ankle sprain; chronic lateral ankle instability; diagnosis and treatment; ligamentum bifurcatum injury. [20] The LB also provides the main static stability of the lateral and medial columns, stabilizing the linking between the midfoot and the hindfoot.[15]. In these cases, if instability is still present after a comprehensive nonoperative treatment, a surgical stabilization is required [5], [6], [7]. Published by Wolters Kluwer Health, Inc. Moreover, when performed under anesthesia, clinical examination exhibited 93.3% sensitivity and 100% specificity. [19]. Of the patients with concurrent LB injury, 82.1% (92/112) returned for final evaluation. HHS Vulnerability Disclosure, Help Part I: Anatomy, biomechanics, diagnosis, and natural history. The Mann-Whitney test was used for unpaired samples. LB = ligamentum bifurcatum. Brostrm technique; Brostrm-Gould technique; Evans technique; anatomic reconstruction; anatomic repair; ankle; ankle instability; arthroscopy; internal brace. Preoperative and final follow-up values of the assessed variables (n = 98). Ankle sprains are common injuries that may recur as chronic conditions. Bachman S, Johnson SR. Torsion of the foot causing fracture of the anterior calcaneal process. Weber B fracture of the lateral malleolus with concomitant anterior talofibular ligament injury following an ankle supination injury. Results: Concomitant intra-articular pathology was addressed accordingly. Andermahr J, Helling HJ, Rehm KE, et al. Mechanical stability was achieved in all cases. Diagnostic and Therapeutic Centre of Athens - Hygeia issued approval JAK20200409P. Orthopaedics Department, Volos General Hospital, Volos, GRC, 3 FOIA The sensitivity and specificity of MRI in detecting CFL ruptures were 46.7% and 87%, respectively. The 218 patients received tendon allograft reconstruction of the lateral ligament. Walking exercise was permitted 10 weeks after the removal of auxiliary support, and patients were permitted to jog from 12 weeks postoperatively. Sixty-eight of the 112 patients underwent LB repair, and 8 underwent LB reconstruction using allogeneic tendon grafts. Therefore, the excellent postoperative outcome documented in both groups supports our hypothesis regarding the lower clinical significance of ATFL. chronic lateral ankle instability surgical repairs: the long term prospective. modify the keyword list to augment your search. It was, therefore, a valuable tool in determining whether ligament reconstruction was required, and if this proved not to be the case, it was used as a standalone treatment option [13,14]. Your message has been successfully sent to your colleague. Conversely, the purpose of non-anatomic reconstruction is to regain stability through various tenodesis techniques. Modified arthroscopic Brostrom procedure. . The indications for treatment, nonoperative and operative treatment, as well as the biomechanical information available regarding these methods of treatment are considered. The calcaneocuboid angle was significantly reduced and the Chopart joint stability was significantly improved at final follow-up compared with preoperatively (Table 2). Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium[J]. LB = ligamentum bifurcatum. HHS Vulnerability Disclosure, Help Lacerations of the lateral . We assessed 67 highly active patients with chronic lateral ankle instability. Nielsen S, Agnholt J, Christensen H. Radiologic findings in lesions of the ligamentum bifurcatum of the midfoot. The anterior talo-fibular ligament reconstruction in surgical treatment of chronic lateral ankle instability. The Brostrom-Gould procedure is the gold standard surgical treatment for patients with chronic ankle instability (CAI) whose symptoms are refractory to conservative treatment. Initial treatment is conservative, either with bracing or neuromuscular training. Treatment for chronic ankle instability is based on the results of the examination and tests, as well as on the patient's level of activity. However, these are markedly rare complications that are more common during non-anatomic reconstruction. Lateral ankle sprains are the most common lower extremity injuries seen by healthcare providers [1]. Most patients had no pain or occasionally mild pain. A modified Brostrm repair with transosseous fixation for chronic ankle instability: a midterm followup study in soldiers. The LB is a major stabilizing factor for the lateral transverse tarsal joint (Chopart lateral joint line),[15] and so LB damage can result in laxity in the lateral part of the transverse tarsal joint; this can be demonstrated by the presence of a widened joint space in a roentgenogram performed while forcefully inverting the forefoot. There are few reports of LB injury in the literature, and reports of diagnosis and treatment of LB injury are extremely rare. Hiness P, Glott T, Ingjer F. Comprehensive testing of 10 different ankle braces. AJR Am J Roentgenol 2009;193:66271. 