123 results on '"Lateral ankle ligaments"'
Search Results
2. Analysis of a Chronic Lateral Ankle Instability Model in the Rat: Conclusions and Suggestions for Future Research.
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Saliba, Ibrahim, Bachy-Razzouk, Manon, Bensidhoum, Morad, Hoc, Thierry, Potier, Esther, Vialle, Raphaël, and Hardy, Alexandre
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LABORATORY rats , *X-ray computed microtomography , *ANIMAL sacrifice , *TIBIA , *ANIMAL disease models , *ANKLE - Abstract
The purpose of this study was to evaluate potential osteoarthritic alterations within the ankle using a surgically-induced chronic lateral ankle instability (CLAI) model. Twelve rats were assigned randomly to either the control (n = 4) or CLAI group (n = 8). Surgery was performed on the right ankle. Osteoarthritis was assessed through in-vivo micro-CT at 8 weeks and a clinical analysis. Macroscopic analysis, high-resolution ex-vivo micro-CT and histological examination were conducted after euthanasia at 12 weeks. Three subgroups (SG) were analyzed. SG1 comprised the operated ankles of the CLAI group (n = 8). SG2 consisted of the non-operated ankles of the CLAI group (n = 8). SG3 included both sides of the control group (n = 8). In-vivo micro-CT revealed no significant differences among the three subgroups when analyzed together (p = 0.42), and when comparing SG1 with SG2 (p = 0.23) and SG3 (p = 0.43) individually. No noticeable clinical differences were observed. After euthanasia, macroscopic analysis employing OARSI score, did not demonstrate significant differences, except between the medial tibia of SG1 and SG3 (p = 0.03), and in the total score comparison between these two subgroups (p = 0.015). Ex-vivo micro-CT did not reveal any differences between the three subgroups regarding bony irregularities and BV/TV measurements (SG1 vs. SG2 vs. SG3: p = 0.72; SG1 vs. SG2: p = 0.80; SG1 vs. SG3: p = 0.72). Finally, there was no difference between the three subgroups regarding OARSI histologic score (p = 0.27). These findings indicate that the current model failed to induce significant osteoarthritis. However, they lay the groundwork for improving the model's effectiveness and expanding its use in CLAI research, aiming to enhance understanding of this pathology and reduce unnecessary animal sacrifice. [ABSTRACT FROM AUTHOR] more...
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- 2024
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Catalog
3. Anatomic and Biomechanical Characteristics of the Ankle Joint
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Hintermann, Beat, Ruiz, Roxa, Hintermann, Beat, and Ruiz, Roxa
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- 2024
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4. Arthroscopic Modified Lasso-Loop Stitch Technique for Chronic Lateral Ankle Instability in Skeletally Immature vs Mature Patients.
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Takao, Masato, Jujo, Yasuyuki, Iwashita, Kosui, Inagawa, Miyu, Chua, Erika Nicole, Lee, Keong Joo, Watanabe, Takashi, and Shimozono, Yoshiharu
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Background: In recent years, arthroscopic lateral ankle ligament repair has become increasingly popular. However, reports on the clinical outcomes of arthroscopic ankle stabilization for skeletally immature patients remain scarce. This study investigated the clinical outcomes of arthroscopic lateral ankle ligaments repair in skeletally immature patients compared to skeletally mature patients. Methods: Our retrospective analysis compared skeletally immature patients and skeletally mature adults who underwent arthroscopic repair of the ankle lateral ligaments with a modified lasso-loop stitch using a suture anchor. Skeletal immaturity was defined as patients whose epiphyseal line of the distal fibula remained open on plain radiography. Clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) at 2 years after surgery. The time to postoperative walking, jogging, and return to full sports activities were also evaluated. Results: Sixty-four skeletally immature patients (IM group) and 103 skeletally mature adults (M group) were included. No significant differences were observed during both walking and jogging after surgery between the groups; however, return to full athletic activities was significantly earlier in IM group (P =.05). The mean scores in all SAFE-Q subscales significantly improved in both groups after surgery (P <.001). There were also no statistically significant differences between the groups in the mean postoperative SAFE-Q scores for all subscales. All patients in the IM group returned to playing sports at their preinjury levels postoperatively. Conclusion: We found that skeletally immature patients with chronic lateral ankle instability had generally similar responses to arthroscopic lateral ankle as skeletally mature adult patients at minimally 2 years' follow-up with a high rate of successful return to sport. Level of Evidence: Level III, retrospective case control study. [ABSTRACT FROM AUTHOR] more...
