5) with p value <0.05 whichis statistically significant.Conclusion: Arthroscopic management of osteochondrallesions of the talus has the advantages of better cosmeticresults, less pain, and less surgical trauma. This techniqueis technically demanding and should be reserved for theexperienced foot and ankle arthroscopist.

Pasos básicos para la realización de la artroscopia de tobillo / Basic steps for the ankle arthroscopy

La artroscopia de tobillo es un procedimiento quirúrgico muy empleado actualmente en personas con afecciones de esta articulación. Teniendo en cuenta lo anterior se realizó el presente estudio con el objetivo de actualizar los pasos básicos para su realización y profundizar en los aspectos más importantes relacionados con el tema, entre los cuales figuran: anatomía, indicaciones quirúrgicas, instrumental necesario, métodos de distracción, portales y recorrido artroscópicos, así como complicaciones relacionadas con el proceder. Entre otras ventajas, permite diagnosticar gran número de enfermedades que afectan la articulación del tobillo y brindar un tratamiento oportuno.

The ankle arthroscopy is a very used surgical procedure at present in people with disorders of this joint. Keeping this in mind the present study was carried out with the objective of updating the basic steps for its use and to deepen in the more important aspects related to the topic, among which there are: anatomy, surgical indications, necessary tools, distraction methods, arthroscopic portals and route, as well as complications related to the procedure. Among other advantages, it allows to diagnose great number of diseases which affect the ankle joint and to offer an opportune treatment.

Dolor crónico del tobillo: banda fibrosa (Web Impingement) / Chronic ankle pain. Web impingement

Objetivo: Presentamos una serie de pacientes con dolor crónico de tobillo y estudios por imágenes negativos, en los que hallamos solamente una banda fibrosa intraarticular como causa probable del dolor en la artroscopia diagnóstica. Métodos: Entre el año 2010 y 2016 se realizaron 212 artroscopias anteriores de tobillo. En 19 pacientes (8,96%) se encontró una banda fibrosa intrarticular. En 13 pacientes se encontraban asociadas con otras patologías y solo en 6 pacientes (2,83%) fueron aisladas, sin lesión asociada. El promedio de edad fue de 40,42 años. El seguimiento promedio de 20,42 meses. La mayoría de los pacientes fueron atendidos en centros de aseguradoras de riesgo de trabajo. Resultados: Se utilizó el score AOFAS con un promedio para el preoperatorio de 55,63 y para el postoperatorio de 92.26. No hubo complicaciones en esta serie. Conclusiones: La banda fibrosa es una patología infrecuente, con sintomatología clínica similar a la de otras patologías que producen un síndrome friccional anterior de partes blandas del tobillo. La mayoría tenía antecedentes traumáticos. Los estudios por imágenes utilizados fueron la radiografía y la Resonancia. Ninguno de ellos fue de utilidad en el diagnóstico. La banda fibrosa es una de las diferentes formas de impingement en la cara anterior del tobillo y puede ser una causa de fricción y dolor. Dado que los estudios por imágenes no fueron concluyentes, la artroscopía fue nuestro método de elección para el diagnóstico y tratamiento en los pacientes con dolor crónico de tobillo con imágenes negativas. Tipo de trabajo: Serie de casos. Nivel de evidencia: IV.

Purpose: We present a series of patients with chronic anterior ankle pain and negative imaging studies, in which we found an isolated fibrous intrarticular band as a probable cause of pain in diagnostic arthroscopy. Methods: Between 2010 and 2016 we performed 212 anterior ankle arthroscopies. In 19 patients (8,96%) a fibrous web like band was found. In 13 cases they were associated with other diseases and only 6 of them (2.83 %) were isolated. Average age was 42 years. Follow up was between 4 months and 3 years (average 20.42 months). Most of them were workers compensation patients. Results: We used the AOFAS scores with an average value of 55,63 preoperative and 92.26 points postoperative. No complications were found in this series. Conclusions: Intra articular fibrous band is an infrequent pathology, with clinical presentation similar to other soft tissues anterior impingement. Most of them had previous trauma. Imaging studies performed were radiographs and MRI, but they have not proven to be useful due to their low or none sensitivity to this condition. Intra articular fibrous bands is one of the causes of anterior impingement of the ankle, and may be a cause of friction and pain. Most of them had history of previous trauma. Imaging studies were not conclusive, and arthroscopy was our election method for diagnosis and treatment in patients with chronic ankle pain and negative imaging studies. Type of study: Case series. Level Of Evidence: IV.