2012 Oct;40(10):2309-17. doi: 10.1177/0363546512455397. The https:// ensures that you are connecting to the Further research is warranted to confirm the present findings. The purpose of this study was to determine the type and frequency of associated injuries and conditions in military patients with chronic lateral ankle instability. It also permitted the management of associated intra-articular injuries that were responsible for the majority of symptoms seen in patients with functional chronic ankle instability [13]. Careers. Some error has occurred while processing your request. The vascularisation of the os calcaneum and the clinical consequences. Check Now Make an appointment Foot and Ankle Conditions Adult Conditions Symptom Checker 2nd MTP Joint Instability 5th Metatarsal Base Fracture Accessory Navicular Achilles Tendon Problems Andermahr et al[14] suggested that lateral and stress radiographs with about 20 kp varus stress should be performed at the level of the calcaneocuboid joint, and then the calcaneocuboid angle should be measured. Clinical rating scale for postoperative ankle reconstruction. 1 The pattern of lateral ankle ligamentous injury is well understood. and transmitted securely. At 14 days postoperatively, the sutures were removed, and plaster fixation was applied for 4 weeks. Bethesda, MD 20894, Web Policies The ATFL is the primary stabilizer against excessive ankle inversion. The oblique view clearly demonstrates the APC. We used 95% confidence intervals. Schmidt HM, Grnwald E. Ligament systems of talocrural and intertarsal joints in humans. It also helped identify synovitis and scar tissue that could not be viewed by MRI scans [6]. The follow-up period was two years. MeSH A long-term clinical and radiological follow-up. Between the third and sixth postoperative weeks, instructions were given for a transition from partial to full weight-bearing. Thirty-six of the 112 patients had excision of the fracture fragment (the APC). The peroneal tendons and sural nerve were to be protected at the posterior end of the incision. Conversely, we postulated that the CFL was the primary restraint for lateral ankle instability and that reconstruction of the lateral capsuloligamentous complex should be offered only to CFL-deficient patients. . [14]. Karlsson J, Bergsten T, Lansinger O, Peterson L. The effect of modified Brostrm-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. 2017 Apr;38(4):405-411. doi: 10.1177/1071100716683348. Return to sport following acute lateral ligament repair of the ankle in professional athletes. Due to its size and thickness, it is rarely injured with excessive ankle inversion. During this period, isometric and progressively active exercises commenced. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Kennedy JG, Smyth NA, Fansa AM, Murawski CD. Chronic instability can lead to loose ankle ligaments, loss of joint cartilage, and tendon injury. Surgical Management of Lateral Ankle Instability in Athletes. The reconstruction technique described by Brostrm [11] is considered the cornerstone of anatomic repair. The posterior talofibular ligament (PTFL) is of less clinical significance. Arthroscopic classification of chronic anterior talo-fibular ligament lesions in chronic ankle instability. Furthermore, the senior surgeon performed the clinical evaluations subjectively, including the assessments of mechanical and functional stabilities, introducing the possibility of evaluation bias. Treatment of Chronic Ankle Lateral Instability using Modified Brostrom Procedure Jae Hoon Ahn, M.D., Young-Geun Lee . Of the 112 cases of CLAI plus concurrent LB injury, 62 patients (55.4%) were men, and 50 (44.6%) were women. Failure after strict rehabilitation may be an indication of surgery. Data were expressed as mean SD for quantitative variables and as frequencies and percentages for qualitative variables. LB = ligamentum bifurcatum. Federal government websites often end in .gov or .mil. Patients achieved satisfactory results after treatment with LB repair and reconstruction with an allograft, and achieved mechanical stability without serious complications. Epidemiology of sprains of the lateral ankle ligament complex. Knee Surg Sports Traumatol Arthrosc. Postoperative routine nursing and standardized rehabilitation exercise were recommended. "Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. 5th Orthopaedics Department, Diagnostic and Therapeutic Centre of Athens - Hygeia, Athens, GRC, 2 Patients suffered from repeated sprains which leaded to pain, swelling and obvious ankle relaxation. It is the weakest ligament of the lateral ligament complex (LLC) and the first to be injured in ankle sprains [8]. Epub 2015 Jan 28. Careers. This study aimed to report our institution's experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury. Tan DW, Teh DJW, Chee YH. After 2 months of correct guidance and extracorporeal shockwave physiotherapy, the ankle stiffness had markedly improved. The 112 patients with concurrent LB injury had this treated simultaneously; 36 patients underwent excision of the anterior process of the calcaneus, 68 underwent LB repair, and 8 underwent LB reconstruction. Over the years, there have been several anatomic and non-anatomic techniques describing the reconstruction or repair of the lateral ankle ligaments. doi: 10.1016/j.otsr.2016.06.026. Please enable it to take advantage of the complete set of features! The preoperative AOFAS mean score was 68.9 14.19 for both groups. Finally, the lateral portion of the inferior extensor retinaculum was tagged to the periosteum of the fibula with absorbable sutures (Figures (Figures2,2, ,3).3). During arthroscopy, osteophytes were encountered and resected in 14 patients in Group A and eight patients in group B. Rupture of calcaneocuboid ligament. Federal government websites often end in .gov or .mil. [2] [10]. Following a lateral ankle sprain, 40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Arthroscopic-assisted Brostrm-Gould for chronic ankle instability: a long-term follow-up. So we summarize the following experience for reference: in type I and type II injuries the fracture fragment should be removed and reconstructed with a wire anchor; cannulated screws were used to fix the fracture in type III patients, and the LB reconstruction was performed with autograft or allograft tendons. However, surgery may be an option in patients with mechanical instability who do not improve with nonoperative treatment. Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3-11-Year Follow-up. Before Ligaments of the transverse tarsal joint complex: MRI-anatomic correlation in cadavers. Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. All patients underwent pre- and postoperative radiographic assessment including talar tilt, anterior talar translation, and calcaneocuboid angle. The patient's parents were overly worried, and so she only began to partially weightbear at 2 months postoperatively. Even though ankle sprains are mostly inconsequential, some may recur as chronic occurrences. Statistical analyses were performed with statistical software (SPSS version16.0; SPSS, Inc, Chicago, IL). [3]. and transmitted securely. Accessibility These findings had a higher prevalence in group A (p = 0.011) and most likely stemmed from post-injury hematomas. Return to play after modified Brostrm operation for chronic ankle instability in elite athletes. Among the disadvantages of non-anatomic reconstruction techniques are altered kinematics, decreased subtalar and talocrural joint mobility, increased risk for adjacent cutaneous nerve injury, and the sacrifice of the peroneus brevis [20-22]. It also prevents the ankle ligaments from weakening. However, the LB is essential for the stability of the transverse tarsal joint (Chopart lateral joint line). Do not disregard or avoid professional medical advice due to content published within Cureus. The mean age was 29.9 6.4 years (range: 13-50 years). Deafferentation due to mechanoreceptor damage postinjury is suggested to contribute to arthrogenic muscle inhibition (AMI). During the 24-month review, we used the Clinical Rating System for the Ankle Hindfoot (AOFAS) and Tegner Activity Level Score for the clinical assessment and patient activity evaluation, respectively. Richie, DH: Effects of foot orthoses on patients with chronic ankle instability. Please try again soon. Introduction. 7). Liu J, Chen M, Xu T, Tian Z, Xu L, Zhou Y. J Orthop Surg Res. The functionality is limited to basic scrolling. and transmitted securely. Edama M, Kageyama I, Kikumoto T, et al. J Athl Train. osteoarthritis subtalar joint pathologies Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. As part of our routine, the lateral ankle ligaments were evaluated. Khalid FM, Abdulla AJ, Fahad A, et al. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Occasionally, a third anterocentral portal was also used. Sports Med 1999 Jan;27(1):61-71. Anatomical repair of the outside (lateral) ankle ligaments is one common means of surgically stabilizing the ankle operatively. In routine examination of the foot, the avulsion of the APC can not be found, because on the lateral x-ray of the foot, the APC is projected on the talus. Clinical examination under anesthesia proved to be highly sensitive and specific. Knee Surg Sports Traumatol Arthrosc. calcaneofibular ligament, chronic ankle instability, arthroscopy, athlete, brostrom-gould. [12]. Calcaneofibular ligament may act as a tensioner of peroneal tendons as revealed by a contactless three-dimensional scan system on cadavers. China (e-mail: [emailprotected]). Bethesda, MD 20894, Web Policies The purpose of this meta-analysis was to compare different surgical techniques for management of chronic lateral ankle instability. Kaikkonen A, Lehtonen H, Kannus P, Jrvinen M. Long-term results of Watson-Jones tenodesis of the ankle. Postoperatively, 98 patients with combined CLAI and LB injury returned for final evaluation (98 ankles; 87.5%), including 32 patients who underwent excision of the fracture fragment, 59 who underwent LB repair, and 7 who underwent LB reconstruction; 14 patients were uncontactable and were lost to follow-up. The difficulty in evaluation and treatment is due in part to the ankle complex is composed of three joints: talocrural, subtalar, and tibiofibular syndesmosis. There were no serious perioperative complications such as infection and suppurative arthritis. A: Inversion-adduction is the common mechanism causing the anterior talofibular ligament and the LB injury. Both the anterior ankle drawer test and the varus stress test were positive. The patients' daily life may be seriously affected by ankle osteoarthritis and other irreversible damages, if the ATFL injury is not treated in time and drags on. The calcaneonavicular part of the LB is thicker (average diameter 3 mm) and longer (average length 15 mm) than the calcaneocuboidal part (2 mm in diameter and 9 mm in length)[8] (Fig. 4). Sun, Yaning MDa; Wang, Huijuan MDb; Tang, Yuchao MDa; Qin, Shiji MDa; Zhao, Mingming MDc; Zhang, Fengqi MDa,*, aDepartment of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, bDepartment of Histology and Embryology, Hebei Medical University. Surgical treatment of lateral ankle instability syndrome Cartilage defects were treated with debridement or microfracture technique. Surgical management for chronic lateral ankle ligament instability is useful when patients have failed nonoperative modalities. Two years after surgery, it improved to 96.6 6.84 in group A and 96.9 6.53 in group B, whereas the overall mean score was 96.9 6.54 (p < 0.001) (Table (Table11). Keywords: http://creativecommons.org/licenses/by-nc-nd/4.0, Received in revised form February 7, 2018. 