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- 2024
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5. Comparison of Direct Repair Versus Anatomic Graft Reconstruction of the Anterior Talofibular Ligament: A Biomechanical Cadaveric Study.
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Mellado-Romero, María Ángela, Guerra-Pinto, Francisco, Ojeda-Thies, Cristina, Arroyo-Hernández, Marta, Abarquero-Diezhandino, Ana, Ramos-Pascua, Luis, and Vilá-Rico, Jesús
- Abstract
The goal of our study is to compare the stability of the anatomic reconstruction of the anterior talofibular ligament (ATFL) with direct repair of the ATFL, in a cadaver model. We performed the following techniques in 18 cadaveric ankles: the intact ATFL was cut, after which a direct repair using 2 anchors was performed. The repair was sectioned, and anatomic reconstruction was then performed with a tendon autograft. We measured angular displacement in 3 anatomic planes (axial, coronal, sagittal) for each situation in response to the anterior drawer test (ADT), talar tilt test (TTT) and pivot test (PT), using a specifically constructed arthrometer. The sectioned ATFL was inferior to the intact ATFL in the axial plane with the ADT (p =.012), in the axial plane with the PT (p =.001) and in the axial and coronal planes with the TTT (p =.013 and p =.016, respectively). Direct anatomic repair was inferior to the intact ATFL in the axial plane upon the PT (p =.009). No differences could be found between anatomic graft reconstructions and the intact ATFL with any manoeuver, nor when comparing anatomic graft reconstruction and direct repair with 2 anchors. We were able to conclude that anatomic graft reconstruction of the ATFL reproduces angular stability of the native ligament in a cadaver model. While we could not detect if anatomic graft reconstruction was superior to direct repair, the latter proved to be less stable in the axial plane upon internal rotation (pivot test) versus the intact ATFL. [ABSTRACT FROM AUTHOR] more...
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- 2024
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6. Lateral Ankle Instability: Rehab and Return to Sport
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Neville, Christopher, Haggerty, Erin, Park, Jeannie, Carrier, Robert, Giza, Eric, D’Hooghe, Pieter, editor, Hunt, Kenneth J., editor, and McCormick, Jeremy J., editor
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- 2022
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7. Unique Perspective of Care of the Elite Athlete
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Marais, C de V., Calder, J. D. F., McCollum, G. A., Pereira, Hélder, editor, Guillo, Stéphane, editor, Glazebrook, Mark, editor, Takao, Masato, editor, Calder, James, editor, Van Dijk, Niek, editor, and Karlsson, Jón, editor more...
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- 2021
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8. Fluoroscopic Evaluation of the Role of Syndesmotic Injury in Lateral Ankle Instability in a Cadaver Model.
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Bhimani, Rohan, Sato, Go, Saengsin, Jirawat, Lubberts, Bart, Waryasz, Gregory, DiGiovanni, Christopher W., and Guss, Daniel
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Background: There is a high prevalence of concomitant lateral ankle ligament injuries and syndesmotic ligamentous injuries. However, it is unclear whether syndesmotic ligaments directly contribute toward the stability of the lateral ankle. Therefore, the aim of this study was to fluoroscopically evaluate the role of the syndesmotic ligaments in stabilizing the lateral ankle. Methods: Twenty-four cadaveric specimens were divided into 3 groups and fluoroscopically evaluated for lateral ankle stability with all syndesmotic and ankle ligaments intact and then following serial differential ligamentous transection. Group 1: (1) anterior talofibular ligament (ATFL), (2) calcaneofibular ligament (CFL), and (3) posterior talofibular ligament (PTFL). Group 2: (1) anterior inferior tibiofibular ligament (AITFL), (2) interosseous ligament (IOL), (3) posterior inferior tibiofibular ligament (PITFL), (4) ATFL, (5) CFL, and (6) PTFL. Group 3: (1) AITFL, (2) ATFL, (3) CFL, (4) IOL, (5) PTFL, and (6) PITFL. At each transection state, 3 loading conditions were used: (1) anterior drawer test performed using 50 and 80 N of direct force, (2) talar tilt <1.7 Nm torque, and (2) lateral clear space (LCS) <1.7 Nm torque. These measurements were in turn compared with those of the stressed intact ligamentous state. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state. A P value <.05 was considered statistically significant. Results: The lateral ankle remained stable after transection of all syndesmotic ligaments (AITFL, IOL, PITFL). However, after additional transection of the ATFL, the lateral ankle became unstable in varus and anterior drawer testing conditions (P values ranging from.036 to.012). Lateral ankle instability was also observed after transection of the ATFL and AITFL in varus and anterior drawer testing conditions (P values ranging from.036 to.012). Subsequent transection of the CFL and PTFL worsened the lateral ankle instability. Conclusion: Our findings suggest that isolated syndesmosis disruption does not result in lateral ankle instability. However, the lateral ankle became unstable when the syndesmosis was injured along with ATFL disruption. Clinical Relevance: When combined with ATFL release, disruption of the syndesmosis appeared to destabilize the lateral ankle. [ABSTRACT FROM AUTHOR] more...
