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Chen Z, Yang H, Zhang X, Su M, Li Z, Liu C, Xiao Z, Liang H, Xu G, Xu C, Ouyang J, Dai J. Anatomical analysis of the lateral ligament complex in the neutral position and during plantar flexion. BMC Musculoskelet Disord 2025; 26:445. [PMID: 40329254 PMCID: PMC12054227 DOI: 10.1186/s12891-025-08699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2025] [Accepted: 04/24/2025] [Indexed: 05/08/2025] Open
Abstract
AIM The purpose of this study was to obtain anatomical information on the anterior talofibular ligament (ATFL), anterior tibiofibular ligament (ATiFL) and calcaneofibular ligament (CFL) in the neutral position and during plantar flexion. METHODS Seventy specimens with whole ankle ligaments were recorded for anatomy education. ATFLs with single, double, and triple bands corresponded to Types A, B, and C. In our study, different types of ATFLs with information on the length, width, ATFL/CFL angle, ATFL/ATiFL angle, and the distance of the fibular center of insertion (fCOI) of ATFL-CFL-ATiFL in the neutral position and 20° plantar flexion, was collected. RESULTS In Type B, the length, width, and ATFL/ATiFL angle of the superior and inferior bands varied (length, P < 0.001; width, P < 0.001; ATFL/ATiFL angle, P < 0.001). Among the types, the total widths of Types A/B and A/C were significantly different (P < 0.01; P < 0.001). In terms of postural changes, significant differences in the ATFL/ATiFL angle were observed for Type A (P < 0.001), Type B (P < 0.001), and Type C (P < 0.01). CONCLUSIONS In conclusion, attention should be given to the ATFL widths of different ATFL types during surgical treatment because of the significant differences among the three ATFL types. The relative independence of ATiFL and the cooperative relationship between ATFL and CFL are instructive for different ATFL surgical procedures. The ATFL, CFL, and ATiFL data can be used for anatomical reconstruction and secondary proofreading for ATFL injury or chronic ankle instability.
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Affiliation(s)
- Zhimin Chen
- Department of Imaging Diagnostics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Han Yang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | | | - Minghao Su
- The First Clinical Medicine College, Southern Medical University, Guangzhou, China
| | - Zeyu Li
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Chang Liu
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhaoming Xiao
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hiabin Liang
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Guangwei Xu
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Chujiang Xu
- Department of Orthopedics, TCM-Integrated Hospital, Southern Medical University, Guangzhou, China.
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology (Southern Medical University) & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
- Department of Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China.
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Gao Q, Li J, Wang Q, Liu D, Guo L. Comparative analysis of sensory-motor function and its correlation with gait biomechanics in patients with unilateral chronic ankle instability. J Orthop Surg Res 2025; 20:396. [PMID: 40251558 PMCID: PMC12008919 DOI: 10.1186/s13018-025-05811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Accepted: 04/11/2025] [Indexed: 04/20/2025] Open
Abstract
OBJECTIVE This study was to evaluate the correlation between postural stability, proprioception, tactile sensation, and gait biomechanics in young patients with unilateral chronic ankle instability (CAI). METHODS A total of 85 patients with CAI (80% females) and 51 healthy individuals (78% females) aged 18-35 years were recruited for this study. Standardized tests were used to assess bilateral sensory-motor function and gait biomechanics, to compare differences in sensory-motor function and gait biomechanics between groups, and to analyze the correlation between sensory-motor function and gait on the affected side of CAI patients. Postural stability was quantified by jump-landing test for stabilization time in the anterior-posterior direction; proprioception was quantified by bilateral thresholds for ankle plantarflexion, dorsiflexion, inversion, and eversion; and plantar sensation was determined by measuring the minimum thresholds of sensation in the five plantar regions. Gait biomechanics were analyzed by collecting ankle dorsiflexion-plantarflexion/inversion-exversion range of motion and ankle-toe kinetic parameters during barefoot walking. RESULTS Compared with Non-CAI, CAI patients had longer stabilization time in both anterior-posterior directions bilaterally (P = 0.015, P = 0.024); longer stabilization time was observed only in the medial-lateral direction on the affected side (P = 0.012). Thresholds for plantarflexion, dorsiflexion, inversion, and eversion of the ankle joint were higher bilaterally in CAI than in Non-CAI (all P < 0.05); tactile sensation was reduced bilaterally in CAI for the big toe, the 1st metatarsal head, the 5th metatarsal head, the lateral arch, and the heel (all P < 0.05); and gait biomechanics were reduced bilaterally in CAI patients than in Non-CAI individuals (all P < 0.05). Thresholds for plantarflexion, dorsiflexion, inversion, and eversion had significant negative correlations with gait biomechanics (r > 0.5, P < 0.05). There was a weak to moderate correlation between the lowest tactile sensation thresholds at the big toe and heel and gait biomechanics (r > 0.3, P < 0.05). No significant correlation was observed between stabilization time and gait biomechanics (P < 0.05). CONCLUSION Young patients with unilateral CAI have poor bilateral postural stability, proprioception and tactile deficits, and altered gait biomechanics. These changes not only affect the affected side but also involve the non-affected side.
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Affiliation(s)
- QiLong Gao
- Department of Orthopedics and Traumatology, Kunming Municipal Hospital of Traditional Chinese Medicine, No.25 Dongfeng East Road, Panlong District, Kunming City, 650011, Yunnan Province, China
| | - Jiao Li
- Department of Orthopedics and Traumatology, Kunming Municipal Hospital of Traditional Chinese Medicine, No.25 Dongfeng East Road, Panlong District, Kunming City, 650011, Yunnan Province, China
| | - Qi Wang
- Department of Orthopedics and Traumatology, Kunming Municipal Hospital of Traditional Chinese Medicine, No.25 Dongfeng East Road, Panlong District, Kunming City, 650011, Yunnan Province, China
| | - Dan Liu
- Department of Teaching, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming City, 650011, Yunnan Province, China
| | - Lei Guo
- Department of Orthopedics and Traumatology, Kunming Municipal Hospital of Traditional Chinese Medicine, No.25 Dongfeng East Road, Panlong District, Kunming City, 650011, Yunnan Province, China.
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Mao W, Jin Z, Li W, Zhu Y, Kong W, Wang Y, Qin J. All-inside arthroscopic repair of ATFL and CFL separately for chronic lateral ankle instability in conjunction with subtalar instability. J Orthop Surg Res 2025; 20:380. [PMID: 40234894 PMCID: PMC12001407 DOI: 10.1186/s13018-025-05780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Accepted: 04/01/2025] [Indexed: 04/17/2025] Open
Abstract
BACKGROUND Chronic lateral ankle instability (CLAI) is a common condition often associated with damage to the anterior talofibular ligament (ATFL). In cases where CLAI is accompanied by subtalar instability (STI) due to calcaneofibular ligament (CFL) injury, the optimal surgical approach remains controversial. While isolated ATFL repair has been shown to effectively restore ankle joint stability, it may be insufficient to address the subtalar joint instability caused by CFL damage. This study aimed to evaluate the clinical importance of CFL repair by comparing the outcomes of isolated ATFL repair versus combined ATFL and CFL repair. METHODS A retrospective cohort study was conducted involving patients diagnosed with CLAI in conjunction with STI from January 2018 to January 2022. Participants were divided into two groups: one underwent isolated ATFL repair (ATFL group), and the other underwent combined ATFL and CFL repair (ATFL + CFL group). Clinical outcomes were assessed using the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS-AH), Karlsson Ankle Functional Score (KAFS) and Visual Analog Scale (VAS) scores, while radiological outcomes were evaluated by MRI and stress radiographs. RESULTS All the functional scores significantly improved in both groups post-surgery. However, the ATFL + CFL group demonstrated superior functional recovery, with higher AOFAS scores and greater reductions in VAS pain scores compared to the ATFL group. Radiological evaluation indicated better restoration of subtalar joint stability in the ATFL + CFL group. At the final follow-up, 3 cases of recurrent instability were observed in the isolated ATFL repair group. No significant difference in other complication rates was observed between the two groups. CONCLUSION The study demonstrated the importance of CFL repair in patients with CLAI in conjunction with STI. While isolated ATFL repair is effective for ankle joint stability, combined ATFL and CFL repair offers superior outcomes by addressing both ankle and subtalar joint instability. These findings suggest that CFL repair should be considered in surgical planning for patients with STI to optimize functional recovery and long-term stability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Weiwei Mao
- Department of Hand and Foot Surgery, the Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Gusu District, Suzhou, 215004, China
| | - Zhigao Jin
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Li
- Department of Hand and Foot Surgery, the Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Gusu District, Suzhou, 215004, China
| | - Ying Zhu
- Suzhou Medical College, Soochow University, Suzhou, China
| | - Weiqi Kong
- Department of Hand and Foot Surgery, the Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Gusu District, Suzhou, 215004, China
| | - Ying Wang
- Department of Wound Center, The Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Gusu District, Suzhou, 215004, China.
| | - Jianzhong Qin
- Department of Hand and Foot Surgery, the Second Affiliated Hospital of Soochow University, No. 1055, Sanxiang Road, Gusu District, Suzhou, 215004, China.
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Babler F, Gaetke-Udager K, Crawford EA, Yablon CM. Imaging of soccer injuries in adolescent female athletes. Skeletal Radiol 2025; 54:743-762. [PMID: 38478081 DOI: 10.1007/s00256-024-04629-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/21/2024] [Accepted: 02/16/2024] [Indexed: 02/22/2025]
Abstract
Soccer participation is increasing among female adolescents with a concomitant rise of injuries in this group. Age- and sex-related factors, such as the transition from skeletal immaturity to skeletal maturity as well as anatomic, physiologic, neuromuscular, and behavioral differences between females and males, all play a role in injury patterns for these athletes. Anterior cruciate ligament (ACL) tears in this group have received a great deal of attention in the medical literature and the media in recent years with increasing knowledge about causative factors, surgical management, and injury prevention. There have been fewer studies specifically focused on female adolescent soccer players in relation to other types of injuries, such as patellar dislocation/instability; other knee and ankle ligament tears; hip labral tears; muscle strains and tears; and overuse injuries such as apophysitis, patellofemoral pain syndrome, and bone stress injuries. Because imaging plays a critical role in diagnosis of soccer-related injuries in female adolescents, knowledge of the mechanisms of injury, imaging findings, and clinical considerations are essential for radiologists involved in the care of these patients.
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Affiliation(s)
- Fernanda Babler
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Eileen A Crawford
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Corrie M Yablon
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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McMillan P, Wilson WT, Hopper GP, MacKay G. Satisfactory patient reported outcomes at five years following primary repair with suture tape augmentation for anterior talofibular ligament injury. J Foot Ankle Surg 2025:S1067-2516(25)00086-9. [PMID: 40122445 DOI: 10.1053/j.jfas.2025.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 03/05/2025] [Accepted: 03/08/2025] [Indexed: 03/25/2025]
Abstract
The Brostrom technique is widely accepted as the gold standard surgical intervention for the treatment of chronic lateral ankle instability. Concerns with persistent postoperative instability, incomplete restoration of preinjury biomechanical strength, and variable return-to-sport rates have, however, led to growing interest in novel augmentation procedures. Suture tape augmentation, which reinforces the anterior talofibular ligament and acts as a secondary stabilizer, is one such method. This study assesses 5-year patient-reported outcomes of primary repair with suture tape augmentation for anterior talofibular ligament injuries. Seventy-seven patients undergoing anterior talofibular ligament repair with suture tape augmentation were prospectively followed for at least 5-years. The visual analogue scale for pain (VAS), veteran rands 12 (VR-12) score, functional foot index (FFI), and the foot and ankle ability measure sports subscale (FAAM-S) were assessed at baseline, 2-year follow-up and 5-year follow-up. Of the seventy-seven patients initially included, sixty-eight (88.3%) completed follow-up. The median VAS, VR-12, FFI, and FAAM-S scores all demonstrated significant improvement at both 2-year and 5-year follow-up, compared to preoperative baseline. Only the FFI demonstrated improvement between the 2-year and 5-year follow-up timepoints. In conclusion, primary repair with suture tape augmentation for anterior talofibular ligament injury demonstrates satisfactory patient-reported outcomes at a minimum of 5-year follow-up. These results suggest that this technique should be considered as an alternative to conventional Brostrom repair for treatment of lateral ankle instability.
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Affiliation(s)
| | | | - Graeme P Hopper
- Department of Orthopaedics, NHS Lanarkshire University Hospitals, Scotland, UK
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Mohamad H, Koh D, Socklingam R, Chandrakumara D, Moo IH, Kon C. Clinical Outcomes After Arthroscopic Broström-Gould Procedure for Chronic Lateral Ankle Instability. Cureus 2025; 17:e81025. [PMID: 40264622 PMCID: PMC12013461 DOI: 10.7759/cureus.81025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2025] [Indexed: 04/05/2025] Open
Abstract
Background Chronic lateral ankle sprains are common injuries that are largely sequelae of inversion injuries of the ankle. These injuries are amenable to surgical intervention, namely, Broström-Gould reconstruction, which is commonly performed for the above injury. Many open and arthroscopic variations of the technique have been described. Arthroscopic Broström-Gould has been shown to have comparable outcomes to the open technique. Analysis of 39 patients who underwent arthroscopic Broström-Gould at a tertiary institution showed excellent outcomes from all three functional scores. Methods Thirty-nine patients underwent arthroscopic Broström-Gould in 2021 at a tertiary institution and were followed up for up to one year postoperatively. All patients had failed conservative treatment and reported pain and chronic instability prior to surgical intervention. Outcomes were measured with functional scores, namely, the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), and Karlsson and Peterson Scoring System (K-P). Other demographics such as age, gender, laterality, and body mass index were also recorded. Statistical analysis was performed with GraphPad Prism (GraphPad Software, San Diego, CA). Outcomes were analysed by paired t-test and statistical significance was set at p < 0.05. Results A total of 39 patients with chronic lateral ankle instability (CLAI) who underwent arthroscopic Broström-Gould were followed up for up to one year postoperatively. Demographics were as follows: 22 males and 17 females, 20 right ankles and 19 left ankles, average age of 36.2 years (19.6-64.8 years), and BMI of 27.4 (19.2-40). At follow-up, functional scores were measured as described in the methods section above. Preoperative VAS scores were 5.87 ± 1.92 (1-10) while postoperative VAS scores were 2.0 ± 2.16 (0-7). Preoperative K-P scores were 43.68 ± 13.2 (7-70) while postoperative K-P scores were 69.21 ± 17.86 (37-100). Preoperative AOFAS scores were 62.53 ± 16.05 (29-83) while postoperative AOFAS scores were 83.8 ± 11.49 (59-100). Conclusions Significant improvement of all three functional scores (VAS, K-P, and AOFAS scores) following arthroscopic Broström-Gould was noted. This shows that the arthroscopic Broström-Gould is an effective method to treat CLAI with good outcomes.
