Arthroscopic ankle lateral ligament repair with biological augmentation gives excellent results in case of chronic ankle instability

2019 ◽  
Vol 28 (1) ◽  
pp. 108-115 ◽  
Author(s):  
Guillaume Cordier ◽  
Johan Lebecque ◽  
Jordi Vega ◽  
Miki Dalmau-Pastor
Keyword(s):  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Lateral Ligament ◽  
Ligament Repair ◽  
Ankle Lateral Ligament ◽  
Biological Augmentation

scholarly journals Arthroscopic Lateral Ligament Repair Through Two Portals in Chronic Ankle Instability

2017 ◽  
Vol 11 (1) ◽  
pp. 617-632 ◽  
Author(s):  
Jorge Pablo Batista ◽  
Jorge Javier del Vecchio ◽  
Luciano Patthauer ◽  
Manuel Ocampo
Keyword(s):  
Ankle Instability ◽  
Medical Condition ◽  
Surgical Techniques ◽  
Clinical Success Rate ◽  
Chronic Ankle Instability ◽  
Tilt Test ◽  
Lateral Ligament ◽  
Return To Sports ◽  
Ligament Repair

Objectives:Injury to the lateral ligament complex of the ankle is one of the most common sports-related injury.Usually lateral ankle evolves with excellent clinical recovery with non surgical treatment, however, near about 30% develop a lateral chronic instability sequela.Several open and arthroscopic surgical techniques have been described to treat this medical condition.Material and Methods:Of the 22 patients who were treated; 18 males and 4 females, and aged from 17-42 years (mean 28 years).All patients presented a history of more than three ankle sprains in the last two years and presented positive anterior drawer and talar tilt test of the ankle in the physical examination.We perform an anterior arthroscopy of the ankle in order to treat asociated disease and then we performed“All inside¨lateral ligament repair through two portals (anteromedial and anterolateral) using an anchor knotless suture.Results:Clinical outcome evaluations were performed at a mean follow up of 25 months. (R: 17-31).Overall results has been shown by means of the American Orthopaedic Foot and Ankle Society (AOFAS). Mean AOFAS scores improved from 63 points (range 52–77) preoperatively to 90 points (range 73–100) at final follow up.No recurrences of ankle instability were found in the cases presented.Conclusion:Several surgical procedures have been described during the last years in order to treat chronic ankle instability.¨All inside¨lateral ligament reconstruction presents lower local morbidity than open procedures with few complications. Moreover, it is a reproductible technique, with high clinical success rate, few complications and relatively quick return to sports activities. A high knowledge of the anatomic landmarks should be essential to avoid unwated injuries.

Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: A systematic review

2018 ◽  
Vol 24 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Matteo Guelfi ◽  
Marco Zamperetti ◽  
Andrea Pantalone ◽  
Federico G. Usuelli ◽  
Vincenzo Salini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Lateral Ligament ◽  
Ligament Repair

Biomechanics Following Anatomic Lateral Ligament Repair of Chronic Ankle Instability: A Systematic Review

2020 ◽  
Author(s):  
Elaheh Ziaei Ziabari ◽  
Bart Lubberts ◽  
Daniel Chiou ◽  
Mohammad Razi ◽  
Mohammad Haghpanahi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Lateral Ligament ◽  
Ligament Repair

Fair evidence consistently supports open surgical treatment for chronic ankle instability: a systematic review

2019 ◽  
Vol 4 (5) ◽  
pp. 254-269
Author(s):  
Chad Alexander Purcell ◽  
James Calder ◽  
Kentaro Matsui ◽  
Pontus Andersson ◽  
Jón Karlsson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ankle Instability ◽  
Chronic Ankle Instability ◽  
Systematic Evaluation ◽  
Anatomical Reconstruction ◽  
Lateral Ligament ◽  
Anterior Talofibular Ligament ◽  
Reconstruction Technique ◽  
Operative Techniques ◽  
Level Of Evidence

ImportancePatients with chronic ankle instability (CAI) who have failed non-operative treatments are most commonly treated with open ankle repair or reconstruction of the anterior talofibular ligament and/or calcaneofibular ligament. Over 50 operative techniques have been described for the treatment of CAI. However, there is no current systematic evaluation of currently used open operative techniques for the treatment of CAI.Aim/ObjectiveThe primary objective of this study is to provide evidence-based treatment recommendations for CAI in adults based on a comprehensive systematic review of the literature.Evidence reviewThe literature review of PubMed, EMBASE, Cochrane and Web of Science databases was completed on 22 February 2017. Search terms included two concepts: lateral ligament of the ankle (patients) and open reconstructive or repair procedures (intervention). All published clinical studies with English translation were included. Biomechanical, cadaveric, review articles, minimally invasive procedures and arthroscopic procedures were excluded. Open operative procedures from included articles were classified as anatomical or non-anatomical and repair or reconstructive. Articles were then assigned a level of evidence (I-V) to denote quality of the research methods. Articles were reviewed collectively to provide a grade of recommendation (A-C or I) in support for or against the operative intervention in treatment of CAI.FindingsSeventy one of 1635 identified articles were included for review. There is fair evidence (Grade B) in support of anatomical repair, anatomical reconstruction and non-anatomical reconstruction procedures. There was insufficient evidence available to grade internal brace and non-anatomical repair procedures.Conclusions and relevanceAlthough only fair-quality evidence exists in support of open operative treatment of CAI, this systematic review helps reassure clinicians of their current practices. The literature reaffirms support for open anatomical repair and anatomical reconstruction technique for CAI.Level of evidenceLevel II, systematic review.