2022 Mar 28;23(1):294. doi: 10.1186/s12891-022-05260-6. Moreover, relevant research suggested that their presence was associated with incomplete or defective ATFL healing [18] and anterolateral ankle impingement syndrome [19]. Its high inter-rater reliability in conjunction with ankle arthroscopy corroborates that it is a highly efficient diagnostic tool for the assessment of chronic ankle instability. . Moreover, the ATFL was incised, pulled distally, and attached with the CFL using the same anchor sutures. the display of certain parts of an article in other eReaders. Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings. FOIA Brostrm reconstruction is associated with lower morbidity, quicker functional recovery, and no proprioception interference [23]. The APC is seen on the lateral view, but is projected over the talus. Ankle arthroscopy provided useful information about the pattern of the injury and decision-making regarding the necessity for LLC reconstruction. A biomechanical evaluation of the tibiofibular and tibiotalar ligaments of the ankle. In cases where the CFL was intact (group A) (Figure (Figure1),1), no further treatment was performed. 19 Younes C, Fowles JV, Fallaha M, et al. Am J Sports Med 2012;40:230917. Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture. 2011 Nov;39(11):2381-8. doi: 10.1177/0363546511416069. Choisne J, Hoch MC, Alexander I, Ringleb SI. cOrthopedics, Hebei Provincial People's Hospital, Shijiazhuang, Hebei, P.R. This test was performed with the ankle held at 15 degrees of plantar-flexion, the talus in extreme varus, and the tibia rotated internally at 10 degrees. The rationale of anatomic reconstruction is to restore anatomy with direct repair of the identified ruptures and imbrication of the lateral ligaments. Kennedy JG, Smyth NA, Fansa AM, et al. Patients with ankle sprain may have concurrent LB injury; so after examination of the ankle joint, the LB should be examined in detail (clinical side differences were noticed). Treatment Non . Patients returned for a clinical and radiologic follow-up evaluation at an average of 31 (range, 2435) months postoperatively. Get into a half-kneeling position on the floor with the ankle you are stretching in front Make sure your front foot flat on the floor and facing straight forward Shift your weight forward while keeping the heel firmly on the ground Keep the inner edge of the knee aligned with the big toe to prevent flaring in or outward The remaining 30 patients (30/67 [44.78%], group B) developed mechanical instability with combined ATFL and CFL rupture. Urits I, Hasegawa M, Orhurhu V, et al. Fractures, syndesmotic injuries, posttraumatic arthritis, loose bodies, bony avulsions, and osteophytes were identified using plain radiographs. The .gov means its official. Yuan C, Wang Z, Zhu G, Wang C, Ma X, Wang X. Biomed Res Int. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. We accepted arthroscopy as the gold standard for assessing the integrity of the ATFL and CFL [13]. Numerous studies have shown that foot orthoses play a significant role in the treatment of lateral ankle instability, although the exact mechanism of their function is debated. A retrospective review was conducted on 67 patients diagnosed with CLAI in the Department of Sports Medicine, Xiangya Hospital, Central South University from January 2015 to January 2018, including 42 males and 25 females, aged from 17 to 41 years old, with disease course of (12.63.2) months. Exclusion criteria: combined medial (deltoid ligament) and lateral ankle instability; local infection of the ankle joint; fracture of the tibia, fibula, talus, or calcaneus (except for the ankle avulsion of small bones). Whole-body vibration (WBV) has the potential to address the neurophysiologic deficits accompanied by CAI and . As well as the routine anteroposterior and lateral radiographic views and oblique view of the midfoot (valgus 45), computed tomography, and/or magnetic resonance imaging, some cases required varus stress radiography. Functional results of modified Mason-Allen suture versus horizontal mattress suture in the arthroscopic Brostrm-Gould procedure for chronic ankle instability. Ankle arthroscopy confirmed the presence of cartilaginous lesions, osteophytes, and loose bodies, as outlined previously by other imaging modalities and clinical examination. Would you like email updates of new search results? Many categorical descriptions have OH 43606, USA; that as many as 55% of patients who sustain an phillip.gribble@utoledo.edu been used to dene this pathology, including ankle sprain do not seek evaluation or treatment chronic ankle instability (CAI), functional ankle Accepted 10 October 2013 from a healthcare professional.6 Subsequently, the . Ths A, Odagiri H, Elkam M, Lopes R, Andrieu M, Cordier G, Molinier F, Benoist J, Colin F, Boniface O, Guillo S, Bauer T; French Arthroscopic Society. Over the next two