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Affiliation(s)
| | - Don Koh
- Orthopaedics, Changi General Hospital, Singapore, SGP
| | | | | | - Ing How Moo
- Orthopaedics, Changi General Hospital, Singapore, SGP
| | - Charles Kon
- Orthopaedics, Changi General Hospital, Singapore, SGP
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Luo X, Xue C, Xue Y, Fehske K, Zhang ZH, Maffulli N, Migliorini F, Feng SM. Augmentation with the inferior extensor retinaculum may facilitate earlier recovery in all-inside arthroscopic management of chronic lateral ankle instability. J Orthop Surg Res 2025; 20:40. [PMID: 39794802 PMCID: PMC11724511 DOI: 10.1186/s13018-024-05437-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Accepted: 12/28/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND To compare the clinical outcomes of inferior extensor retinaculum (IER) augmentation following repair of the anterior talofibular ligament (ATFL) with isolated ATFL repair in patients with an arthroscopically confirmed grade 3 lesion of the ATFL. METHODS We conducted a retrospective study of consecutive chronic lateral ankle instability (CLAI) patients who underwent arthroscopic ATFL repair between March 2018 and August 2022. The average age of the patients was 31.5 ± 7.4 years (range, 16-50 years). All patients underwent all-inside arthroscopic repair, and were divided into two groups based on the ligament repair method: the Broström-Gould group (n = 64) and the Broström group (n = 67). At 3, 6, 12 and 24 months after surgery, ankle inversion stress tests and anterior drawer tests were employed to assess the stability of the ankle joint. The American Orthopedic Foot and Ankle Society ankle hindfoot scale(AOFAS-AH) and Karlsson ankle function score (KAFS) were employed to assess ankle function; the Tegner score was employed to assess the patient's level of exercise; the Foot and Ankle Outcome Score [FAOS, including score of symptoms-diseases, pain, function-daily living score, function in sports and recreational activities, and quality of life] was used to assess the patient's daily activity ability. RESULTS The Tegner score, FAOS-function-daily living score, and FAOS-function in sports and recreational activities in the Broström-Gould group consistently outperformed the Broström group at 3 months and 6 months post-surgery, with the differences being statistically significant (all P < 0.05). However, although the differences are statistically significant, the clinical relevance of this statistical significance remains uncertain. At 12 and 24 months, there were no statistically significant differences between the two groups. CONCLUSIONS For CLAI patients with arthroscopic grade 3 lesion of the ATFL, both the all-inside arthroscopic Broström-Gould procedure and the Broström procedure provide stability and enhance ankle joint function, resulting in similar functional outcomes at a 2-year follow-up. IER augmentation following ATFL repair may facilitate earlier recovery exercises compared to isolated all-inside ATFL repair.
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Affiliation(s)
- Xin Luo
- Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, Jiangsu, 221009, China
| | - Chong Xue
- Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, Jiangsu, 221009, China
| | - Yue Xue
- Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, Jiangsu, 221009, China
| | - Kai Fehske
- Department of Trauma Surgery, University Hosptial Wuerzburg, Wuerzburg, Germany
- Department of Orthopedic and Trauma Surgery, Johanniter Waldkrankenhaus Bonn, Bonn, Germany
| | - Zi-He Zhang
- Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, Jiangsu, 221009, China
| | - Nicola Maffulli
- Department of Orthopaedic Surgery, Sant'Andrea Hospital, University La Sapienza, Rome, Italy.
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-on- Trent, Staffordshire, ST4 7QB, England.
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England.
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano, Teaching Hospital of the Paracelsus Medical University, Bolzano, 39100, Italy
| | - Shi-Ming Feng
- Sports Medicine Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, No. 199, the Jiefang South Road, Xuzhou, Jiangsu, 221009, China.
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Sano S, Kanzaki N, Kataoka K, Nukuto K, Yamamoto T, Nakanishi Y, Nishida K, Nagai K, Hoshino Y, Matsushita T, Kuroda R. Clinical outcomes over 2 years following arthroscopic ankle lateral ligament repair with os subfibulare. Asia Pac J Sports Med Arthrosc Rehabil Technol 2025; 39:9-14. [PMID: 39660165 PMCID: PMC11626778 DOI: 10.1016/j.asmart.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 10/30/2024] [Accepted: 11/19/2024] [Indexed: 12/12/2024] Open
Abstract
Background There are reports indicating that between 10 and 38.5 % of patients with chronic lateral ankle instability (CLAI) have an os subfibulare. In cases where CLAI accompanied by os subfibulare is resistant to conservative treatment, surgery may be necessary; however, there is no consensus on the most appropriate surgical method. We report outcomes of arthroscopic lateral ligament repair for chronic lateral ankle instability with os subfibulare at our hospital, followed for over 2 years post-operatively. Methods We reviewed 33 patients (39 ankles) whom underwent arthroscopic lateral ankle ligament repair (ALLR) for CLAI and followed for at least 2 years post-operatively between November 2015 and May 2020. Patients were classified into two groups: a group with os subfibulare (ossicle group) and a group without os subfibulare (non-ossicle group), based on the presence of an os subfibulare on pre-operative plain radiographs. ALLR surgeries were performed without resection of the os subfibulare in ossicle group. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) scale and the Self-administered Foot Evaluation Questionnaire (SAFE-Q). In addition, the bone-union rate was evaluated by using plain computer tomography in the ossicle group. Results There were significant improvements in the mean total JSSF scale scores from pre-operative to post-operative measurements in both the ossicle and non-ossicle groups. The mean scores for pain and related symptoms, foot function and activities of daily living, social functioning, shoe-related, and general health and well-being subscales of the SAFE-Q also showed significant improvements in both groups. There were no significant differences between the post-operative ossicle and non-ossicle groups regarding the JSSF scale scores or the SAFE-Q subscale scores. In the ossicle group, the bone-union rate was 14.3 % (2 of 14 ankles), but no symptom recurrence was observed. Conclusion The 2 years outcomes of arthroscopic lateral ligament repair for chronic lateral ankle instability with os subfibulare revealed good results and no symptom recurrence.
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Affiliation(s)
- Shohei Sano
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Koji Nukuto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Fares A, Picot B, Lopes R, Nader F, Bohu Y, Meyer A, Gerometta A, Grimaud O, Lefevre N, Moussa MK, Hardy A. Indicators of Return to Sports at Preinjury Levels Following Surgery for Chronic Ankle Instability: Comparison of ALR-RSI, AOFAS, and Karlsson Scores. Orthop J Sports Med 2025; 13:23259671241302078. [PMID: 39811152 PMCID: PMC11729418 DOI: 10.1177/23259671241302078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 01/16/2025] Open
Abstract
Background While there are several scales for measuring patients' outcomes after chronic ankle instability (CAI) surgery, a study comparing the predictive ability of these scores with regard to return to sports (RTS) at the preinjury level is lacking. Purpose/Hypothesis The purpose of this study was to compare the Ankle Ligament Reconstruction-Return to Sport After Injury (ALR-RSI), American Orthopaedic Foot and Ankle Society (AOFAS), and Karlsson scores in predicting 2-year RTS outcomes after arthroscopic treatment of CAI. It was hypothesized that ALR-RSI would be superior in predicting 2-year RTS outcomes after CAI surgery and that a quantifiable increase in this score would significantly improve RTS outcomes. Study design Cohort study; Level of evidence, 2. Methods This prospective cohort study analyzed patients who underwent surgery for CAI at a sports surgery center between 2016 and 2018. The inclusion criteria focused on adult patients undergoing their first surgery for CAI with a minimum 2-year follow-up. The primary outcome was RTS at 2 years. The study evaluated 3 scores at 1 year postoperatively to predict RTS at the same level as the preinjury level at 2 years-ALR-RSI, AOFAS Ankle-Hindfoot Scale, and Karlsson score. The most predictive score, with its corresponding optimal threshold, was determined using the receiver operating characteristic (ROC) curve. This threshold signifies the score value above which the likelihood of RTS at the preinjury level is significantly increased. Once identified, the secondary outcome evaluated the impact of a 10-point increase in this score on RTS, after adjusting for confounding factors. Results A total of 159 patients (age, 35.7 ± 11.4 years) were included. Two years after surgery, 40.25% of patients returned to their preinjury level of sports. ROC curve analysis of the tested scores at 1-year postoperatively showed the ALR-RSI score had the best predictive ability for RTS (area under the curve [AUC], 0.70 [95% CI, 0.6-0.77]), whereas Karlsson and AOFAS scores were less predictive (AUC, 0.53 [95% CI, 0.43-0.63] and 0.61 [95% CI, 0.52-0.70], respectively). The optimal threshold for the ALR-RSI score was identified at 83 (Youden index = 0.35, sensitivity = 63%, and specificity = 71%). Confounder identification revealed earlier surgery and arthroscopic techniques were associated with higher RTS rates. A 10-point increase in the ALR-RSI score correlated with increased odds of RTS (1.27 [95% CI, 1.12-1.46]; P = .0004) in univariate analysis and (1.29 [95% CI, 1.06- 1.61]; P = .01) in multivariate analysis. Conclusion This study showed that none of the scores were great predictors of RTS after surgery for CAI. The ALR-RSI score was a stronger predictor of RTS to the same preinjury level after CAI surgery than AOFAS and Karlsson scores. The ALR-RSI optimal threshold identified was 83. A 10-point increase in the ALR-RSI score boosted the odds of RTS by 1.29 times.
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Affiliation(s)
- Ali Fares
- Clinique du sport, Paris, Île-de-France, France
| | - Brice Picot
- Inter-University Laboratory of Human Movement Biology, Savoie Mont-Blanc University, Chambery, Auvergne-Rhône-Alpes, France
- French Society of Sports Physical Therapy, Pierrefitte sur Seine, France
| | - Ronny Lopes
- Centre Orthopedique Santy, Lyon, Auvergne-Rhône-Alpes, France
| | - Fadi Nader
- Clinique du sport, Paris, Île-de-France, France
| | - Yoann Bohu
- Clinique du sport, Paris, Île-de-France, France
| | - Alain Meyer
- Clinique du sport, Paris, Île-de-France, France
| | | | | | | | - Mohamad K Moussa
- Groupe Hospitalier Selestat-Obernai, Selestat, Alsace-Champagne-Ardenne-Lorraine, France
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10
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Yoshizuka H, Nakao Y, Kuraoka A. Application of stretchable strain sensors and an inertial measurement unit for simulative tension analysis of the calcaneofibular ligament in formalin-fixed cadavers. Clin Biomech (Bristol, Avon) 2024; 120:106358. [PMID: 39378649 DOI: 10.1016/j.clinbiomech.2024.106358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 09/24/2024] [Accepted: 09/30/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND The calcaneofibular ligament, a component of the lateral ligament complex of the ankle joint, plays an essential role in ankle-joint stability. To understand the mechanism of sprain-induced calcaneofibular ligament injury, the effect of ankle positions on calcaneofibular ligament tension needs to be ascertained. METHODS We propose a convenient method that combines stretchable strain sensors and an inertial measurement unit for simulative tension analysis of the calcaneofibular ligament in formalin-fixed cadavers. The stretchable strain sensor was pre-stretched approximately 1.3 times and, then set along the direction of the calcaneofibular ligament; a capacitance value from the sensor was used as a parameter to reflect the tension generated. Accurate three-axial inertial measurement unit-based monitoring of joint angles was undertaken for ten cadaveric ankles in measurements at 10° intervals from 30° plantarflexion to 20° dorsiflexion, followed by the investigation of additional effects with 10° inversion and eversion. FINDINGS Two-way repeated-measures ANOVA revealed a significant interactive effect for plantar/dorsiflexion × inversion/eversion and main effects for plantar/dorsiflexion and inversion/eversion. Post hoc pairwise analysis confirmed that 20° dorsiflexion or 10° inversion induces tension, whereas 10° eversion causes relaxation. Moreover, a promotional interactive effect by 20° dorsiflexion and 10° inversion and an offsetting effect by 10° eversion to 20° dorsiflexion were revealed. The measured values showed high levels of reliability and reproducibility (intraclass correlation coefficient [1,1] = 0.89). INTERPRETATION These results appropriately demonstrate the tensile action of calcaneofibular ligament. The novel approach investigated herein potentially opens new avenues for precise ligament-function evaluation.
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Affiliation(s)
- Hisayoshi Yoshizuka
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan; Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan.
| | - Yutaro Nakao
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan; Department of Rehabilitation Medicine, Nishikawa Orthopedic Clinic, 2171-5 Mikatsukicho-chokanda, Ogi 845-0021, Japan
| | - Akio Kuraoka
- Department of Anatomy and Physiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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11
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Elnewishy A, Elsenosy AM, Symeon N, Abdalla M, Hamada A. Comprehensive Analysis of Minimally Invasive Management for Persistent Anterolateral Ankle Pain: A Systematic Review. Cureus 2024; 16:e76629. [PMID: 39759689 PMCID: PMC11695436 DOI: 10.7759/cureus.76629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2024] [Indexed: 01/07/2025] Open
Abstract
Persistent anterolateral ankle pain is a debilitating condition often associated with soft tissue impingement following inversion injuries. It can lead to significant limitations in daily activities and overall quality of life, particularly in individuals with chronic ankle instability. This systematic review examines the efficacy and safety of minimally invasive arthroscopic decompression techniques in managing anterolateral ankle impingement syndrome. A total of 246 cases from nine studies were reviewed, involving 135 males with a mean age of 29.6 years and an average follow-up period of 29.5 months (range: 15-83.7 months). Outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Meislen criteria. The AOFAS scores improved significantly from a mean of 40.75 preoperatively to 84.2 postoperatively, reflecting substantial functional recovery. Based on the Meislen criteria, 124 cases (50%) were rated as excellent, 71 (29%) as good, 14 (6%) as fair, and three (1%) as poor. Postoperative mobility was restored to normal in 130 cases, with complications reported in 24 cases (9.8%), including hypoesthesia, infections, intra-articular haemarthrosis, scar tissue formation, nerve irritation, and persistent pain or numbness. Patient satisfaction was high, with most patients reporting significant improvements in pain relief and functional capacity. Arthroscopic decompression is a safe, minimally invasive, and effective intervention for managing persistent anterolateral ankle impingement, offering substantial improvements in pain, mobility, and overall function with low morbidity and a manageable complication rate. This approach is an invaluable option for patients unresponsive to conservative treatments.