scholarly journals Location and Morphology of Acute Lateral Ligament Injury of the Ankle

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0031
Author(s):  
Hideo Noguchi
Keyword(s):  
Ankle Instability ◽  
Surgical Reconstruction ◽  
Ligament Injury ◽  
Lateral Ligament ◽  
Ligament Injuries ◽  
Ligament Repair ◽  
Reconstruction Procedure ◽  
Side Body ◽  
Lateral Ligament Injury ◽  
Almost All

Category: Ankle, Sports, Trauma Introduction/Purpose: Acute ankle ligament injuries are usually treated non-operatively, even if the injury is severe. However, when chronic ankle instability is symptomatic, operative treatment is required. When planning local repair, the condition of the remaining ligament is important. We surgically treated acute severe lateral ligament injuries in 103 ankles and investigated the locations of the injuries in the anterior talofibular (ATF) and calcaneofibular (CF) ligaments, subdividing each into three parts. This paper should facilitate more precise planning of the surgical reconstruction procedure. Methods: From 2006 to 2014, 1,042 patients visited our outpatient clinic with a diagnosis of acute lateral ligament injury of the ankle. In total, 103 feet underwent surgical treatment and the locations of the ATF and CF ligament ruptures were investigated. The rupture location in the ATF ligament was subclassified as fibular side, body, or talar side, while for the CF ligament it was classified as fibular side, body, or calcaneal side. Results: The ATF ligament was ruptured on the fibular side in 38 feet (36.9%), body in 30 feet (29.1%), and talar side in 35 feet (34.0%). The CF ligament was ruptured on the fibular side in 15 feet (14.6%), body in 26 feet (25.2%), and calcaneal side in 62 feet (60.2%). Conclusion: Almost all surgical reports on lateral ligament reconstruction procedures (Brostrom et al.) describe ATF ligament repair and advancement on the fibular side, although only one-third of the ligaments were injured on the fibular side in our series. About two-thirds of the CF ligaments had damage to the calcaneal side structure of the entheses. When CF ligament repair is needed, surgeons should be aware of our finding that this ligament was ruptured at the fibular attachment in only 15% of cases, and on the calcaneal side in 60%. This knowledge should lead to better results of surgical reconstruction.

scholarly journals Cost Comparison of Suture Anchor Modified Broström Repair and Augmentation of the Modified Broström with FiberTape Device

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0047
Author(s):  
Emily Vannatta ◽  
Chris M. Stauch ◽  
Jesse King ◽  
Morgan S. Kim ◽  
Laura R. Luick ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Return To Work ◽  
Ankle Instability ◽  
Group Versus ◽  
Cost Savings ◽  
Chronic Ankle Instability ◽  
Cost Comparison ◽  
Suture Anchors ◽  
Ligament Repair ◽  
The Cost

Category: Ankle; Sports Introduction/Purpose: Augmentation of the Broström procedure with FiberTape device has been described for the treatment of chronic ankle instability. However, it has yet to be determined if the cost of the implant is negated by the benefits to the patient. The purpose of this study was to perform a comprehensive cost analysis by comparing the cost of surgical procedure, physical therapy visits, time off work, and any costs related to revision surgery between the Broström reconstruction with suture anchors alone versus augmentation with a FiberTape device. Methods: 166 patients undergoing lateral ankle ligament repair were analyzed retrospectively. Patients underwent either a modified Broström ligament repair with two suture anchors or Broström ligament repair with FiberTape augmentation. All patients followed the same post-operative protocol for early weight bearing and initiation of physical therapy once the wound was healed. Timing of return to work and the total number of visits of physical therapy before discharge were recorded. Implant costs, facility charges and professional fees were obtained from billing records. Lost income for missed days of work was based on the Pennsylvania Bureau of Labor Statistics. Complications requiring return to the operating room were recorded. Patients were followed out to one year. Results: Aggregate cost in the modified Broström group was $2,219 more expensive than when augmenting with FiberTape ($20,970 vs. $18,751) despite an increased implant cost of $900. This difference was the result of a greater number of therapy visits and days out of work in the modified Broström group versus the augmentation group (14.9 vs 12.4) as well as a significantly higher amount of days out of work in the modified Broström group versus augmentation (63.3 vs. 53.8 days respectively). No statistically significant difference was found for operation time between groups, and failure rates were similar; 2.0% (1/49) for FiberTape and 3.4% (4/117) for modified Broström. Conclusion: The aim of this study was to explore the cost comparison of the modified Broström procedure for chronic ankle instability versus the FiberTape augmentation. Despite an upfront increase in implant costs, the average cost per procedure was lower for the augmentation group. The majority of cost savings occurred in decreases in the number of physical therapy visits and faster return to work times. The results of this study suggest that the use of FiberTape to augment modified Broström repair may have a financial benefit and cost savings to patients and the healthcare system.