weeks, patients were allowed to perform proprioception, resistance, and closed chain training exercises. Ankle sprain is a common type of sports injury that may cause chronic ankle instability in approximately20 30% of cases. Baumbach SF, Braunstein M, Herterich V, Bcker W, Waizy H, Polzer H. Oper Orthop Traumatol. Hermans JJ, Wentink N, Beumer A, Hop WC, Heijboer MP, Moonen AF, Ginai AZ. Between the second and fifth week, patients were advised to perform passive and active range of motion, progressive resistance exercises, and intrinsic muscle strengthening. Assessing such groups is rather interesting since the functional demands of the latter are substantially higher compared to people living a sedentary lifestyle. Postoperative follow-up was conducted for 12-24 (15.643.17) months. Lateral ankle sprains cause damage to the ligaments and other soft tissues of the foot. However, several factors may lead to chronic ankle instability with recurring ankle sprains: Inadequate primary treatment Incomplete healing of the ligaments Repetitive trauma with deteriorated tissue quality With myriad procedures described for chronic lateral ankle instability, there is little consensus on optimal treatment outcome or a truly "ideal" operation. J Athl Train 2002;37:45862. Orthop Traumatol Surg Res. Failure after strict rehabilitation may be an indication for surgery. The LB is a double ligament with a common origin on the lateral aspect of the anterior process of the calcaneus (APC). AITFL, anterior inferior tibiofibular ligament; ATFL, anterior talofibular ligament; PTFL, posterior talofibular ligament; CFL, calcaneofibular ligament. Gribble PA, Bleakley CM, Caulfield BM, et al. Care was taken not to damage the intermediate cutaneous branch of the superficial peroneal nerve anteriorly. Ankle instability and arthroscopic lateral ligament repair. A 30-year-old high level athlete sustained a low ankle sprain 1 week ago. No PTFL ruptures were identified in either group. Group B (capsule ligamentous reconstruction): During the first two postoperative weeks, a below-knee cast was applied. The anatomic location of the lateral ankle ligament and the LB. . It was used for recognizing those with CFL deficient ankles and for addressing associated intra-articular pathologies. The anchors were in good position. Please enable it to take advantage of the complete set of features! 2022 Feb 25;35(2):172-7. doi: 10.12200/j.issn.1003-0034.2022.02.016. You may be trying to access this site from a secured browser on the server. It provides ankle and subtalar joint stability and acts as a pulley for the peroneal tendons during their course through the peroneal groove of the lateral malleolus. Patients with LB lesions experience substantially more pain in the region of the LB with radiation of pain to the forefoot compared with patients with only lesions in the region of the ankle joint. Despite their previous high level of activity, our studied population demonstrated a very low post-injury mean Tegner score of 3.62 1.29 (range: 0-10). Krips R, van Dijk CN, Lehtonen H, Halasi T, Moyen B, Karlsson J. Both groups demonstrated significant improvement in their Tegner (p = 0.009) and AOFAS scores (p = 0.001) during their 24 months follow-up. This test was performed with the ankle held plantar-flexed at 15 degrees. The latter improved to 6.2 2.15 two years after surgery (p = 0.009). The ePub format is best viewed in the iBooks reader. Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. An ankle inversion injury is the most common type of ankle sprain to occur. Agnholt J, Nielsen S, Christensen H. Lesion of the ligamentum bifurcatum in ankle sprain. Disclosure Dr E. Ferkel discloses that he is a consultant and instructor for Arthrex and Ferring Pharmaceuticals. Secondly, the incidence of LB was high in CLAI patients, >40% greater than the incidence described by Agnholt et al.[5]. Foot Ankle Int 1998;19:65360. [7] It comprises with 2 components, medial and lateral. In patients with CFL tear, our algorithm mandated further treatment. [3,4] It is reported that 40.5% of patients with chronic lateral ankle instability (CLAI) have clinical signs of damage to the ligamentum bifurcatum (LB) of the midfoot[5]; missed or delayed diagnosis of LB injury is common, meaning that the true incidence of LB injury is probably higher. Wolters Kluwer Health The patient who underwent LB reconstruction and rated the surgical result as poor was a 42-year-old man who had been involved in a motorcycle accident in which he sustained fractures of the right ankle; he returned to the hospital for open reduction and internal fixation of the calcaneal fractures, and recovered well after the second surgery. Ankle arthroscopy is a useful adjunct to ligamentous procedures, performed at the time of repair to identify and treat intra-articular conditions that may be associated with chronic ankle instability. 3); the extruding base of the fifth metatarsal can be palpated with the middle finger of the examiner, and the external malleolus be hold with the thumb, the marked tender point of the LB injury can be felt upon by the crooked index finger, between these 2 bones. The "giving way" usually happens while walking or doing other activities, but it can also happen while standing still. Ioannis K Triantafyllopoulos, Dimitrios G Economopoulos, [], and Louw van Niekerk. These three issues need to all be considered as part of a triad of chronic ankle instability issues. 