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Affiliation(s)
- Ahmed Elnewishy
- Trauma and Orthopaedics, Royal Berkshire Hospital, Reading, GBR
| | | | - Naoum Symeon
- Orthopaedics and Trauma Surgery, 251 Hellenic Air Force General Hospital, Athens, GRC
| | - Mohammad Abdalla
- Trauma and Orthopaedics, Aneurin Bevan Health Board, Newport, GBR
| | - Ahmed Hamada
- Trauma and Orthopaedics, Royal Devon and Exeter University Hospital, Devon, GBR
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12
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Zhao Y, Gu X, Chen Z, Li H, Hua Y. Functional Outcomes of Immediate Weightbearing After Arthroscopic Lateral Ankle Ligament Repair: A Prospective Randomized Single-Center Trial. Am J Sports Med 2024; 52:3618-3624. [PMID: 39491495 DOI: 10.1177/03635465241289946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2024]
Abstract
BACKGROUND Previous studies have revealed that early postoperative rehabilitation of chronic lateral ankle instability is just as crucial as surgical intervention. Immediate weightbearing has yielded good clinical results; however, randomized controlled studies have been limited. PURPOSE To compare the clinical outcomes of patients with immediate weightbearing after lateral ankle ligament repair with those with delayed weightbearing after 2 weeks in a prospective randomized controlled study. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS Patients who underwent arthroscopic anterior talofibular ligament repair between August 2021 and December 2022 were randomized into 2 groups-immediate weightbearing with a hard ankle brace and nonweightbearing casting for 2 weeks followed by cast removal and weightbearing. Primary outcomes were the ankle function scores as assessed using the visual analog scale at rest and during activities, the American Orthopaedic Foot & Ankle Society (AOFAS) score, and the Karlsson Ankle Functional Score (Karlsson score). Secondary outcomes were the time to return to unsupported walking, jogging, work, and exercise and change in the ankle range of motion (ROM) at 3-, 6-, and 12-month follow-ups. RESULTS A total of 88 participants were included, consisting of 58 men and 30 women, with a mean age of 30.26 years. Computerized randomization resulted in 44 patients per group. These 2 groups displayed no difference in the AOFAS score, Karlsson score, and ankle ROM at all follow-ups. Patients who underwent immediate weightbearing had a significantly shorter time of returning to unsupported walking (P < .001). No differences were observed in the time of returning to work, jogging, and sports exercise. CONCLUSION For patients with chronic ankle instability after arthroscopic anterior talofibular ligament repair, immediate weightbearing allowed patients to return to unsupported walking more quickly and had no negative effects on the AOFAS score, Karlsson score, times of returning to normal life, jogging, sports exercise, and ankle ROM at 3-, 6-, and 12-month follow-ups compared with cast fixation. REGISTRATION ChiCTR2100049612 (Chinese Clinical Trial Registry; https://www.chictr.org.cn/).
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Affiliation(s)
- Yujie Zhao
- Department of Nursing, Huashan Hospital, Fudan University, Shanghai, China
| | - Xicheng Gu
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Ziyi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyun Li
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
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13
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Yan Z, Zhuang C, Chen W, Pan Y, Wu X, Zhuang R, Guo W. Arthroscopically assisted accurate location of the bone tunnel entrance for lateral ankle ligament reconstruction may be a better choice for patients with chronic ankle instability: a retrospective study. J Orthop Surg Res 2024; 19:760. [PMID: 39543618 PMCID: PMC11566172 DOI: 10.1186/s13018-024-05251-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 11/07/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND The anatomical location for lateral ligament reconstruction remains a significant challenge. With the development of arthroscopic technology, arthroscopic-assisted lateral ligament reconstruction can significantly facilitate the correct localization of anatomical points. However, there is limited evidence on the clinical efficacy of arthroscopic ligament reconstruction compared with percutaneous ligament reconstruction. METHODS This study included 72 patients who underwent lateral ligament reconstruction for chronic lateral ankle instability from 2018 to 2022. The follow-up duration in the percutaneous(n = 35) and the arthroscopic(n = 37) groups was 6-30 months. The patients were evaluated before the operation, at 6 months after surgery, and at the final follow-up. The American Orthopaedic Foot and Ankle Society score (AOFAS), Karlsson-Peterson score, and Visual Analog Scale (VAS) were evaluated at each time point. The complications and the time required to return to sports were documented during the follow-up. RESULTS All clinical evaluations significantly improved after surgery in both groups. There was no significant difference between the two groups in the AOFAS score, VAS score, and complications. The Karlsson-Peterson score (85.4 vs 83.6, p = 0.044), surgical duration (50.4 min vs 60.2 min, p < 0.001), and time to return to sports (17.8 weeks vs 20.5 weeks, p = 0.033) were all improved in the arthroscopic group. CONCLUSION Satisfactory clinical outcomes can be achieved through both arthroscopic and percutaneous anatomic ligament reconstruction. The ligament remnant and anatomical localization point can be observed directly by using an arthroscope. Arthroscopic ligament reconstruction can be a more viable alternative for patients with chronic ankle instability due to its minimal disturbance to the stump of the ligament and reduced operative aggression.
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Affiliation(s)
- Zechen Yan
- The First School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Chen Zhuang
- Alberta Institute, Wenzhou Medical University, Wenzhou, China
| | - Wenhuan Chen
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Yu Pan
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Xiangke Wu
- Orthopedic Department, Quzhou Traditional Chinese Medicine (TCM) Hospital at the Junction of Four Provinces Affiliated to Zhejiang, Chinese Medical University, Quzhou, China
| | - Rujie Zhuang
- Orthopedic Department, Quzhou Traditional Chinese Medicine (TCM) Hospital at the Junction of Four Provinces Affiliated to Zhejiang, Chinese Medical University, Quzhou, China.
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
| | - Wenxuan Guo
- Orthopedic Department, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, China.
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14
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Aslan L, Ghandour S, Ashkani-Esfahani S, Gedik CC, Guss D, Waryasz G, Bejarano-Pineda L, DiGiovanni CW, Kwon JY. Association of Extraosseous Arterial Diameter With Talar Dome Osteochondral Lesions. Foot Ankle Int 2024; 45:1199-1209. [PMID: 39412746 DOI: 10.1177/10711007241278672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2024]
Abstract
BACKGROUND Etiology of osteochondral lesions of the talus (OLT) is multifactorial and may develop from trauma, genetics, or hypovascularity. The talar dome is supplied by the posterior tibial artery (PTA) and, to a lesser degree, the sinus tarsi artery (STA). The role of talar dome hypovascularity on OLT remains poorly studied. We aimed to determine any relationship between the diameter of PTA (dPTA) and STA (dSTA) and the incidence and characteristics of talus OLT. METHODS This retrospective study included 77 patients with OLT and 77 subjects as a matched control group (age range: 30-40 years). Using magnetic resonance imaging, the dPTA was measured 1 cm above the tibial plafond, at the plafond, and at the level of medial malleolar tip. Likewise, dSTA was measured at the level of the talar neck. The area, volume, depth, localization, and surgical intervention for OLT were recorded as well. RESULTS The study group had significantly smaller dPTA at all 3 levels (1.05 ± 0.22 mm, 0.99 ± 0.18 mm, 0.98 ± 0.31 mm, proximal to distal, respectively) compared with controls (1.25 ± 0.23 mm, 1.20 ± 0.22 mm, 1.14 ± 0.18 mm, respectively) (P < .001). The dSTA was also significantly smaller in the study group compared with the control group (0.5 ± 0.11 mm vs 0.57 ± 0.08 mm, respectively; P = .001). The mean dPTA (of all 3 levels) cutoff value for predicting the occurrence of OLT was 1.1 mm with 74% sensitivity and 75% specificity. A significant inverse correlation was observed between OLT area and arterial diameters (P < .001). CONCLUSION Smaller luminal dPTA and dSTA appear to be associated with higher incidence of OLT, with defect size inversely correlated to arterial diameter.
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Affiliation(s)
- Lercan Aslan
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Samir Ghandour
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soheil Ashkani-Esfahani
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cemil Cihad Gedik
- Department of Orthopaedics and Traumatology, Koc University School of Medicine, Istanbul, Turkey
| | - Daniel Guss
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Waryasz
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorena Bejarano-Pineda
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher W DiGiovanni
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John Y Kwon
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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15
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Oh M, Lee H, Han S, Bruening DA, Seeley MD, Hopkins JT. Effects of Chronic Pain on Static and Dynamic Postural Control in Chronic Ankle Instability. Clin J Sport Med 2024; 34:552-558. [PMID: 38967593 DOI: 10.1097/jsm.0000000000001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/11/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To identify the effects of chronic pain levels on static and dynamic postural (DP) control in individuals with chronic ankle instability (CAI). DESIGN Cross-sectional study. SETTING Controlled laboratory. PARTICIPANTS Sixty participants were divided into the following 3 groups: 20 high pain individuals with CAI (high pain), 20 low pain individuals with CAI (low pain), and 20 healthy controls (control). INDEPENDENT VARIABLES Groups (CAI with high pain, CAI with low pain, and control) and visual conditions (eyes open and closed) for single-leg stance. MAIN OUTCOME MEASURES Participants performed single-leg stance with eyes open and closed, the star excursion balance test, and single-leg hop to stabilization. RESULTS The high pain group experienced worse self-reported outcomes, including Foot and Ankle Ability Measure activities of daily living and sports, than the low pain and control groups. Regardless of visual condition, both the high and low pain groups exhibited decreased static postural control in mediolateral (ML) compared with the control group. Specifically, the high pain group showed decreased static postural control in ML under closed eyes compared with the low pain and the control groups. The high pain group showed less reach distance than the control group and increased DP control in vertical and overall DP stability index compared with the low and control groups. CONCLUSIONS Chronic pain can significantly affect both static and DP control in individuals with CAI. Therefore, clinicians should consider chronic pain as one of the factors affecting postural control in individuals with CAI.
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Affiliation(s)
- Minsub Oh
- Department of Exercise Science, Brigham Young University, Provo, Utah
| | - Hyunwook Lee
- Department of Exercise Science, Brigham Young University, Provo, Utah
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Seunguk Han
- Department of Exercise Science, Brigham Young University, Provo, Utah
- Division of Sport Science, Pusan National University, Busan, South Korea
| | - Dustin A Bruening
- Department of Exercise Science, Brigham Young University, Provo, Utah
| | - Matthew D Seeley
- Department of Exercise Science, Brigham Young University, Provo, Utah
| | - J Ty Hopkins
- Department of Exercise Science, Brigham Young University, Provo, Utah
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16
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Han YJ, Kang XP, Hu AM, Yu HX. Impact of subtalar joint mobilization on walking ability in patients with intra-articular varus of the hindfoot joint with chronic ankle instability. J Orthop Surg Res 2024; 19:692. [PMID: 39456089 PMCID: PMC11515219 DOI: 10.1186/s13018-024-05178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Patients with chronic ankle instability (CAI) often experience recurrent swelling and pain, which hinder their ability to walk long distances. Emerging evidence suggests that joint mobilization can enhance ankle function in patients with CAI. OBJECTIVE The aim of this study is to investigate the effects of subtalar joint mobilization on enhancing ankle stability, alleviating ankle pain, and improving the walking ability of patients diagnosed with CAI. METHODS A retrospective analysis was conducted on 46 patients who were treated between April 2022 and October 2023. They were randomly divided into two groups: a treatment group with 23 cases receiving conventional treatment along with subtalar joint mobilization treatment, and a control group with 23 cases receiving only conventional treatment. The treatment duration was eight weeks. Pain levels and walking ability were assessed before and after the treatment period. RESULTS After eight weeks of treatment, the treatment group showed significant increases in the number of heel raises on the affected leg (NLHSL), improvements in the star excursion balance test (SEBT), and higher American Orthopedic Foot and Ankle Society (AOFAS) scores compared to the control group. Additionally, resting pain (RVAS) and walking pain (WVAS) scores were significantly lower in the treatment group. However, there was no statistically significant difference in single-leg standing time (SLT) between the two groups. Within the control group, post-treatment assessments indicated significant improvements in dynamic balance and control measures (SLT, NLHSL, SEBT), but no significant changes were observed in pain levels (RVAS, WVAS) or rear foot function (AOFAS). In contrast, the treatment group showed significant improvements across all measured parameters (RVAS, WVAS, SLT, NLHSL, SEBT, and AOFAS) following treatment. CONCLUSION Subtalar joint mobilization effectively reduces ankle pain and enhances walking ability among patients with CAI by improving ankle stability. The observed improvements in walking ability may stem from mitigating compensatory mechanisms associated with varus of the calcaneus and ankle instability.
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Affiliation(s)
- Yu-Juan Han
- Tiantan Xiaotangshan Rehabilitation Center, Beijing Xiaotangshan Hospital, Beijing, 102200, China
| | - Xiao-Ping Kang
- Tiantan Xiaotangshan Rehabilitation Center, Beijing Xiaotangshan Hospital, Beijing, 102200, China
| | - An-Min Hu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hui-Xian Yu
- Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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17
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Vulcano E, Marciano GF, Pozzessere E. Clinical Outcomes of a Minimally Invasive Percutaneous Brostrom Technique without Arthroscopic Assistance. Diagnostics (Basel) 2024; 14:2252. [PMID: 39410656 PMCID: PMC11475592 DOI: 10.3390/diagnostics14192252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 10/01/2024] [Accepted: 10/04/2024] [Indexed: 10/20/2024] Open
Abstract
BACKGROUND/OBJECTIVES Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon's arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. METHODS Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. RESULTS A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. CONCLUSIONS The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology.
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Affiliation(s)
- Ettore Vulcano
- Mount Sinai Medical Center, Columbia University, Miami, FL 33140, USA
| | - Gerard F. Marciano
- Department of Orthopedics, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY 10032, USA
| | - Enrico Pozzessere
- Department of Orthopaedics and Traumatology, University of Insubria, Ospedale di Circolo—Fondazione Macchi, 21100 Varese, Italy
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Kowalczyk M, Truszczyńska-Baszak A. The impact of fatigue on dynamic balance in coopers athletes with chronic ankle instability. Sci Rep 2024; 14:23101. [PMID: 39367043 PMCID: PMC11452648 DOI: 10.1038/s41598-024-73908-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 09/23/2024] [Indexed: 10/06/2024] Open
Abstract
Athletes who have successfully regained high sports performance despite prior inversion injuries, and who do not have persistent symptoms, are referred to as "copers" in the literature. The aim of the study was to assess dynamic stability under fatigue in patients with chronic ankle instability in comparison to healthy controls. We conducted a case - controlled study on a group of 60 young, physically active individuals aged 29.8 ± 4.6. They were divided into 3 groups: I - unilateral ankle instability n = 14, II - bilateral ankle instability n = 15, III - no ankle instability, n = 31. All participants filled out questionnaires on the health, the FADI and FADI-S. The study protocol consisted of a dynamic stability measurements by Biodex Balance System, followed by a fatigue test, followed by the series of the same measurements. General stability index value before and value after fatigue test did not differ significantly. The differences between groups in measurements taken before fatigue test (F (2.49) = 1.59; p = 0.214; ηp2 = 0.06) and after fatigue test also proved insignificant (F (2.49) = 1.28; p = 0.286; ηp2 = 0.05). The incidence of structural ankle instability did not affect functional stability. "Copers" had efficient neural-muscular control in dynamic stabilography tests.