Ankle arthroscopy for diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis / 中华创伤骨科杂志

Objective To evaluate the clinical value of ankle arthroscopy in diagnosis and treatment of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis.Methods A retrospective study was conducted of the 35 patients who had been treated at Department of Orthopaedics,Ruijin Hospital North for Danis-Weber type B ankle fracture from February 2014 to December 2016.They were 23 males and 12 females,with an average age of 43.1 years (from 18 to 65 years).Each of them underwent 4 examinations to detect whether injury to the distal tibiofibular syndesmosis was complicated or not:preoperative CT and MRI,C-ann roentgenography and ankle arthroscopy before and after internal fixation of the ankle.The diagnostic rates of the complicated injury by the 4 examinations were compared.The patients complicated with injury to the distal tibiofibular syndesmosis received surgical repair of the injury using TightRope in addition to internal fixation of the ankle,and injury to the deltoid ligament was repaired simultaneously using 3.5 mm anchor nails in case the injury was concomitant.The repair and stability of the distal tibiofibular syndesmosis were observed using ankle arthroscopy again.Results The Cotton and external rotation tests under C-arm roentgenography before surgery and after internal fixation of the ankle demonstrated that 13 cases were complicated with injury to the distal tibiofibular syndesmosis.Of the other 22 patients who had not been diagnosed with the injury by C-arm roentgenography,6,13 and 11 were diagnosed with the injury respectively by CT,MRI and ankle arthroscopy.The diagnostic rates of Danis-Weber type B ankle fracture associated with injury to the distal tibiofibular syndesmosis were 37.1％ (13/35),54.3％ (19/35),74.3％ (26/35) and 68.6％ (24/35) respectively by C-arm roentgenography,CT,MRI and ankle arthroscopy.In the sensitivity to the injury,MRI ＞ ankle arthroscopy ＞ CT ＞ C-arm roentgenography,with significant differences between them (P ＜ 0.05).The ankle arthroscopy confirmed the repair efficacy in the 24 patients complicated with injury to the distal tibiofibular syndesmosis and negative results of Cotton and external rotation tests in them.Additionally,ankle arthroscopy revealed 16 cases of injury to the deltoid ligament at the medial ankle.Conclusions Ankle arthroscopy can provide evidence for correct diagnosis and treatment of Type B ankle fracture complicated with injury to the distal tibiofibular syndesmosis,because it allows direct observation of the medial deltoid ligament of the ankle and the distal tibiofibular syndesmosis.It can be also used to assess the stability of the tibiofibular syndesmosis after repair of the injury.

Clinical observation of micro-fracture operation combined with sodium hyaluronate in the treatment of talar cartilage injury with ankle arthroscopy / 中国生化药物杂志

Objective To explore the clinical situation of ankle arthroscopic surgery combined with sodium hyaluronate in the treatment of osteochondral lesions of the talus.Methods 40 cases of osteochondral lesions of the talus were treated in our hospital from June 2014 to October 2016 were treated with ankle arthroscopic surgery combined with sodium hyaluronate,the situation after the treatment were observed, and according to the patient's rehabilitation the rehabilitation exercises were conducted according to the patient's condition, and the therapeutic effect was analyzed.Results The total effective rate was 87.5%;The mean value of ankle function score before treatment was(34.26±2.13)points,the mean value of ankle function score after treatment was(74.35±2.07)points, the difference was statistically significant before and after treatment(P<0.05).Conclusion The clinical observation of ankle arthroscopic surgery combined with sodium hyaluronate in the treatment of osteochondral lesions of the talus, the treatment effect is better, and can help the patient's ankle joint function get improve, and ultimately improve the prognosis, it is worthy of reference.

Cirugía artroscópica de la cámara anterior de tobillo / Arthroscopic surgery of the ankle

La cirugía artroscópica del tobillo es un procedimiento relativamente nuevo y forma parte del arsenal terapéutico actual del cirujano ortopedista. Se considera un procedimiento demandante desde el punto de vista técnico y requiere de gran pericia para trabajar en un espacio reducido. Sin embargo, con el perfeccionamiento de la técnica se ha convertido en el gold standard para el tratamiento de ciertas patologías como el síndrome de fricción anterior y las lesiones osteocondrales. Consideramos de mucha importancia, el conocimiento de la anatomía para evitar lesiones de elementos vasculares en la realización de los portales y el conocimiento de los sectores pasibles de exploración en cada una de las puertas de entrada, como así también las distintas técnicas que permiten una visualización más extensa de la articulación. En esta nota técnica describiremos los puntos más sobresalientes en cuanto a la topografía periarticular y la técnica per se para la correcta realización de este procedimiento y para evitar, en la medida de lo posible, potenciales complicaciones.