2015 Mar;20(1):59-69. doi: 10.1016/j.fcl.2014.10.002. Under normal circumstances, the calcaneocuboid angle is <5. This is essential for high-demand patients like athletes and combat-ready military personnel. Beumer A, van Hemert WL, Swierstra BA, Jasper LE, Belkoff SM. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. All identified randomized and quasi-randomized controlled trials of operative treatment for . What is the best surgical treatment for this patient? Ankle arthroscopy was performed in all patients. The objective of this study was to compare the difference of plantar pressure distribution between surgical treatment and conservative treatment for CAI. Foot Ankle Clin. 2). Chronic ankle instability most commonly occurs as a result of repeated ankle sprains. Foot Ankle Surg. Chronic ankle instability (medial and lateral). Minimally invasive treatment of chronic ankle instability: a comprehensive review[J]. Sixty-four patients (95.5%) worked and exercised as before the surgery. Orthop Traumatol Surg Res. The VAS pain score was significantly reduced at the last follow-up compared with preoperatively (Table 2). These findings agree with other studies citing that MRI has limitations in diagnosing CFL injuries [29,30]. Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Moreover, this injury pattern precludes isolated CFL ruptures [11]. In contrast, the rationale for anatomic repair is to restore normal anatomy by imbrication of the lateral capsuloligamentous complex. Open anatomic reconstruction is an effective method of stabilization. Postoperative stiffness developed in two patients in group A, with severe restriction of ankle dorsiflexion (greater than 15 degrees). Foot Ankle Int 2017;38:76978. Acta Chir Scand 1953;105:4606. In the present study, the LB was examined as described by Gellman[18] (Fig. The site is secure. Funding support: This study was not supported by any funding. PMC A key point to surgical treatment of chronic lateral ankle instability is choosing a suitable surgical procedure. In preoperative assessment, a detailed history was taken and a thorough clinical examination was performed. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. The effect of landing heights and loads on ankle inversion proprioceptive performance in individuals with or without chronic ankle instability (CAI) may be important but are still unclear. B: The calcaneocuboid angle is 10.8. The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Epub 2018 Sep 20. An official website of the United States government. Purpose Treatment of chronic lateral ankle instability (CLAI) with poor remnant quality is challenging. 2018 Dec;104(8S):S207-S211. Careers. Manual therapy is effective in promoting soft tissue repair. Allograft or suture tape augmentation can be useful for patients with generalized ligamentous laxity, patients with high body mass index, and elite athletes. Prospective observational study of midtarsal joint sprain: epidemiological and ultrasonographic analysis. Surgical management of chronic lateral ankle instability: a meta-analysis. This study is limited by its retrospective nature. Chronic Ankle Instability Treatment - London Foot and Ankle Centre Chronic Ankle Instability Treatment - London Foot and Ankle Centre. Between weeks 6 and 12, closed chain as well as passive and active range of motion exercises were added to the rehabilitation program. MRI is most useful for chronic ankle instability. A P-value of <.05 was considered to indicate a statistically significant difference. official website and that any information you provide is encrypted Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Melo L, Canella C, Weber M, et al. You may notice problems with Yoshimoto K, Noguchi M, Maruki H, Tominaga A, Ishibashi M, Okazaki K. Knee Surg Sports Traumatol Arthrosc. Li X, Lin TJ, Busconi BD. With a history of ankle sprain, this patient presented with pain and ankle instability months after a precipitating injury as a result of tearing of the ligaments near the ankle bone at the outside aspect of the foot/ankle. official website and that any information you provide is encrypted Surgery of the Foot and Ankle. Comparison of repeated measurements documented during preoperative assessment and 24-month postoperative review was performed using the paired samples Students t-test or Wilcoxon test (in case of violation of normality). Stability of the ankle joint: analysis of the function and traumatology of the ankle ligaments. J Bone Joint Surg Br 1991;73:8025. Regardless, examination under anesthesia remains impractical since it can only be performed in the operating room before arthroscopy. Seven patients sought professional help for their instability elsewhere before our consultation. Sports injuries were the cause for ankle instability in 44 (44/67; 65.7%) cases, whereas trauma suffered during military training was the cause in 23 (23/67; 34.3%) cases. 