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Affiliation(s)
- Małgorzata Kowalczyk
- Department of Physiotherapy, Józef Piłsudski University of Physical Education in Warsaw, ul. Marymoncka 34, 00-968, Warsaw, Poland
| | - Aleksandra Truszczyńska-Baszak
- Department of Physiotherapy, Józef Piłsudski University of Physical Education in Warsaw, ul. Marymoncka 34, 00-968, Warsaw, Poland.
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Kleinevoß M, Yao D, Plaass C, Stukenborg-Colsman C, Daniilidis K, Ettinger S, Claassen L. Lateral ligament reconstruction and additive medial ligament reconstruction in chronic ankle instability: a retrospective study. Orthop Rev (Pavia) 2024; 16:120051. [PMID: 39258011 PMCID: PMC11386540 DOI: 10.52965/001c.120051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 05/01/2024] [Indexed: 09/12/2024] Open
Abstract
Background Ligamentous lesions of the ankle joint are common. Isolated medial ligament injuries are rare but are often associated with lateral ligament injuries, isolated medial ligament lesions are often overlooked. The present study aimed to evaluate the clinical and functional differences in the outcomes of isolated lateral and combined medial and lateral ligament reconstruction. The study is based on patient-reported outcome measurements and motion sensor technology to assess these outcomes. Objective The purpose of this study was to compare the clinical and functional outcomes of isolated lateral and combined lateral and medial ankle ligament reconstruction. Methods From December 2014 to August 2018, 111 patients underwent either isolated lateral ligament (LG) or medial and lateral ligament (MLG) reconstruction. Of the 104 patients meeting the inclusion criteria, 49 had LG and 55 had MLG reconstruction. Outcome measures included the Short Form-36 Health Survey SF-36, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAMG), Tegner Activity Scale, the European Foot and Ankle Society (EFAS), American Orthopaedic Foot and Ancle Society (AOFAS) hindfoot score, and the Karlsson Peterson Score. Mobility and stability were assessed using the Ortheligent™ motion sensor for both healthy and treated ankles. Results While there were no significant differences in outcome scores between the groups, overall scores improved after treatment (p >0.00). Notably LG showed improved movement, with better dorsal extension measured by the Sensor (p ÷ 0.02). The sensor's results correlated significantly with FAOS subscales for pain (p ÷0.05), stiffness (p ÷ 0.01), ADL (p ÷0.02), and sports (p >0.00). Conclusion Postoperative results, regardless of LG or MLG, showed significant subjective well-being improvement. LG's advantages were highlighted by a significant improvement in dorsal extension, supported by correlated results from a portable motion sensor assessing ankle stability.
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Affiliation(s)
- Moritz Kleinevoß
- Diakovere Annastift - Orthopedic Department Medizinische Hochschule Hannover
| | - Daiwei Yao
- Diakovere Annastift - Orthopedic Department Medizinische Hochschule Hannover
| | - Christian Plaass
- Diakovere Annastift - Orthopedic Department Medizinische Hochschule Hannover
| | | | - Kiriakos Daniilidis
- Diakovere Annastift - Orthopedic Department Medizinische Hochschule Hannover
| | - Sarah Ettinger
- Diakovere Annastift - Orthopedic Department Medizinische Hochschule Hannover
| | - Leif Claassen
- Diakovere Annastift - Orthopedic Department Medizinische Hochschule Hannover
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20
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Xu J, Yang S, Fan R, Wu H, Mo H. MRI and single-cell RNA sequence results reveal the influence of anterior talofibular ligament injury on osteochondral lesions of the talus. J Orthop Surg Res 2024; 19:474. [PMID: 39127696 DOI: 10.1186/s13018-024-04826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/30/2024] [Indexed: 08/12/2024] Open
Abstract
Anterior talofibular ligament injuries and osteochondral lesions of the talus present unique challenges to orthopedic surgeons. This study aimed to investigate the relevant relationship between them by analyzing the Magnetic resonance imaging (MRI) results of clinical patients and single-cell RNA sequence (scRNA seq) results of healthy talus cartilage to discuss the risk factors. Data from 164 patients from 2018 to 2023 was retrospectively analyzed. The correlation analysis between ATFL injury grade and the Hepple stage of OLT determined by MRI was performed. Publicly available single-cell RNA datasets were collected. Single-cell RNA datasets from five volunteers of healthy talus cartilage were analyzed. ATFL injury grade was relevant with the Hepple stage of OLT (P < 0.05). The results of multivariate logistic regression analysis showed that injured area was the independent influencing factor of the incidence rate and the severity of OLT (P < 0.05). The Hepple stage of OLT was relevant with AOFAS and VAS (P < 0.05). Single-cell RNA sequence results showed that among the 9 subtypes of chondrocytes, the interaction strength between HTC-A and HTC-B is the highest. Their physical interactions are mainly achieved through the CD99 signaling pathway, and factor interactions are mainly achieved through the ANGPTL signaling pathway. Anterior talofibular ligament injury may lead to osteochondral lesions of the talus. Early medical intervention should be carried out for ligament injuries to restore joint stability and avoid cartilage damage.
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Affiliation(s)
- Jie Xu
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, 999078, China
- Macau University of Science and Technology, Macau, 999078, China
| | - Siyi Yang
- School of Clinical Medicine, Beijing University of Chinese Medicine, Beijing, 100000, China
| | - Ruiqi Fan
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, 999078, China
| | - Hongbo Wu
- The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Hui Mo
- Macau University of Science and Technology, Macau, 999078, China.
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21
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Zhang G, Li W, Yao H, Tan R, Li C. The precision of technical aspects in the minimally invasive Broström-Gould procedure: a cadaveric anatomical study. J Orthop Surg Res 2024; 19:450. [PMID: 39080695 PMCID: PMC11289923 DOI: 10.1186/s13018-024-04916-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND A comprehensive understanding of the anatomy of the anterolateral ankle joint and its interrelationships is essential for advancing the development of minimally invasive Broström-Gould procedure, thereby enhancing surgical efficacy and minimizing postoperative complications. METHODS Ten fresh human ankle specimens were dissected to observe the shape and trajectory of the lateral bundle of the inferior extensor retinaculum (IER) and its relationship with the deep fascia. To observe the relationship between the ankle capsule and the anterior talofibular ligament (ATFL). The center of the insertion point of ATFL at the lateral malleolus was used as the reference point. The vertical distance from the reference point to the fibula tip, the horizontal distance from the reference point to the lateral branch of the superficial peroneal nerve, the shortest distance from the reference point to IER, the narrowest width of the IER, the angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula were measured. The tension and elasticity of ATFL was understood. To describe the minimally invasive Broström-Gould procedure according to the anatomical characteristics of the anterolateral ankle joint. RESULTS Among the 10 cases, 8 cases (80%) had double bundles of ATFL, 2 cases (20%) had single bundle of ATFL, and no outer superior oblique bundle was observed in IER. The vertical distance from the reference point to the fibula tip was 1.2 ± 0.3 (range 1.1-1.3) mm. The shortest distance from the reference point to the level of the superficial peroneal branch was 28.2 ± 4.3 (range 24.5-32.4) mm. The shortest distance from the reference point to IER was 12.5 ± 0.6 (range 12.1-12.9) mm, and the width of IER at this point was 7.2 ± 0.3 (range 7.0-7.6) mm. The angle between the line connecting the shortest distance from the reference point to the IER and the longitudinal axis of the fibula was about 60° ± 2.8° (range 58.1°-62.1°) mm. The space between the anterolateral deep fascia of the ankle joint and the ankle capsule is very small, and only a few fat granules are separated between them. The ATFL is largely fused to the ankle capsule. The ATFL exhibited high tension and poor elasticity after traction with the probe hook. CONCLUSIONS The results showed that in the minimally invasive Broström-Gould technique for lateral ankle stabilization, the Broström procedure actually sutured the insertion of the ATFL together with the ankle capsule to the anterior edge of the lateral malleolus. In the Gould procedure, the deep fascia was mostly reinforced with the ankle capsule. The minimum suture span was obtained when the Gould suture needle direction was at an Angle of 60° to the longitudinal axis of the fibula.
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Affiliation(s)
- Guolei Zhang
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China.
| | - Wenqing Li
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China.
| | - Haibo Yao
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China
| | - Rongzhi Tan
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China
| | - Chuyan Li
- Department of Hand and Foot & Ankle Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, Guangdong Province, China
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22
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Zhou Z, Zhou H, Jie T, Xu D, Teo EC, Wang M, Gu Y. Analysis of stress response distribution in patients with lateral ankle ligament injuries: a study of neural control strategies utilizing predictive computing models. Front Physiol 2024; 15:1438194. [PMID: 39113939 PMCID: PMC11303170 DOI: 10.3389/fphys.2024.1438194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Ankle sprains are prevalent in sports, often causing complex injuries to the lateral ligaments. Among these, anterior talofibular ligament (ATFL) injuries constitute 85%, and calcaneofibular ligament (CFL) injuries comprise 35%. Despite conservative treatment, some ankle sprain patients develop chronic lateral ankle instability (CLAI). Thus, this study aimed to investigate stress response and neural control alterations during landing in lateral ankle ligament injury patients. METHOD This study recruited twenty individuals from a Healthy group and twenty CLAI patients performed a landing task using relevant instruments to collect biomechanical data. The study constructed a finite element (FE) foot model to examine stress responses in the presence of laxity of the lateral ankle ligaments. The lateral ankle ligament was modeled as a hyperelastic composite structure with a refined representation of collagen bundles and ligament laxity was simulated by adjusting material parameters. Finally, the validity of the finite element model is verified by a high-speed dual fluoroscopic imaging system (DFIS). RESULT CLAI patients exhibited earlier Vastus medialis (p < 0.001) and tibialis anterior (p < 0.001) muscle activation during landing. The FE analysis revealed that with laxity in the ATFL, the peak von Mises stress in the fifth metatarsal was 20.74 MPa, while with laxity in the CFL, it was 17.52 MPa. However, when both ligaments were relaxed simultaneously, the peak von Mises stress surged to 21.93 MPa. When the ATFL exhibits laxity, the CFL is subjected to a higher stress of 3.84 MPa. Conversely, when the CFL displays laxity, the ATFL experiences a peak von Mises stress of 2.34 MPa. CONCLUSION This study found that changes in the laxity of the ATFL and the CFL are linked to shifts in metatarsal stress levels, potentially affecting ankle joint stability. These alterations may contribute to the progression towards CLAI in individuals with posterolateral ankle ligament injuries. Additionally, significant muscle activation pattern changes were observed in CLAI patients, suggesting altered neural control strategies post-ankle ligament injury.
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Affiliation(s)
- Zhifeng Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Huiyu Zhou
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Tianle Jie
- Faculty of Sports Science, Ningbo University, Ningbo, China
| | - Datao Xu
- Faculty of Sports Science, Ningbo University, Ningbo, China
- Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Ee-Chon Teo
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Meizi Wang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, China
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23
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Luo X, Huang B, Huang Y, Li M, Niu W, Wang T. Central imaging based on near-infrared functional imaging technology can be useful to plan management in patients with chronic lateral ankle instability. J Orthop Surg Res 2024; 19:361. [PMID: 38890731 PMCID: PMC11184706 DOI: 10.1186/s13018-024-04790-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/08/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Near infrared brain functional imaging (FNIRS) has been used for the evaluation of brain functional areas, the imaging differences of central activation of cognitive-motor dual tasks between patients with chronic lateral ankle instability (CLAI) and healthy population remain unclear. This study aimed to evaluated the role of central imaging based on FNIRS technology on the plan management in patients with CLAI, to provide insights to the clinical treatment of CLAI. METHODS CLAI patients treated in our hospital from January 1, 2021 to June 31, 2022 were selected. Both CLAI patients and health controls were intervened with simple task and cognitive-motor dual task under sitting and walking conditions, and the changes of oxygenated hemoglobin concentration in bilateral prefrontal cortex (PFC), premotor cortex (PMC) and auxiliary motor area (SMA) were collected and compared. RESULTS A total of 23 participants were enrolled. There were significant differences in the fNIRS ΔHbO2 of barefoot subtractive walking PFC-R and barefoot subtractive walking SMA-R between experimental and control group (all P < 0.05). There was no significant difference in ΔHbO2 between the experimental group and the control group in other states (P > 0.05). There was no significant difference in ΔHbO2 between the experimental group and the control group in each state of the brain PMC region. CONCLUSION Adaptive alterations may occur within the relevant brain functional regions of individuals with CLAI. The differential activation observed between the PFC and the SMA could represent a compensatory mechanism emerging from proprioceptive afferent disruptions following an initial ankle sprain.
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Affiliation(s)
- Xiaoming Luo
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Ben Huang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Yonglei Huang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Ming Li
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China
| | - Wenxin Niu
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China.
| | - Taoli Wang
- Department of Rehabilitation, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China.
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, 201619, China.
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Tonsuthanluck S, Handoyo HR, Tharincharoen R, Angthong C. Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1487-1495. [PMID: 38260990 DOI: 10.1007/s00590-023-03825-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Little is known regarding the comparative analyses of the medium-term outcomes (with a mean minimum follow-up period of 24 months), between arthroscopic and open repairs of lateral ligament complex (LLC) injuries of the ankle. Thus, in this study, we aimed to explore the comparative analyses regarding the medium-term follow-up outcomes of these repairs, by conducting a systematic review and meta-analysis. METHODS The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; data were extracted from the PubMed and Google Scholar databases. From an initial search, a total of 1182 abstracts (280 and 902 abstracts, from PubMed and Google Scholar, respectively) were found and screened in accordance with the eligibility criteria. Subsequently, six articles were found to be eligible for further review. RESULTS A total of 419 patients underwent surgical repairs; 205 and 214 patients underwent arthroscopic and open repairs, respectively. The mean minimum follow-up period was 29.2 months. The medium-term follow-up for arthroscopic LLC repairs was found to be superior to that of open LLC repairs, with more favorable outcomes; as evidenced by better clinical scores, lower pooled complication rates, earlier return times to pre-injury sport, and higher early sport ratios. CONCLUSIONS The findings of this systematic review and meta-analysis support near-future developments validating arthroscopic repair as the new gold standard for LLC repairs, similarly to arthroscopic ligament and tendon repairs, as well as arthroscopic reconstruction surgeries, of the knee and shoulder.