Arthroscopic surgery of the ankle is a relatively new procedure and is part of the current orthopedic surgeon arsenal. It is considered technically demanding and requires a skilled surgeon in order to be able to work in a restricted space. However, with the improvement of the technique, it has become the gold standard for the treatment of certain pathologies such as anterior impingiment syndrome and osteochondral lesions . To avoid injury, portal placement must be based on a thorough understanding of the ankle and foot extra-articular anatomy. The risk of injury to neurovascular structures is the greatest concern, as well as the different techniques that allow a wider visualization of the articular surface. This technical note will describe the most important points regarding the periarticular topography and the technique itself for the successful completion of this procedure and to avoid potential complications as far as possible.

Experience of Arthroscopy of Ankle Joint with Manual Traction / 대한족부족관절학회지

PURPOSE: Number of arthroscopic surgery is gradually increasing with development of its equipment and technique. Arthroscopic ankle surgery performed with the traction device has various complications and need more time for preparation. We investigated whether the complication rate increased when surgery was performed without the traction device, and compared the complication rate of arthroscopic surgery with the traction device. MATERIALS AND METHODS: From January 2009 to June 2012, arthroscopic ankle surgery was performed without the traction device in four hundred eleven cases. There were two hundred sixty-one males and one hundred fifty females. The average age at operation was 35 years (range, 17-56), and the average follow up period was 28 months (range, 12-41). Postoperative symptoms and complications were checked. RESULTS: There were difficulties performing arthroscopic surgery without the traction device in five cases with severe traumatic osteoarthritis. However, after burring and shaving, we had enough space to work on. Superficial peroneal nerve symptom was found in two cases, grooving of talus was found in 11, and saphenous vein injury was found in five. Since preparing for the traction device was unnecessary, we were able to save time with the mean duration of surgery of 50 minutes (range, 30-120). CONCLUSION: With only manual traction, we could explore the entire ankle joint without damage on cartilage. Yet, skilled arthroscopic technique will be necessary for arthroscopic surgery without the traction device.

Pseudoaneurysm of Anterior Tibial Artery after Ankle Arthroscopy / 대한족부족관절학회지

Pseudoaneurysm is extremely rare complication after ankle arthroscopy with standard anteromedial and anterolateral portals. We report a case of a pseudoaneurysm of the anterior tibial artery detected at 3 months after ankle arthroscopy in a 16-year-old male. He had sustained painful swelling of his right ankle after the arthroscopic surgery, and referred to our hospital with an MRI checked postoperatively. We failed to make the diagnosis of pseudoaneurysm with the postoperative MRI, thus the patient underwent another arthroscopy which revealed massive hemarthrosis within the joint. The diagnosis was confirmed with an angiography, and the vascular lesion was ligated.

Ankle arthroscopy in Viet Duc Hospital: 10 cases report

Background: Ankle arthroscopy has been used in Viet Duc Hospital for 4 years and now has become a routine surgery with about 200 patients, who has had ankle arthroscopy to reconstruct the anterior cruciate ligament or operate ragged meniscectomy. Objectives: Evaluate the result of ankle arthroscopy in Viet Duc Hospital and review the indication and surgical technique of ankle arthroscopy in the literature. Subject and methods: Retrospective study on 10 patients with ankle arthroscopy in Viet Duc Hospital from May 2006 to May 2007. Results: 5 patients with impingement, 4 patients with OCD lesion and 1 case of an old displaced fracture of lateral malleolar. Postoperative evaluation with Olerud Molander, ankle function improves at least 10 points and all the patients are satisfied with the results. Conclusions: Ankle arthroscopy gives good result and can be recommended for other cases.

Arthroscopic Findings and Treatment of Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: To assess the arthroscopic findings in chronic lateral ankle instability and to evaluate the results of modified Brostrom operation and arthroscopic procedures. MATERIALS AND METHODS: Twenty-nine cases with chronic lateral ankle instability were treated with modified Brostrom operation and ankle arthroscopy from May 2004 to January 2007. There were 19 male and 10 female with the mean age of 29.7 years. Mean follow up period was 15.8 months. All patients were checked preoperative stress anterior drawer and varus test with X-ray. RESULTS: Associated injuries were 28 fat impingement projected into the joint between distal tibio-fibular space, 20 anterior impingement of soft tissue, 19 osteochondral defects and 13 loose body. Preoperative AOFAS score of pain, function and alignment were 28.9, 34.1 and 7.9 each other. They were improved into 38.7, 40.8 and 9.8 postoperatively. CONCLUSIONS: Modified Brostrom operation with ankle arthroscopy for chronic lateral ankle instability is believed to be a reliable option to obtain satisfactory results. Careful attention to the associated injuries such as distal fat impingement, anterior impingement, osteochondral defect and loose body is needed during the arthroscopy.