2022 Oct 20;17(1):459. doi: 10.1186/s13018-022-03354-4. Standing X-ray examination indicated normal joint space without stenosis, and the internal fixation was in good position. Curr Pain Headache Rep, 2020, 24(3): 8. Epub 2016 Nov 18. These demands lead to a proportionately higher threshold for expectations. Patients who underwent LB repair or reconstruction had an excellent or good outcome regarding patient subjective self-assessment, pain scores, Karlsson scores, and AOFAS scores at final follow-up. A 5-year follow-up study of the modified Evans procedure. With the assistance of a GUHL Ankle Distractor (ACUFEX, Smith & Nephew Inc., Andover, MA, USA), two standard portals were made (anteromedial and anterolateral). Conclusions: [15] (Fig. Wainright WB, Spritzer CE, Lee JY, Easley ME, DeOrio JK, Nunley JA, DeFrate LE. For chronic lateral ankle instability, we also need to look for other conditions such as peroneal tendon pathology, fractures, joint lesions . Inter-rater reliability for CFL tears was moderate on clinical examination (k = 0.514) and fair on MRI, in conjunction with ankle arthroscopy (k = 0.357). [2]. ment reconstruction in surgical treatment of chronic lateral ankle instability. [1,2] Especially in the active population, where lateral ankle sprain accounts for up to 20% of all sports-related injuries. [23]. The Authors. . Keywords: . Six patients from each group developed postoperative synovitis that necessitated treatment with secondary arthroscopic synovectomy. Lateral ankle instability is a complex condition that can, at times, prove difficult to evaluate and treat for general practitioners. Tourne Y, Besse JL, Mabit C (2010) Sofcot chronic ankle . 2017 Mar;38(3):324-330. doi: 10.1177/1071100716674997. PMC This review article discusses chronic lateral ankle ligament instability from a functional, anatomical point of view. treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter study. I wish to designate a dual first authorship by D. G. Economopoulos and I. K. Triantafyllopoulos. Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair. Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence Authors Song Ho Chang 1 , Brandon L Morris , Jirawat Saengsin , Yves Tourn , Stephane Guillo , Daniel Guss , Christopher W DiGiovanni Affiliation Patients typically suffer from pain, recurrent ankle sprains and swelling of the ankle. Valderrabano V, Hintermann B, Horisberger M, Fung TS. The patients' daily life may be seriously affected by ankle osteoarthritis and other irreversible damages, if the ATFL injury is not treated in time and drags on. Osteochondral lesions associated with chronic lateral ankle instability are larger (150mm2 or larger) in ankles without . All patients underwent ankle arthroscopy. [4]. The incision was then rinsed with saline and sutured. Long-term results of surgical reconstruction for chronic lateral instability of the ankle: comparison of Watson-Jones and Evans techniques. 2015 Sep;21(3):216-9. doi: 10.1016/j.fas.2015.01.008. Parkes J. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Generating an ePub file may take a long time, please be patient. .. . 80% patients with LB injury would present with all 3 clinical signs described above[17,19] (Fig. eCollection 2022. This site needs JavaScript to work properly. For more information, please refer to our Privacy Policy. All the patients had surgical indications and no obvious contraindications, and they were treated with arthroscopic debridement and double-bundle anatomical reconstruction of the AFTL's fibular enthesis under anesthesia. Sports Med 2014;44:12340. Gould N, Seligson D, Gassman J. The authors have declared that no competing interests exist. Cao S, Wang C, Ma X, Wang X, Huang J, Zhang C. Accuracy of magnetic resonance imaging in diagnosing lateral ankle ligament injuries: a comparative study with surgical findings and timings of scans. Open anatomic reconstruction is an effective method of stabilization. J Bone Joint Surg Am 1951;33-A:3826. Impact of chronic lateral ankle instability with lateral collateral ligament injuries on biochemical alterations in the cartilage of the subtalar and midtarsal joints based on MRI T2 mapping. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Clipboard, Search History, and several other advanced features are temporarily unavailable. Highlight selected keywords in the article text. APC = anterior process of the calcaneus. We evaluated our outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS clinical rating system) [15] and Tegner activity level score [16]. English, Chronic Lateral Ankle Instability - Everything You Need To Know - Dr. Nabil Ebraheim 218,176 views Dec 14, 2016 Dr. Ebraheims animated educational video describing the condition of. Normative data for the American Orthopedic Foot and Ankle Society ankle-hindfoot, midfoot, hallux and lesser toes clinical rating system. Background: Chr onic lateral ankle instability causes significant problems in physical activity and accelerates development of . Katakura M, Odagiri H, Charpail C, Calder J, Guillo S; Ankle Instability Group. An overview of different treatment options, possibilities and cascade to simplify the therapy of chronic ankle instability is given. Chronic ankle instability is defined by the outer (lateral) side of the ankle "giving way" on a regular basis. Overall, no postoperative ankle instability or relapsing ankle sprain was documented. [11]. All the authors declare that they have no conflict of interest. government site. In contrast, patients who underwent LB repair or LB reconstruction showed significant improvements in VAS pain score and AOFAS score at the last follow-up. sharing sensitive information, make sure youre on a federal The integrity of the ATFL was assessed with the anterior drawer test. They were then supplied with a detailed physiotherapy program and were discharged a day after surgery. Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. B: An uncommon mechanism of fracture, consisting of dorsiflexion and eversion, causing a compression-type lesion. CLAI occurs when functional or mechanical insufficiencies of the lateral ankle ligamentous complex persist. Ankle traction was removed and a 4-cm incision was made, starting from the anterior margin of the fibula and ending downwards and posteriorly, approximately 1 cm distal from the tip of the lateral malleolus. Arthroscopic treatment for anterolateral impingement of the ankle: Systematic review and exploration of evidence about role of ankle instability. They specialize in Orthopedic Surgery, has 36 years of experience, and is board certified in Orthopedic Surgery. J Am Podiat Med Assoc 97:19-30, 2007; Tropp H, Odenick P, Gillquist J: Stabilometry . Southern California Orthopedic Institute Sports Medicine and Arthroscopy Fellowship receives institutional support from Depuy Mitek and Smith & Nephew. More than half of these injuries occur after excessive ankle plantar-flexion and inversion during athletic activities or military training. These methods offer good results even in very active groups such as athletes and military personnel. They were recreational athletes or active military personnel. Epidural anesthesia was administered, and the patient was placed in supine position with a thigh tourniquet. Anat Anzeiger Off Organ Anat Gesellschaft, 2018, 216: 69- 74. Keyword Highlighting This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Du MZ, Su T, Jiang YF, Jiao C, Guo QW, Hu YL, Jiang D. Front Surg. 2018 Jun 25;13(1):159. doi: 10.1186/s13018-018-0870-6. The https:// ensures that you are connecting to the 2022 Nov 19;17(1):502. doi: 10.1186/s13018-022-03402-z. For chronic ankle instability, a combination of the following treatments is often successful at relieving symptoms and minimizing the risk of recurrent ankle sprains: . Patients with CLAI often have concurrent LB injury. Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Brostrm repair using suture anchors. The ankle should be in neutral or slight plantar flexion to help align ATFL and CFL. Keywords: Foot Ankle Int 2000;21:996-1003. Injections For Chronic Ankle Sprain Operative Treatment Options Potential Complications Post Operative Period & Recovery FAQs Symptom Checker Where is your pain? 2009;4:41. Zentr Bl Chir 1986;111:12504. Am J Sports Med. Objectives: Anterior talofibular ligament (ATFL) injury is one of the most common injuries in sports medicine, resulting in chronic lateral ankle instability (CLAI). [24] reported poor results in patients with generalized ligamentous laxity, long-standing ligamentous insufficiency, or previous operation. This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. Ankle sprain is often combined with LB damage. Repeated ankle sprains are a common cause of this syndrome. Both the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are considered the primary static restraints during ankle inversion [6]. Finally, between the third and sixth postoperative month, patients would gradually start sports specific exercises. 2019. Arthroscopic debridement and double-bands anatomical reconstruction of the ATFL's fibular enthesis for the treatment of CLAI gains beneficial short-term effects for its minimal invasion and quick recovery. Of the patients who underwent excision of the fracture fragment, the surgical result was rated as excellent by 1/32 (3.1%) patients, good by 11/32 (34.4%) patients, and fair by 20/32 (62.5%) patients. Song and G. Zhang of the Department of statistics and applications for their kind assistance. Its most serious complication is superficial peroneal or sural nerve injury. Treatment of acute lateral ankle ligament rupture in the athlete. Proprioception is essential for neuromuscular control in relation to sport injury and performance. Preoperative and final follow-up values of the assessed variables of excision of the fracture fragment (n = 32). DVT (deep vein thrombosis) prophylaxis was prescribed until the cast was removed. Strength of the kappa coefficients was interpreted in the following manner: 0.01 to 0.20: slight; 0.21 to 0.40: fair; 0.41 to 0.60: moderate; 0.61 to 0.80: substantial; 0.81 to 1.00: near perfect. Clipboard, Search History, and several other advanced features are temporarily unavailable. [25]. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2020 Apr;12(2):505-514. doi: 10.1111/os.12651. All included CLAI patients underwent allogeneic tendon reconstruction. Clipboard, Search History, and several other advanced features are temporarily unavailable. This site needs JavaScript to work properly. The 1 patient who underwent LB repair and rated the surgical result as poor was very young (18 years old). As the calcaneocuboid joint is part of Chopart joint line, we also performed dorsoplantar, lateral, and stress radiographs with about 20 kp varus stress at the level of the calcaneocuboid joint to measure the calcaneocuboid angle.[1315]. Evaluation of passive and rapidly induced stability in subjects with chronic ankle instability. All operations were carried out successfully, and both the anterior ankle drawer test and the varus stress test were negative under anesthesia after surgery. 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