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Affiliation(s)
- Sora Tonsuthanluck
- Foot and Ankle surgery unit, Department of Orthopedic Surgery, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | | | - Ramita Tharincharoen
- Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang (KMITL), Bangkok, Thailand
| | - Chayanin Angthong
- Division of Digital and Innovative Medicine, Faculty of Medicine, King Mongkut's Institute of Technology Ladkrabang (KMITL), Bangkok, Thailand.
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25
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Maria PA, Vuurberg G, Kerkhoffs GMMJ. Exploring influences and risk of bias of studies on return to sport and work after lateral ankle sprain: A systematic review and meta-analysis. World J Meta-Anal 2024; 12:87026. [DOI: 10.13105/wjma.v12.i1.87026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 01/02/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Lateral ankle sprains are the most common traumatic musculoskeletal injuries of the lower extremity, with an incidence rate of 15%-20%. The high incidence and prevalence highlights the economic impact of this injury. Ankle sprains lead to a high socioeconomic burden due to the combination of the high injury incidence and high medical expenses. Up to 40% of patients who suffer from an ankle sprain develop chronic ankle instability. Chronic instability can lead to prolonged periods of pain, immobility and injury recurrence. Identification of factors that influence return to work (RTW) and return to sports (RTS) after a lateral ankle sprain (LAS) may help seriously reduce healthcare costs.
AIM To explore which factors may potentially affect RTW and RTS after sustaining an LAS.
METHODS EMBASE and PubMed were systematically searched for relevant studies published until June 2023. Inclusion criteria were as follows: (1) Injury including LAS or chronic ankle instability; (2) Described any form of treatment; (3) Assessment of RTW or RTS; (4) Studies published in English; and (5) Study designs including randomized controlled clinical trials, clinical trials or cohort studies. Exclusion criteria were: (1) Studies involving children (age < 16 year); or (2) Patients with concomitant ankle injury besides lateral ankle ligament damage. A quality assessment was performed for each of the included studies using established risk of bias tools. Additionally quality of evidence was assessed using the GRADEpro tool in cases where outcomes were included in the quantitative analysis. A best evidence synthesis was performed in cases of qualitative outcome analysis. For all studied outcomes suitable for quantitative analysis a forest plot was created to calculate the effect on RTW and RTS.
RESULTS A total of 8904 patients were included in 21 studies, 10 randomized controlled trials, 7 retrospective cohort studies and 4 prospective cohort studies. Fifteen studies were eligible for meta-analysis. The overall RTS rate ranged were 80% and 83% in the all treatments pool and surgical treatments pool, respectively. The pooled mean days to RTS ranged from 23-93 d. The overall RTW rate was 89%. The pooled mean time to RTW ranged from 5.8-8.1 d. For patients with chronic ankle instability, higher preoperative motivation was the sole factor significantly and independently (P = 0.001) associated with the rate of and time to RTS following ligament repair or reconstruction. Higher body mass index was identified as a significant factor (P = 0.04) linked to not resuming sports or returning at a lower level (median 24, range 20-37), compared to those who resumed at the same or higher level (median 23, range 17-38). Patients with a history of psychological illness or brain injury, experienced a delay in their rehabilitation process for sprains with fractures and unspecified sprains. The extent of the delayed rehabilitation was directly proportional to the increased likelihood of experiencing a recurrence of the ankle sprain and the number of ankle-related medical visits. We also observed that 10% of athletes who did return to sport after lateral ankle sprain without fractures described non-ankle-related reasons for not returning.
CONCLUSION All treatments yielded comparable results, with each treatment potentially offering unique advantages or benefits. Preoperative motivation may influence rehabilitation after LAS. Grading which factor had a greater impact was not possible due to the lack of comparability among the included patients.
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Affiliation(s)
- Priscilla A Maria
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam 1105 AZ, Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Department of Radiology and Nuclear Medicine, Rijnstate Arnhem, Arnhem 6815AD, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC-Location AMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Movement Sciences, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Amsterdam Collaboration on Health and Safety in Sports, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Academic Center for Evidence-based Sports medicine, Amsterdam UMC, Amsterdam 1105 AZ, Netherlands
- Faculty of Medicine, University of Amsterdam, Amsterdam, 1105 AZ, Netherlands
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26
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Yetiş M, Kocaman H, Canli M, Alkan H, Yildirim H, Yildiz NT, Kuzu Ş. Validity and reliability of the Modified Four Square Step Test in individuals with ankle sprain. J Orthop Surg Res 2024; 19:182. [PMID: 38491530 PMCID: PMC10941393 DOI: 10.1186/s13018-024-04664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Postural instability and gait abnormalities are frequently observed after an ankle sprain. A modified Four Square Step Test (mFSST) was developed to assess dynamic balance during gait. The aim of this study was to evaluate the reliability and validity of the mFSST in individuals with ankle sprains. METHODS The study included 39 individuals with grade 1 and 2 ankle sprains with a mean age of 30.36 ± 6.21 years. The dynamic balance of the participants was assessed with the mFSST and Timed Up & Go test (TUG). To determine the test-retest reliability of the mFSST, the test was repeated approximately 1 h apart. RESULTS The test-retest reliability of the mFSST was excellent (ICC = 0.85). Furthermore, when the concurrent validity of the mFSST was examined, a high correlation was found between with the TUG (r = 0.78, p < 0.001). CONCLUSION The mFSST is a valid and reliable clinical assessment method for evaluating dynamic balance during walking in individuals with ankle sprains. We think that the mFSST is preferable in clinical evaluations because its platform is easy to prepare and requires very little equipment.
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Affiliation(s)
- Mehmet Yetiş
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kirşehir Ahi Evran University, Kirşehir, Turkey
| | - Hikmet Kocaman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Mehmet Canli
- School of Physical Therapy and Rehabilitation, Kirşehir Ahi Evran University, Kirşehir, Turkey.
| | - Halil Alkan
- Deparment of Physiotherapy and Rehabilitation, Faculty of Health Science, Muş Alparslan University, Muş, Turkey
| | - Hasan Yildirim
- Department of Mathematics, Faculty of Kamil Özdağ Science, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Nazim Tolgahan Yildiz
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Karamanoglu Mehmetbey University, Karaman, Turkey
| | - Şafak Kuzu
- School of Physical Therapy and Rehabilitation, Kirşehir Ahi Evran University, Kirşehir, Turkey
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27
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Harrasser N, Toepfer A. [Injuries of the ankle ligaments]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:223-233. [PMID: 38324018 DOI: 10.1007/s00132-023-04462-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 02/08/2024]
Abstract
Lateral ligament injuries are the most common injuries of the ankle joint and are usually treated with early weight bearing after a short period of immobilization. If the clinical presentation is suspicious, additional injuries to the deltoid ligament complex and the syndesmosis should be considered. The indications for additional diagnostics should be generously applied. Injuries to the deltoid ligament usually occur as part of a complex ankle injury and should also be addressed in the surgical treatment of accompanying injuries. Chronic instability in this area necessitates complex bony and soft tissue procedures. Syndesmotic injuries with insufficiency of the capsule-ligament apparatus are frequent in ankle fractures and are stabilized during fracture treatment. Isolated syndesmotic instability should also be surgically treated as chronic injuries are usually associated with poor clinical results and early osteoarthritis.
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Affiliation(s)
- N Harrasser
- Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
- ECOM Excellent Center of Medicine, München, Deutschland.
| | - A Toepfer
- Klinik für Orthopädische Chirurgie und Traumatologie des Bewegungsapparates, Kantonsspital St. Gallen, St. Gallen, Schweiz
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Park JM, Han SH, Cho BC, Lee SM, Shin MS, Yu JH, Kim HJ, Noh HD, Cho MS, Kim MK. Enhancing Post-Surgical Rehabilitation Outcomes in Patients with Chronic Ankle Instability: Impact of Subtalar Joint Axis Balance Exercises Following Arthroscopic Modified Broström Operation. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:328. [PMID: 38399615 PMCID: PMC10890246 DOI: 10.3390/medicina60020328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/08/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: This study aimed to evaluate the effects of subtalar joint axis-based balance exercises on the anterior talofibular ligament (ATFL) thickness, ankle strength, and ankle stability after an arthroscopic modified Broström operation (AMBO) for chronic ankle instability (CAI). Materials and Methods: The study included 47 patients diagnosed with CAI who underwent AMBO and were randomly divided into three groups: control (n = 11), general balance exercise (n = 17), and subtalar joint axis balance exercise (n = 19), regardless of the affected area. Participants in the exercise rehabilitation group performed exercises for 60 min twice a week for six weeks, starting six weeks after AMBO. ATFL thickness, ankle strength, and ankle dynamic stability were measured using musculoskeletal ultrasonography, Biodex, and Y-balance test, respectively, before and after treatment. Results: Compared with the remaining groups, the subtalar joint axis balance exercise group had reduced ATFL thickness (p = 0.000), improved ankle strength for eversion (p = 0.000) and inversion (p = 0.000), and enhanced ankle stability (p = 0.000). Conclusions: The study results suggest that subtalar joint axis-based balance exercises may contribute to the early recovery of the ankle joint after AMBO.
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Affiliation(s)
- Ji-Myeong Park
- Sports Medical Research Center, Daechan Hospital, 590 Inju-daero, Namdong-gu, Incheon 21570, Republic of Korea; (J.-M.P.); (S.-H.H.); (H.-D.N.)
| | - Sang-Ho Han
- Sports Medical Research Center, Daechan Hospital, 590 Inju-daero, Namdong-gu, Incheon 21570, Republic of Korea; (J.-M.P.); (S.-H.H.); (H.-D.N.)
| | - Byeong-Chae Cho
- Nowon Samsung Orthopedics, 456 Nohae-ro, Nowon-gu, Seoul 01762, Republic of Korea; (B.-C.C.); (S.-M.L.)
| | - Se-Min Lee
- Nowon Samsung Orthopedics, 456 Nohae-ro, Nowon-gu, Seoul 01762, Republic of Korea; (B.-C.C.); (S.-M.L.)
| | - Mal-Soon Shin
- Department of Global Sport Studies, Korea University, 2511 Sejong-ro, Jochiwon-eup, Sejong 30019, Republic of Korea;
| | - Jae-Ho Yu
- Department of Physical Therapy, Sunmoon University, 70, Seonmun-ro 221beon-gil, Tangjeong-myeon, Asan-si 31460, Republic of Korea;
| | - Ho-Jin Kim
- Department of Sports and Exercise Medicine, Biomedical Science, Korea University, 2511 Sejong-ro, Jochiwon-eup, Sejong 30019, Republic of Korea; (H.-J.K.); (M.-S.C.)
| | - Hyun-Dong Noh
- Sports Medical Research Center, Daechan Hospital, 590 Inju-daero, Namdong-gu, Incheon 21570, Republic of Korea; (J.-M.P.); (S.-H.H.); (H.-D.N.)
| | - Min-Suk Cho
- Department of Sports and Exercise Medicine, Biomedical Science, Korea University, 2511 Sejong-ro, Jochiwon-eup, Sejong 30019, Republic of Korea; (H.-J.K.); (M.-S.C.)
| | - Myung-Ki Kim
- Department of Global Sport Studies, Korea University, 2511 Sejong-ro, Jochiwon-eup, Sejong 30019, Republic of Korea;
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Mao M, Yin Y, Luo D, Liu H, Yu B. Evaluation of dynamic postural control during single-leg landing tasks using initial impact force, landing leg stiffness and time to stabilisation. Sports Biomech 2024; 23:182-195. [PMID: 33594918 DOI: 10.1080/14763141.2020.1833969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Time to stabilisation (TTS) provides limited information to evaluate the dynamic postural control for individuals with functional ankle instability in single-leg landing task. More information is needed to understand TTS and evaluate the dynamic postural control better. The purpose is to develop a method estimating TTS, initial impact force (IIF) and landing leg stiffness (LLS) through fitting ground reaction force (GRF) decay in single leg landing with exponential vibration decay function (EVDF), and investigate effects of landing directions and GRF components on these parameters. Thirty-nine healthy participants were recruited. EVDF was used to fit GRF decays in different single-leg landings. TTS, IIF, and LLS were compared across landing directions and GRF components. The mean regression determinants of fitting GRF decays with EVDF were greater than 0.50. TTS was sensitive to GRF components (P = 0.041 females, P = 0.028 males). IIF was sensitive to GRF components (P = 0.001) for both genders. LLS was sensitive to GRF components (P = 0.023) for males. This method showed a moderate to strong feasibility for reporting GRF decay during landing, and provided movement characteristic information for better understanding of dynamic postural control together with TTS during landing.
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Affiliation(s)
- Min Mao
- Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yan Yin
- Department of Physical Education, Beijing University of Post and Telecommunication, Beijing, China
| | - Dongmei Luo
- College of Human Movement Science, Beijing Sport University, Beijing, China
| | - Hui Liu
- College of Human Movement Science, Beijing Sport University, Beijing, China
| | - Bing Yu
- Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Robbins JB, Stahel SA, Morris RP, Jupiter DC, Chen J, Panchbhavi VK. Radiographic Anatomy of the Lateral Ankle Ligament Complex: A Cadaveric Study. Foot Ankle Int 2024; 45:179-187. [PMID: 37994643 PMCID: PMC10860354 DOI: 10.1177/10711007231213355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
BACKGROUND When lateral ankle sprains progress into chronic lateral ankle instability (CLAI), restoring precise anatomic relationships of the lateral ankle ligament complex (LALC) surgically is complex. This study quantifies the radiographic relationships between the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and prominent osseous landmarks visible under fluoroscopy to assist in perioperative practices for minimally invasive surgery for CLAI. METHODS Ten fresh frozen ankle specimens were dissected to expose the LALC and prepared by threading a radiopaque filament through the ligamentous footprints of the ATFL and CFL. Fluoroscopic images were digitally analyzed to define dimensional characteristics of the ATFL and CFL. Directional measurements of the ligamentous footprints relative to the lateral process of the talus and the apex of the posterior facet of the calcaneus were calculated. RESULTS Dimensional measurements of the ATFL were a mean length of 9.3 mm, fibular footprint of 9.4 mm, and talar footprint of 9.1 mm. Dimensional measurements of the CFL were a mean length of 19.4 mm, fibular footprint of 8.2 mm, and calcaneal footprint of 7.3 mm. From the radiographic apparent tip of the lateral process of the talus, the fibular attachment of the ATFL was found 13.3 mm superior and 4.4 mm posterior, whereas the talar attachment was found 11.5 mm superior and 4.8 mm anterior. From the radiographic apparent posterior apex of the posterior facet of the calcaneus, the fibular attachment of the CFL was found 0.2 mm inferior and 6.8 mm anterior, whereas the calcaneal attachment was found 14.3 mm inferior and 5.9 mm posterior. CONCLUSION The ATFL and CFL were radiographically analyzed using radiopaque filaments to outline the ligamentous footprints in their native locations. These ligaments were also localized with reference to 2 prominent osseous landmarks. These findings may assist in perioperative practices for keyhole incision placement and arthroscopic guidance. Perfect lateral ankle joint imaging with talar domes superimposed is required to be able to do this. CLINICAL RELEVANCE Radiographic evaluation of the ATFL and CFL with reference to prominent osseous landmarks identified under fluoroscopy may assist in perioperative practices for minimally invasive surgery to address CLAI for keyhole incision placement and arthroscopic guidance.