Arthroscopic Findings in Patients with Chronic Ankle Instability

2002 ◽  
Vol 30 (3) ◽  
pp. 402-409 ◽  
Author(s):  
Beat Hintermann ◽  
Andreas Boss ◽  
Dirk Schäfer
Keyword(s):  
Structural Changes ◽  
Ankle Instability ◽  
Cartilage Damage ◽  
Case Series ◽  
Chronic Ankle Instability ◽  
Ankle Arthroscopy ◽  
Lateral Ligament ◽  
Deltoid Ligament ◽  
Anterior Talofibular Ligament ◽  
Ligament Injuries

Background There are little objective data on structural changes of the chronically unstable ankle. Such knowledge could help with preoperative planning. Hypothesis Preoperative ankle arthroscopy provides important insights into the causes and mechanisms of ankle instability and the resulting disability. Study Design Case series. Methods From 1993 to 1999, arthroscopic examination was performed in the ankles of 148 patients with symptomatic chronic ankle instability that had lasted 6 months or more. All structural changes were recorded and compared with the clinical diagnosis. Results A rupture or elongation of the anterior talofibular ligament was noted in 86% of ankles, of the calcaneofibular ligament in 64%, and of the deltoid ligament in 40%. Cartilage damage was noted in 66% of ankles with lateral ligament injuries, whereas 98% of the ankles with deltoid ligament injuries had cartilage damage. Although lateral instability could be verified arthroscopically in 127 patients, medial instability was presumed clinically in 38 patients but was actually detected in 54 patients arthroscopically. Conclusion Preoperative ankle arthroscopy revealed an essential amount of information that would otherwise have been undetected. For instance, the ligaments showed typical abnormalities corresponding to different entities of ankle instability and different intra-articular pathologic conditions.

scholarly journals There is No Difference in Post-operative Complication Rates between Single and Multiple Incision Approaches to Lateral Ligament Repair for Chronic Ankle Instability

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Ashish Shah ◽  
Brent Cone ◽  
Cesar de Cesar Netto ◽  
Ibukunoluwa Araoye ◽  
Parke Hudson ◽  
...  
Keyword(s):  
Single Incision ◽  
Ankle Instability ◽  
Demographic Data ◽  
Lateral Ligament ◽  
Complication Rates ◽  
Ligament Repair ◽  
Ankle Ligaments ◽  
Lateral Ankle ◽  
Significant Difference ◽  
Lateral Ankle Ligaments

Category: Ankle Introduction/Purpose: Ankle sprains are common orthopaedic injuries. Some patients may develop chronic instability, requiring ligament reconstruction surgery. While laxity of the lateral ankle ligaments most commonly contributes to ankle instability, there may be other associated factors such as peroneal pathology or misalignment of the hindfoot that must be addressed. Classically, a small curvilinear incision is made to access the lateral ankle ligaments, and separate incisions are made to address the peroneals, or to perform a calcaneal osteotomy if needed. A more recent method involves making a single longitudinal incision that allows access the lateral ankle ligaments, the peroneals and calcaneus without the need for further incisions. This study evaluates the post-operative complication rates between the single and multiple incision approach for patients undergoing lateral ligament repair. Methods: This is a retrospective review of patients who underwent ligament reconstruction for lateral ankle instability from 2011 to 2015. A total of 231 patient records were reviewed. Records with insufficient data, patients with history of prior ligament repair and insufficient follow-up (< 1 year) were excluded. A total of 187 patients met inclusion criteria. Complications including chronic pain, sural neuritis, and skin infections were recorded during the follow up period. Demographic data and complication rates between the two groups were compared using chi-squared test. Results: Of the 187 patients, 160 were in the single incision group and 27 in the multiple incision group. Women comprised 69.0 (90/148) percent of the total patient population. There was no significant difference in demographic data between the two groups. There was also no significant difference in the rate of complications between the single incision and multiple incision groups (p= 0.808). The single incision group had a complication rate of 24% (39/160), while the multiple incision group had a complication rate of 22% (6/27). The most frequent complication in both groups was sural neuritis with it comprising 31% (12/39) and 50% (3/6) of the complications in the single and multiple incision groups respectively. Conclusion: Performing a single longitudinal incision for lateral ligament repair, as well as access to the peroneal tendons and calcaneus does not have increased rates of post-operative complications compared to a multiple incision approach. A longitudinal single incision may be performed without concern for increased rates of post-operative complications in lateral ligament repair surgery for chronic ankle instability.

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