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Affiliation(s)
- Jordan B. Robbins
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Shepheard A. Stahel
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Randal P. Morris
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Daniel C. Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Biostatistics and Data Science, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jie Chen
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
| | - Vinod K. Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Nakasa T, Ikuta Y, Sumii J, Nekomoto A, Kawabata S, Adachi N. Relationship between pain and intra-articular pathology in patients with chronic lateral ankle instability. Arch Orthop Trauma Surg 2024; 144:815-822. [PMID: 37982838 DOI: 10.1007/s00402-023-05123-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/29/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Repeated ankle sprains can lead to chronic lateral ankle instability (CLAI). It is unclear whether CLAI causes pain unless complicated by intra-articular lesions. This study aimed to analyze the characteristics of pain and the relationship between pain and intra-articular pathology in patients with CLAI. MATERIALS AND METHODS Fifty-three ankles in 46 patients with CLAI who had undergone surgery were retrospectively reviewed. The self-administered foot evaluation questionnaire (SAFE-Q) was given to patients the day before surgery. Intra-articular lesions were assessed using arthroscopy and magnetic resonance imaging (MRI). In addition, the Hounsfield Unit (HU) on computed tomography (CT) of the medial gutter was measured. The relationship between pain and intra-articular findings was also analyzed. RESULTS The pain and pain-related scores in the SAFE-Q were significantly correlated with synovitis in 96.3% (rs = - 0.532). HU ratios in the tibia and talus were also significantly correlated with pain (rs = - 0.603, - 0.534, respectively). The arthroscopic synovitis score and HU ratios in patients with high pain scores were significantly higher than those in patients with low pain scores. Forty ankles (75.5%) had synovitis and articular cartilage injuries were observed in 22 ankles (41.5%). Patients with fluid collection or bone marrow lesions (BML) scored significantly lower in pain than those without, but there was no significant difference between patients with and without cartilage injury. Multiple regression analysis revealed that a high synovitis score and HU ratio of the talus were significantly associated with high pain. CONCLUSIONS Intra-articular lesions such as synovitis and BML were associated with pain in patients with CLAI. Osteosclerotic changes in the medial gutter also induced ankle pain, indicating that osteoarthritic changes had already begun. Therefore, lateral ankle ligament injuries after ankle sprain should be appropriately treated to avoid secondary degenerative changes. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Tomoyuki Nakasa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan.
| | - Yasunari Ikuta
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Shingo Kawabata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minamiku, Hiroshima City, Hiroshima, 734-8551, Japan
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Esparó J, Vega J, Cordier G, Johnson R, Dallaudière B, Gasol-Santa X, Dalmau-Pastor M. Anterior talofibular ligament's superior fascicle as a cause of ankle microinstability can be routinely identified by ultrasound. Knee Surg Sports Traumatol Arthrosc 2024; 32:352-360. [PMID: 38258974 DOI: 10.1002/ksa.12052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE Chronic pain can affect up to 40% of patients after ankle inversion sprains. The current hypothesis to explain this high percentage of chronic pain is a partial/total rupture of anterior talofibular ligament (ATFL) superior fascicle, a structure that has recently been described as intra-articular and as having a different function than ATFL's inferior fascicle. This has created the need for diagnosing ATFL superior and inferior fascicles independently. Therefore, the objective of this study is to investigate if the ATFL's superior fascicle can be visualized on ultrasound, and to describe its ultrasonographic appearance. METHODS Twenty fresh-frozen ankle specimens were used in this 4-phases study. First, the specimens were scanned on US to identify what was believed to be ATFL's superior fascicle. Second, ATFL's superior fascicle was sutured under direct arthroscopic vision. Next, the specimens were scanned on US to obtain an image of the sutured structure. Finally, the specimens were dissected to confirm that the suture was indeed placed on ATFL's superior fascicle. RESULTS On the 20 specimens studied, full correlation was obtained between US, arthroscopic suture and specimen dissection. ATFL's superior fascicle US appearance is provided. CONCLUSION ATFL's superior fascicle can be visualized on US, which will allow to undergo diagnosis of isolated injuries to that fascicle, a common finding in ankle microinstability. The results of this study will facilitate the diagnosis of partial or complete rupture of ATFL's superior fascicle, likely increasing the amount of ankle microinstability diagnosis, impacting clinical management of ankle sprain consequences.
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Affiliation(s)
- Jordi Esparó
- Osteosport Clinic, Manresa, Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
| | - Jordi Vega
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Foot and Ankle Unit, iMove Tres Torres, Barcelona, Spain
| | - Guillaume Cordier
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Sport Surgery-Foot and Ankle, Clinique du Sport, Bordeaux-Merignac, Mérignac, France
| | - Rowena Johnson
- Fortius Clinic, London, UK
- Carnegie School of Sport, Leeds Beckett University, Headingley Campus, Leeds, UK
| | - Benjamin Dallaudière
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, Bordeaux, France
- Centre d'Imagerie Ostéo-articulaire, Clinique du Sport de Bordeaux-Mérignac, Mérignac, France
- Département d'Imagerie Musculo-squelettique, Centre Hospitalier Universitaire Pellegrin, Place Amélie Léon Rabat, Bordeaux, France
| | | | - Miki Dalmau-Pastor
- Department of Pathology and Experimental Therapeutics, Human Anatomy and Embryology Unit, School of Medicine and Health Science, University of Barcelona, Barcelona, Spain
- MIFAS by GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
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Marvulli R, Ianieri G, Pignatelli G, Santagati D, Ranieri M, Megna M. Electronic Method (Pro-Kin) for Improving and Speeding Up the Recovery After Ankle Sprain. Endocr Metab Immune Disord Drug Targets 2024; 24:1572-1580. [PMID: 35616674 DOI: 10.2174/1871530322666220523155452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Ankle sprains, very common injuries occurred especially during sports activities, are mainly caused by indirect trauma, which influences exaggerated stress exceeding the strength of stabilization mechanisms. Up to 85% of such injuries result from a sudden flexion and inversion of the foot. In this study, we analyzed the effectiveness of the platform Pro-kin, an innovative system that has given us the possibility to combine the functionality of the older proprioceptive boards with very accurate software in order to improve and accelerate the recovery after ankle injuries. METHODS 30 patients with moderate ankle sprain outcomes in two groups (A and B) were included in this study. Group A was only treated with proprioceptive exercises for 3 weeks, while the group B was trained with the innovative Pro-kin. In both groups, we evaluated VAS scale, the ratio between the number of circumductions performed by the injured foot and the time spent on doing them and the percentage of load among the injured and the healthy foot in statics and dynamics with electronic baropodometry. Our data has been collected at t0 (beginning of study), t1 (one week later), t2 (two weeks later), t3 (one month later), t4 (two months later), and then analyzed by the two-way analysis of variance (2-way ANOVA) test. RESULTS At t0 no statistical differences of pain in the 2 groups (3.3 and 3.4); the values were similar, as well as at time t1, t2, t3 and t4. Therefore we deduce that Pro-kin treatment is not painful. The number of circumductions performed was definitely better in B group since the first week; for the A group the values considerably increased only at t3 (one month later). Comparing the load percentages on two feet detected by the electronic baropodometer in statics and in dynamics, we deduced that the patients of A group tend to lean mostly on the healthy foot than B group. CONCLUSION This study demonstrates that new technological resources (such as Pro-kin) may be helpful to improve and speed up the recovery of ankle sprain in athletes.
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Affiliation(s)
- Riccardo Marvulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- Local Healthcare Company of Bari-Health District of Bari City, Bari, Italy
| | - Giancarlo Ianieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giovanni Pignatelli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- Local Healthcare Company of Brindisi-Health District of Brindisi 1, Bari, Italy
| | - Dario Santagati
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
- Rehabilitation Center Marcoccio SRL, Via Umberto I, 121, 95129 Catania, Italy
| | - Maurizio Ranieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Marisa Megna
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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Owoeye OBA, Paz J, Emery CA. Injury severity at the time of sport-related ankle sprain is associated with symptoms and quality of life in young adults after 3-15 years. Ann Med 2023; 55:2292777. [PMID: 38092008 PMCID: PMC10880560 DOI: 10.1080/07853890.2023.2292777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Ankle sprains are the most common sports-related injuries. Individuals with time-loss ankle sprains often experience residual symptoms and chronic ankle instability years after injury. Up to 90% of post-traumatic ankle osteoarthritis cases are associated with severe ankle sprain. This study aimed to examine whether ankle injury severity sustained during youth sports participation is associated with ankle symptoms and function. MATERIALS AND METHODS Cohort study included 50 young adults (mean age, 23 years) with a 3-to 15-year history of a youth-sport related 'significant ankle sprain' (SAS). The primary independent variable was injury severity, which was captured in the index SAS injury details through interviews. SAS was defined as ligament and other intra/extra-articular structure injuries that disrupted youth sport participation, at least 3 days of time loss, and required medical consultation. Severe SAS was defined as SAS involving >28 days of time loss, and non-severe SAS only involved ankle ligaments and/or with ≤28 days of time loss. The Foot and Ankle Outcome Score questionnaire was used to assess ankle symptoms and function. Descriptive statistics and multivariable linear regression models were used to examine the association between SAS severity and outcomes, with sex and time since injury as covariates. RESULTS Compared to participants with non-severe SAS, participants with a history of severe SAS demonstrated significantly poorer outcomes in symptoms [-18.4 (99% CI: -32.2 to -4.6)], pain [-10.1 (99% CI: -19.2 to -1.1)] and QoL [-17.1 (99% CI: -33.1 to -1.1)] in multivariable linear regression models. CONCLUSIONS Severe ankle sprain with a loss of > 4 weeks from sports participation at the time of injury is independently associated with poorer ankle symptoms, pain, and ankle-related quality of life after 3-15 years. Secondary prevention measures are needed in individuals with a history of severe ankle sprains to mitigate the potential health consequences.
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Affiliation(s)
- Oluwatoyosi B. A. Owoeye
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St Louis, MO, USA
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Center of Excellence in Maternal and Child Health Education, Science and Practice, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA
| | - Juan Paz
- Department of Physical Therapy and Athletic Training, Doisy College of Health Sciences, Saint Louis University, St Louis, MO, USA
| | - Carolyn A. Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Takaba K, Takenaga T, Tsuchiya A, Takeuchi S, Fukuyoshi M, Nakagawa H, Matsumoto Y, Saito M, Futamura H, Futamura R, Sugimoto K, Murakami H, Yoshida M. Plantar flexion with inversion shows highest elastic modulus of calcaneofibular ligament using ultrasound share wave elastography. J Ultrasound 2023; 26:765-770. [PMID: 35513766 PMCID: PMC10632312 DOI: 10.1007/s40477-022-00687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The functional role of the calcaneofibular ligament (CFL) is still controversial. We aimed to investigate the anatomical features of the CFL on sonography and the elastic modulus of the CFL in different ankle positions using ultrasound shear-wave elastography (SWE). METHODS In 14 cadaveric ankles, the angle of the CFL with respect to the long axis of the fibula was measured in the following ankle positions: neutral (N), 30° plantar flexion (PF), and 20° dorsiflexion (DF). In addition, in 24 ankles of healthy adult volunteers, the elastic modulus of the CFL was evaluated with ultrasound SWE in the following ankle positions: neutral (N), 30° plantar flexion with inversion (PI), 30° plantar flexion with eversion (PE), 20° dorsiflexion with inversion (DI), and 20° dorsiflexion with eversion (DE). RESULTS The mean angle of the CFL in N, PF, and DF positions was 139.9° ± 12.7°, 121.3° ± 14.1°, and 158.6° ± 13.1°, respectively. The angle of the CFL in N was significantly greater than that in PF and smaller than that in DF (P < 0.0001, both). The mean elastic modulus of the CFL in the N, PI, PE, DI, and DE positions was: 63.6 ± 50.8, 148.0 ± 39.4, 75.8 ± 40.6, 88.1 ± 31.6, and 61.7 ± 29.4 kPa, respectively. The elastic modulus in PI was significantly higher than in other positions, while the values obtained in DI and DE were also significantly different (P < 0.001, both). CONCLUSIONS The angle of the CFL increased with DF. Moreover, ultrasound SWE showed that the CFL was tensed and likely to be injured in the PI position.
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Affiliation(s)
- Keishi Takaba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Tetsuya Takenaga
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Atsushi Tsuchiya
- Arthroscopy and Sports Medicine Center, Meitetsu Hospital, Nagoya, Japan
| | - Satoshi Takeuchi
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
- Department of Orthopaedic Surgery, Toyohashi Medical Center, Toyohashi, Japan
| | | | | | | | | | | | | | | | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Masahito Yoshida
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
- Department of Musculoskeletal Sports Medicine, Research and Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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Guelfi M, Baalbaki R, Malagelada F, Dalmau-Pastor M, Vega J. Arthroscopic all-inside ligament repair has similar or superior clinical outcomes compared to open repair for chronic ankle instability without concomitant intra-articular pathology at 5 years follow-up. Knee Surg Sports Traumatol Arthrosc 2023; 31:6052-6058. [PMID: 37843588 DOI: 10.1007/s00167-023-07621-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Open ligament repair is widely considered the gold standard treatment for chronic ankle instability. Nevertheless, arthroscopic treatment of ankle instability has gained popularity becoming the preferred technique for many surgeons. This study aimed to compare the clinical outcomes of all-inside arthroscopic versus open lateral ligament repair for chronic ankle instability at 5 years follow-up. METHODS Ninety consecutive patients were surgically treated for chronic ankle instability without concomitant intra-articular pathology observed on MRI: 41 patients [median age 28 (range 15-54) years] underwent an open lateral ligament repair (OLR); 49 patients [median age 30 (range 19-47) years] underwent an all-inside arthroscopic ligament repair (ALR). Functional outcomes using the Foot Functional Index (FFI), the American Orthopaedic Foot and Ankle Society (AOFAS) Hindfoot Score, and the Foot and Ankle Ability Measure-Sports Subscale (FAAM-SS) were assessed preoperatively and at the latest follow-up. At the latest follow-up, the satisfaction rate and complications were also recorded. RESULTS The mean follow-up was 58 ± 17.6 (range 47-81) months. In both groups FFI, AOFAS and FAAM-SS score significantly improved compared to preoperative values (p < 0.001). There was no statistically significant difference in postoperative outcomes between groups in the AOFAS (n.s) and FAAM-SS (n.s), but the FFI results were significantly better in the ALR group (p < 0.05). No major complications were reported in either group. CONCLUSION Open and arthroscopic ligament repair to treat chronic ankle instability without concomitant intra-articular pathology produced excellent comparable clinical outcomes at 5 years follow-up. The complications were minimal in both study groups with no significant differences in AOFAS and FAAM-SS scores. However, arthroscopic repair showed significantly better results on the FFI. Therefore, when treating chronic lateral ankle instability, surgeons should consider arthroscopic ligament repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Matteo Guelfi
- Foot and Ankle Unit, Casa di Cura Villa Montallegro, Genoa, Italy.
- Department of Orthopaedic Surgery "Gruppo Policlinico Di Monza", Clinica Salus, Alessandria, Italy.
| | - Rayan Baalbaki
- Foot and Ankle Department, Clinique Montchoisi, Lausanne, Switzerland
| | - Francesc Malagelada
- Foot and Ankle Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Miki Dalmau-Pastor
- MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | - Jordi Vega
- MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
- Foot and Ankle Unit, Hospital Quirón, Barcelona, Spain
- iMove Traumatology Tres Torres, Barcelona, Spain
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Kim JS, Kim MS, Kim DK, Lee SH. Magnetic Resonance Imaging Characteristics of a Lateral Ligament Injury in Acute Ankle Sprains Among Athletes. Orthop J Sports Med 2023; 11:23259671231207688. [PMID: 37954866 PMCID: PMC10637175 DOI: 10.1177/23259671231207688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 11/14/2023] Open
Abstract
Background It is important to identify the location and pattern of lateral ligament injuries that are related to the development and prognosis of chronic ankle instability in athletes with ankle sprains. Purpose To describe the location and pattern of lateral ligament injuries on magnetic resonance imaging (MRI) in elite-level or amateur athletes with acute ankle sprains and to further assess the risk of associated concomitant injuries. Study Design Cross-sectional study; Level of evidence, 3. Methods The anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) of 110 athletes with an ankle lateral ligament injury (mean age, 24.7 years) were evaluated. MRI scans were evaluated for the location and pattern of ATFL and CFL tears such as sleeve avulsions as well as concomitant deltoid ligament injuries, bone contusions, and osteochondral lesions of the talus (OLTs). Results On MRI, 52 (47.3%) athletes had an isolated ATFL tear, 56 (50.9%) athletes had both ATFL and CFL tears, and 2 (1.8%) athletes had an isolated CFL tear. ATFL injuries occurred at the fibula, midsubstance, and talus in approximately equal numbers, whereas the majority of CFL injuries occurred at the calcaneal insertion. Concomitant deltoid ligament injuries were identified in 18 (16.4%) athletes. In addition, concomitant bone contusions and OLTs were identified in 38 (34.5%) and 6 (5.5%) athletes, respectively. Using linear-by-linear analysis, CFL injuries correlated with concomitant deltoid ligament and bone injuries (P = .023 and P = .001, respectively) and a sleeve injury pattern (P = .005). Conclusion After an acute ankle ligament rupture, almost all athletes involved in this study had injured their ATFL, and approximately 50% had a concomitant injury to the CFL. The rate of sleeve-type CFL injuries at the calcaneal insertion was high, and concomitant deltoid ligament injuries and OLTs were associated with this pattern of injury.
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Affiliation(s)
- Jin Su Kim
- Department of Orthopedic Surgery, Sejong Sports Medicine and Performance Center, Seoul, Republic of Korea
| | - Min Seok Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Do Kyun Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
| | - Sung Hyun Lee
- Department of Orthopedic Surgery, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Republic of Korea
- Musculoskeletal and Immune Disease Research Institute, School of Medicine, Wonkwang University, Iksan, Republic of Korea
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Piming G, Yaming Y, Hai S, Xia L, Xiaobing L. Three-dimensional ankle kinematics of the full gait cycle in patients with chronic ankle instability: A case-control study. Heliyon 2023; 9:e22265. [PMID: 38053855 PMCID: PMC10694306 DOI: 10.1016/j.heliyon.2023.e22265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023] Open
Abstract
Objectives The ankle kinematic characteristics of chronic ankle instability (CAI) at different gait phases and dimensions were not directly and overall explained. These characteristics have yet to be established. This study aimed to observe ankle kinematic changes of CAI, and explore their mechanisms, at different gait phases and dimensions in full gait cycle. Methods A three-dimensional (3D) motion capture system measured the 3D ankle movements of 53 individuals with CAI (meanage = 25.11 ± 6.01years, meanheight = 170.77 ± 7.80 cm, meanmass = 64.28 ± 9.28 kg) and 53 healthy controls (meanage = 24.66 ± 6.32 years, meanheight = 169.98 ± 9.00 cm, meanmass = 63.11 ± 9.62 kg) during barefoot walking overground at a self-selected speed. Once the acquisition results were processed with visual 3D software, the kinematics data were exported, and the eight phases of the gait cycle were identified. Results As compared with the control group, individuals with CAI displayed a significantly smaller plantarflexion in toe off (P = 0.049, Cohen's d = 0.387), a significantly increased inversion in heel strike (P = 0.007, Cohen's d = 0.271) and initial swing (P = 0.035, Cohen's d = 0.233), mid-swing (P = 0.019, Cohen's d = 0.232) and end-swing (P = 0.021, Cohen's d = 0.214), and significantly smaller eversion in mid stance（P = 0.010, Cohen's d = 0.288）and heel off (P = 0.033, Cohen's d = 0.089). Significant between-group differences in ankle kinematics were observed in the sagittal and frontal planes, but not in the horizontal plane, during walking. Conclusion When walking, patients with CAI have altered sagittal- and frontal-plane kinematics during different stance and swing phases. These kinematic changes require multi-dimensional, dynamic, continuous functional assessment and specialized rehabilitation intervention.
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Affiliation(s)
- Gao Piming
- Department of Sports Injury Prevention and Treatment, Sichuan Province Orthopedic Hospital, Chengdu, China
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Yu Yaming
- Department of Sports Injury Prevention and Treatment, Sichuan Province Orthopedic Hospital, Chengdu, China
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Shen Hai
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Li Xia
- Department of Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
| | - Luo Xiaobing
- Department of Sports Injury Prevention and Treatment, Sichuan Province Orthopedic Hospital, Chengdu, China
- Department of Sports Medicine, Sichuan Province Orthopedic Hospital, Chengdu, China
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Comfort SM, Marchetti DC, Duncan PP, Dornan GJ, Haytmanek CT, Clanton TO. Broström Repair With and Without Augmentation: Comparison of Outcomes at Median Follow-up of 5 Years. Foot Ankle Int 2023; 44:691-701. [PMID: 37282349 DOI: 10.1177/10711007231176806] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND An augmented Broström repair with nonabsorbable suture tape has demonstrated strength and stiffness more similar to the native anterior talofibular ligament (ATFL) compared to Broström repair alone at the time of repair in cadaveric models for the treatment of lateral ankle instability. The study purpose was to compare minimum 2-year patient-reported outcomes (PROs) following treatment of ATFL injuries with Broström repair with vs without suture tape augmentation. METHODS Between 2009 and 2018, patients >18 years old who underwent primary surgical treatment for an ATFL injury with either a Broström repair alone (BR Cohort) or Broström repair with suture tape augmentation (BR-ST Cohort) were identified. Demographic data and PROs, including Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sport subscales, 12-Item Short Form Health Survey (SF-12), Tegner Activity Scale, and patient satisfaction with surgical outcome, were compared between groups, and proportional odds ordinal logistic regression was used. RESULTS Ninety-one of 102 eligible patients were available for follow-up at median 5 years. The BR cohort had 50 of 53 patients (94%) completed follow-up at a median of 7 years. The BR-ST cohort had 41 of 49 (84%) complete follow-up at a median of 5 years. There was no significant difference in median postoperative FAAM ADL (98% vs 98%, P = .67), FAAM sport (88% vs 91%, P = .43), SF-12 PCS (55 vs 54, P = .93), Tegner score (5 vs 5, P = .64), or patient satisfaction (9 vs 9, P = .82). There was significantly higher SF-12 MCS (55.7 vs 57.6, P = .02) in the BR-ST group. Eight patients underwent subsequent ipsilateral ankle surgery, of which one patient (BR-ST group) was revised for recurrent lateral ankle instability. CONCLUSION At median 5 years, patients treated for ATFL injury of the lateral ankle with Broström repair with suture tape augmentation demonstrated similar patient-reported outcomes to those treated with Broström repair alone. LEVEL OF EVIDENCE Level II, retrospective cohort study.
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Affiliation(s)
| | | | - Parker P Duncan
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | | | - C Thomas Haytmanek
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
| | - Thomas O Clanton
- Steadman Philippon Research Institute, Vail, CO, USA
- The Steadman Clinic, Vail, CO, USA
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Usuelli FG, Montagna A, Sangaletti R, Indino C, Maccario C, Grassi FA. Minimally Invasive Reconstruction of the Ankle Lateral Ligament Complex in Chronic Ankle Instability: Clinical Outcomes, Return to Sport and Recurrence Rate at Minimum Follow up of 5 Years. APPLIED SCIENCES 2023; 13:7923. [DOI: 10.3390/app13137923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Chronic ankle instability is a common condition that develops after lateral ankle sprains. Many surgical techniques have been described in case of failure of conservative treatment. The purpose of this paper is to present the results in terms of clinical outcomes, return to sport and recurrence rate after reconstruction of the lateral ligament complex of the ankle with a minimally invasive approach at a minimum follow up of five years. Methods: This retrospective study involved forty-seven patients treated for chronic ankle instability from January 2013 to November 2017. The clinical outcomes were evaluated with the American Orthopedic Foot and Ankle Society ankle and hindfoot score (AOFAS score), the University of California–Los Angeles Rating Scale (UCLA Rating Scale), the Karlsson–Peterson ankle instability score and the Halasi scale at a mean follow up time of 80 months. Results: The mean age of the patients was 42 years (23–63). The mean VAS pain score decreased from 5.6 (2–9) pre-operatively to 0.7 (0–7) post-operatively. The mean UCLA Rating Scale score improved from 7.7 (4–8) before surgical treatment to 9.2 (6–10) afterwards. The AOFAS score increased from a pre-operative mean value of 66.5 (40–95) to a post-operative mean value of 94 (88–100) and the Halasi scale from a pre-injury mean value of 4.3 (2–8) to 4.5 post-operatively (2–8). The mean Karlsson–Peterson ankle instability score increased from 71 (40–90) pre-operatively to 87.9 (70–90) post-operatively. During this period of follow up, the procedure survival rate was 95.7%, with two cases of recurrence of ankle sprain post-operatively after twelve months in one case and forty months in the other case. Conclusions: The described technique of reconstruction of the anterior talofibular and calcaneofibular ligament with a minimally invasive approach with a semitendinosus autograft is a viable treatment option for chronic ankle instability and enables the majority of patients to regain their activity and sport level with a low recurrence rate at a mid-term follow up.
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Affiliation(s)
| | - Alice Montagna
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
| | - Rudy Sangaletti
- Sezione di Chirurgia Protesica ad Indirizzo Robotico-Unità di Traumatologia dello Sport, U.O.C Ortopedia e Traumatologia, Fondazione Poliambulanza, Via Bissolati 57, 25124 Brescia, Italy
| | - Cristian Indino
- Ankle and Foot Unit, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Camilla Maccario
- Ankle and Foot Unit, Humanitas San Pio X Hospital, 20159 Milan, Italy
| | - Federico Alberto Grassi
- Orthopedics and Traumatology Clinic, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
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Koh D, Chandrakumara D, Kon Kam King C. Incidence of Injuries Associated With Anterior Talofibular Ligament Injury Based on the Reporting of Magnetic Resonance Imaging. Cureus 2023; 15:e41738. [PMID: 37575750 PMCID: PMC10415230 DOI: 10.7759/cureus.41738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction This paper aims to report the incidence of ligamentous, tendon, and other structural injuries associated with an anterior talofibular ligament (ATFL) injury based on magnetic resonance imaging (MRI) findings. Methods The reports of all patients who underwent surgical treatment for ATFL injury between 2021 and 2022 at Changi General Hospital and had preoperative MRI ankle scans performed were analyzed in this retrospective study. Patients who had a preoperative MRI ankle scan performed with specific reporting of the ATFL, calcaneofibular ligament (CFL), deltoid ligaments, peroneal tendons, and the presence of an osteochondral defect (OCD) were included in this study. Patients who underwent surgery but did not have a preoperative MRI ankle scan done or had ankle fractures or systemic conditions affecting the same ankle were excluded. Results Eighty-six patients were included in this study, of which 59 were males and 27 were females. About 73.3% (63 of 86) of patients had sustained injuries in association with ATFL injury, and 58.1% (50 of 86) of patients suffered an associated injury to the calcaneofibular ligament (CFL). There were injuries to the superficial and deep deltoid ligaments in 29.1% (25 of 86) and 44.2% (38 of 86) of patients, respectively. The peroneal tendons were also injured in 17.4% (15 of 86) of patients. Lastly, there were also associated OCDs found in 19.8% (17 of 86) of patients. Conclusion There is a high incidence of injuries associated with an ATFL injury. The CFL and deltoid ligament complex are the most commonly injured structures in association with the ATFL. One in five patients will also have an associated OCD. The ATFL tends to be the only structure that is commonly addressed during surgery. Repair of the ATFL only may thus lead to poorer outcomes and persistent pain, if the underlying cause is due to the other concurrent injuries. Clinical evaluation of the other structures should thus be thoroughly performed to allow the addressing of any concurrent injuries in the same surgical setting to achieve better outcomes.
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Affiliation(s)
- Don Koh
- Orthopaedics, Changi General Hospital, Singapore, SGP
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Abstract
Ankle sprains are extremely common. It is important to have a clear insight of the course of recovery after such injury to evaluate the effective strategies to guide management decisions, and understand the potential risk factors involved in the development of chronic problems and recurrent ankle sprains. When a prompt diagnosis is not formulated, ligament tears can remain untreated, and chronic ankle instability can result after acute lateral or medial ankle sprain. When the medial ligament complex (MLC), in particular the anterior fascicle of the deltoid ligament, is involved, rotational ankle instability (RAI) can develop. Generally, a tear of the anterior fibres of the MCL accompanied by anterior talofibular ligament (ATFL) insufficiency has been associated with RAI, while injury of the intermediate fibres of the MLC has been associated with medial ankle instability (MAI). Conservative management is the first line of treatment, with surgery reserved for special cases or if rehabilitation has failed. Regarding surgery, several options are available, including anatomic repair, anatomic reconstruction, and tenodesis procedures. Ankle arthroscopy is increasingly used to address ligament insufficiency and to identify and treat intra-articular pathologies. Repair of MLC tears by an arthroscopic all-inside procedure is effective in both MAI and RAI.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Fisciano, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Fisciano, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
- Keele University, Faculty of Medicine, School of Pharmacology and Bioengineering, Guy Hilton Research Centre, Hartshill, Stoke-on-Trent, UK
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Peng L, Yu L, Jia J, Gan Y, Ding A, Xiong P, Zhao Y, Yao Y. The effect of thickness and elastic modulus of the anterior talofibular ligament on anterior ankle joint stiffness: A subject-specific finite element study. Front Bioeng Biotechnol 2023; 11:1175347. [PMID: 37180042 PMCID: PMC10166853 DOI: 10.3389/fbioe.2023.1175347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023] Open
Abstract
Ankle sprain is a frequent type of sports injury leading to lateral ligament injury. The anterior talofibular ligament (ATFL) is a primary ligamentous stabilizer of the ankle joint and typically the most vulnerable ligament injured in a lateral ankle sprain (LAS). This study aimed to quantitively investigate the effect of the thickness and elastic modulus of ATFL on anterior ankle joint stiffness (AAJS) by developing nine subject-specific finite element (FE) models under acute injury, chronic injury, and control conditions of ATFL. A 120 N forward force was applied at the posterior calcaneus leading to an anterior translation of the calcaneus and talus to simulate the anterior drawer test (ADT). In the results, the ratio of the forward force to the talar displacement was used to assess the AAJS, which increased by 5.85% in the acute group and decreased by 19.78% in the chronic group, compared to those of the control group. An empirical equation described the relationship between AAJS, thickness, and elastic modulus (R-square 0.98). The equation proposed in this study provided an approach to quantify AAJS and revealed the effect of the thickness and the elastic modulus of ATFL on ankle stability, which may shed light on the potential diagnosis of lateral ligament injury.
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Affiliation(s)
- Linjing Peng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Lu Yu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Jingyi Jia
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Yaokai Gan
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Angang Ding
- Department of Ultrasound, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Xiong
- Department of Ultrasound, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yichen Zhao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yifei Yao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
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Ergün T, Peker A, Aybay MN, Turan K, Muratoğlu OG, Çabuk H. Ultrasonography vıew for acute ankle ınjury: comparison of ultrasonography and magnetic resonance ımaging. Arch Orthop Trauma Surg 2023; 143:1531-1536. [PMID: 35867114 DOI: 10.1007/s00402-022-04553-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We aim to asses the diagnostic performance of ankle ultrasonography in patients presenting with acute ankle sprain injury, with comparison to MRI (Manyetik Rezonans İmaging). MATERIALS AND METHODS The study included patients who applied to the hospital within 48 h after an ankle sprain, and who presented with signs of pain, swelling, and tenderness in the ankle. Ankle ultrasonography examination was performed and an ankle MRI took place the same day. RESULTS 30 patients were included in the study. 53.3% (n = 16) were female. The mean age was 30 ± 6.4 years. The ultrasonography examination determined 76.6% (n = 23) of the patients to have anterior talofibular ligament (ATFL) injury, 33.3% to have (n = 10) CFL injury, and 33.3% to have (n = 10) anterior inferior tibia-fibular ligament (AITFL) injury. The MRI of the patients determined 73.3% (n = 22) of the patients to have ATFL injury, 43.3% (n = 13) to have calcaneal fibular ligament (CFL) injury, and 33.3% to have (n = 10) AITFL injury. The ATFL, CFL, and AITFL injuries diagnosed on ultrasonography correlated with the MRI results (ICC = 0.875, ICC = 0.879, and ICC = 0.858). However, among the ATFL injuries observed on MRI, 26.6% (n = 8) were grade I, 26.6% (n = 8) were grade II, and 20% (n = 6) were grade III injuries. Of the ATFL injuries observed on ultrasonography, 46.6% (n = 14) were grade I, 8.6% (n = 2) were grade II, and 30.4% (n = 7) were grade III injuries. CONCLUSIONS Findings on all types of ATFL, CFL and AITFL appear to have a higher degree of correlation. Ultrasonography could have an added role as a triaging tool, to fast-track MRI.
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Affiliation(s)
- Tuğrul Ergün
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey.
| | - Ahmet Peker
- Koç University Hospital, İstanbul, Zeytinburnu, Türkiye
| | | | - Kaya Turan
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey
| | - Osman G Muratoğlu
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey
| | - Haluk Çabuk
- Department of Orthopedics and Traumatology, Istinye University Bahçeşehir Liv Hospital, Istanbul, Turkey
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Hewitt RL, Brocker JL. Chiropractic Management of Chronic Ankle Pain and Limited Mobility in a Pediatric Athlete: A Case Report. J Chiropr Med 2023; 22:85-88. [PMID: 36844988 PMCID: PMC9947970 DOI: 10.1016/j.jcm.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/26/2022] [Accepted: 10/12/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The purpose of this case study was to report the chiropractic management of a teenage athlete who had chronic pain after a lateral ankle sprain. Clinical Features A 15-year-old male patient presented with persistent ankle pain due to an inversion sprain while playing soccer approximately 8.5 months prior. Emergency department records noted a left lateral ankle sprain, including the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament. The examination revealed ankle tenderness upon palpation, limited active and passive dorsiflexion range of motion, restricted talocrural joint posterior glide, and moderate lateral compartment muscular hypertonicity. Intervention and Outcome Chiropractic management included high-velocity, low-amplitude chiropractic ankle manipulation and education on home-based ankle dorsiflexion stretching. After 4 treatments, the athlete returned to unencumbered athletic participation. Follow-up evaluation at 5 months revealed no pain or functional complaints. Conclusion This teen athlete's chronic pain from a lateral ankle sprain resolved with a short course of chiropractic manipulation coupled with home-based stretching.
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Intermediate-term Outcomes in Adolescent Recurrent Ankle Instability Managed With a Modified Broström-Gould Procedure Augmented With Distal Fibular Periosteum Incorporation. J Pediatr Orthop 2023; 43:e199-e203. [PMID: 36729607 DOI: 10.1097/bpo.0000000000002329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Once a child has developed chronic ankle instability with recurrent events despite conservative treatment, then ligamentous repair is warranted. We utilize a modification of the modified Broström-Gould technique that further incorporates the distal fibular periosteum into the construct. The purpose of this study was to describe the intermediate-term outcomes of our modified Broström-Gould technique for chronic lateral ankle instability in childhood athletes. METHODS A retrospective review of children who underwent the surgical technique over a 10-year time period (2010 to 2019) was performed, excluding those with <2 years of follow-up. Demographic, surgical, and clinical data were recorded, as well as outcome scores: (1) the Marx activity scale, (2) University of California, Los Angeles activity score, and (3) foot and ankle outcomes score. Recurrent instability events, repeat surgeries, satisfaction with the surgical experience, and return to sport (if applicable) were also recorded. RESULTS Forty-six children (43 females) with 1 bilateral ankle met the criteria with a mean age at surgery of 14.8 years, and a mean follow-up duration of 4.9 years. The mean Marx activity score was 9.0±5.1, the mean University of California, Los Angeles score was 8.3±1.8, and the mean total foot and ankle outcomes score was 84.0±15.6. Twenty-six ankles (55.3%) reported having at least 1 recurrent episode of instability and 6 of the ankles (12.8%) underwent revision surgery between 3.5 months and 6.5 years of the index procedure. Thirty-nine (84.8%) patients responded that they would undergo our surgery again. CONCLUSION A modified Broström-Gould procedure can be performed in children with the incorporation of the adjacent periosteum, but recurrence of instability is distinctly possible with longer follow-up with a risk for revision surgery despite good subjective outcomes. LEVEL OF EVIDENCE Level IV; retrospective case series.
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Al-Janabi MM, Apostolides M, Southgate C, Dhinsa BS. Early mobilization following elective ankle lateral collateral ligament reconstruction in adults. Foot (Edinb) 2023; 55:101988. [PMID: 36863249 DOI: 10.1016/j.foot.2023.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Emergency departments in the UK are overwhelmed with musculoskeletal trauma, 50 % of which resulting from ligamentous injuries. Of these, ankle sprains are the most prevalent, however with poor rehabilitation in the recovery period, 20 % of patients may develop chronic instability that may necessitate operative reconstruction. At present, there are no national guidelines or protocols to help direct postoperative rehabilitation and determine weightbearing status. Our aim is to review the existing literature that investigated postoperative outcomes following different rehabilitation protocols in patients with Chronic Lateral Collateral Ligament (CLCL) instability. METHODS A literature search was performed via Medline, Embase and Pubmed databases using the terms 'ankle', 'lateral ligament', 'repair'. 'reconstruction' and 'early mobilisation'. A total of 19 studies were identified after filtering that they were English language papers. A gray literature search was also performed using the Google search engine. RESULTS Based on the literature reviewed, patients undergoing early mobilisation and Range Of Movement (ROM) following lateral ligament reconstruction for chronic instability seem to have better functional outcomes and earlier return to work and sports. This is however in the short-term, and there are no medium to long-term studies evaluating the effects of early mobilisation on ankle stability. Furthermore, there may be an increased risk of postoperative complications, mainly wound related, with early mobilization compared to delayed mobilization. CONCLUSION Further randomized studies and long-term prospective studies with larger cohorts of patients are required to improve the level of evidence available but based on current literature it would appear that controlled early ROM and weight-bearing is advisable in patients undergoing surgery for CLCL instability.
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One double-loaded suture anchor is sufficient for all-inside arthroscopic anterior talofibular ligament repair. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07348-5. [PMID: 36810947 DOI: 10.1007/s00167-023-07348-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE All-inside anterior talofibular ligament (ATFL) repair using anchors is frequently used to manage chronic lateral ankle instability (CLAI) with satisfactory functional outcomes. It remains unclear whether there are differences in the functional results between the use of one or two double-loaded anchors. METHODS This retrospective cohort study included 59 CLAI patients who underwent an all-inside arthroscopic ATFL repair procedure from 2017 to 2019. Patients were divided into two groups according to the number of anchors used. In the one-anchor group (n = 32), the ATFL was repaired with one double-loaded suture anchor. In the two-anchors group (n = 27), the ATFL was repaired with two double-loaded suture anchors. At the last follow-up time point, the Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports in both groups were compared. RESULTS All the patients were followed up for at least 24 months. Improvement in the functional results (VAS, AOFAS, KAFS, ATT, and AJPS) were recorded at the final follow-up time point. No significant differences were observed regarding VAS, AOFAS, KAFS, ATT, and AJPS between the two groups. CONCLUSION In patients with CLAI undergoing all-inside arthroscopic ATFL repair, the use of either one or two double-loaded suture anchors produces comparable and predictably good functional outcomes. LEVEL OF EVIDENCE Level III.
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Rhyu HS, Hong SY, Rhi SY. EFEITOS DO EXERCÍCIO DE REABILITAÇÃO ACELERADA DEPOIS DE TBM SOBRE A FUNÇÃO E A FORÇA NA INSTABILIDADE DO TORNOZELO. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329022022_0117p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
RESUMO Introdução: Os atletas de taekwondo com instabilidade lateral crônica do tornozelo (ILCT) podem apresentar dificuldades com propriocepção e força muscular do tornozelo. Depois da cirurgia, um programa de exercícios de reabilitação convencional pode ser ineficaz, porque a propriocepção ou a força muscular podem não se restaurar e, portanto, resultar em melhora mínima. Objetivos: Este estudo teve como objetivo avaliar os efeitos de um programa de ERA depois de TBM sobre a propriocepção, força isocinética e resistência do tornozelo. Métodos: Trinta atletas com diagnóstico de ILCT foram submetidos à TBM. Eles foram divididos em grupo ERA (n=15) e grupo controle CON (n = 15). O grupo ERA realizou exercícios ERA precoces seis vezes por semana durante 4 semanas. Os parâmetros aplicados para testar a força muscular do tornozelo foram velocidade angular de 30°/s e 180°/s (inversão: Inv e eversão: Eve, respectivamente). A propriocepção foi medida pela capacidade de sentir a posição articular de 15° de Inv e 5° de Eve Resultados: Foram observadas diferenças significativas entre os grupos ERA e CON na força do tornozelo 30°/s (Inv: p < 0,001, Eve: p < 0,001), 180°/s (Inv: p < 0,001, Eve: p < 0,001), e propriocepção a 15° (Inv: p < 0,001) e 5° (Eve: p < 0,001). Conclusões: Registramos efeitos de curto prazo significativos com ERA precoce em atletas de taekwondo com ILCT depois da TBM. Os resultados fornecem dados de referência para o reabilitador esportivo ou ATC (Certified athletic trainer) na avaliação da fase de reabilitação e informar os pacientes sobre as expectativas depois da TBM em termos de condições de desempenho e momento de retorno ao esporte. Nível de evidência III; Estudos terapêuticos – Investigação dos resultados do tratamento - Estudo de caso-controle.
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Rhyu HS, Hong SY, Rhi SY. EFFECTS OF ACCELERATED REHABILITATION EXERCISE AFTER MBO ON ANKLE FUNCTION AND STRENGTH IN ANKLE INSTABILITY. REV BRAS MED ESPORTE 2023. [DOI: 10.1590/1517-8692202329022022_0117i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
ABSTRACT Background: Taekwondo athletes with lateral chronic ankle instability (LCAI) may experience difficulties with proprioception and ankle muscle strength. After surgery, a conventional rehabilitation exercise program can be ineffective, as it may not restore proprioception or muscle strength and, thus, result in minimal improvement. Objective: This study aimed to assess the effects of an ARE program following MBO on the proprioception, isokinetic strength, and endurance of ankle. Methods: Thirty athletes diagnosed with LCAI underwent MBO. They were divided into the ARE group (n=15) and the control group (CON, n=15). The ARE group performed early ARE exercises six times per week for 4 weeks. The parameters applied to test ankle muscle strength were angular speed of 30°/sec and 180°/sec (inversion: Inv. and eversion: Eve., respectively). Proprioception was measured as being able to sense a joint position of 15° of Inv. and 5° of Eve. Results: Significant differences were observed between the ARE and CON groups in ankle strength 30°/sec (Inv.: p<0.001, Eve.: p<0.001), 180°/sec (Inv.: p<0.001, Eve.: p<0.001), and proprioception at 15° (Inv.: p<0.001) and 5° (Eve.: p<0.001). Conclusions: We recorded significant short-term effects from early ARE in Taekwondo athletes with LCAI after MBO. The results provide reference data for the sports rehabilitator or ATC in evaluating the rehabilitation phase and informing patients about expectations after MBO in terms of performance status and the timing of return to sports. Level of evidence III; Therapeutic studies–Investigation of treatment outcomes - Case-control Study.
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