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- 2022
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9. Mini-Incision Technique for Lateral Ankle Ligament Repair in Chronic Instability
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Canata, Gian Luigi, Casale, Valentina, Pulici, Luca, Canata, Gian Luigi, editor, d'Hooghe, Pieter, editor, Hunt, Kenneth J., editor, Kerkhoffs, Gino M.M.J., editor, and Longo, Umile Giuseppe, editor
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- 2019
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10. The anatomy of the anterior inferior tibiofibular ligament and its relationship with the Wagstaffe fracture.
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Fisher, Andrew, Bond, Alistair, Philpott, Matthew D.G., Jayatilaka, Malwattage Lara Tania, Lambert, Laura-Ann, Fisher, Lauren, Weigelt, Lizzy, Myatt, Darren, Molloy, Andrew, and Mason, Lyndon
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ANKLE fractures , *LIGAMENTS , *FRACTURE fixation , *FIBULA , *MEDICAL cadavers , *LIGAMENT injuries , *ANKLE , *ANKLE injuries , *TIBIA , *COMPUTED tomography , *JOINT hypermobility , *DEAD , *LONGITUDINAL method - Abstract
Background: Our aim in this study was to identify the fibular footprint of the Anterior Inferior Tibiofibular Ligament (AITFL) and its relation to Wagstaffe fracture fragment size.>Methods: We examined 25 cadaveric lower limbs which were carefully dissected to identify the lateral ankle ligaments. The AITFL anatomy was compared to 40 Wagstaffe fractures identified from our ankle fracture database. Results: The AITFL origin was from the anterior fibular tubercle with an average length of 21.61 mm (95% CI 20.22, 22.99). The average distance of the distal aspect of the AITFL footprint to the distal fibula margin was 11.60 mm (95% CI 10.49, 12.71). In the ankle fractures analyzed, the average length of the Wagstaffe fragment was 17.88 mm (95% CI 16.21, 19.54). The average distance from the distal tip of the fibula to the Wagstaffe fracture fragment was 21.40 mm (95% CI 19.78, 23.01). In total there were 22 syndesmosis injuries. There was no statistical difference in Wagstaffe fragment size between stable and unstable groups.Conclusion: The AITFL fibular origin was both larger and more distal than the Wagstaffe fracture fragments seen in our institution. Therefore, this suggests that a ligamentous failure will also have to occur to result in syndesmotic instability. The size of fracture fragment also did not confer to syndesmotic instability on testing. Level of Evidence - 3. [ABSTRACT FROM AUTHOR] more...- Published
- 2021
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11. Anterior talofibular ligament (ATFL) repair using two suture anchors produced better functional outcomes than using one suture anchor for the treatment of chronic lateral ankle instability.
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Li, Hong, Hua, Yinghui, Li, Hongyun, and Chen, Shiyi
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ANKLE injuries , *LIGAMENT injuries , *JOINT hypermobility , *ARTHROSCOPY , *MAGNETIC resonance imaging - Abstract
Purpose: To compare the function and activity level after one-anchor repair versus two-anchor repair of the anterior talofibular ligament (ATFL) in patients with chronic lateral ankle instability.Methods: All patients who underwent arthroscopic surgical ATFL repair using suture anchors were included in this study. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (Karlsson score) and Tegner activity score were used to evaluate ankle function at a follow-up of a minimum of 2 years. A magnetic resonance imaging (MRI) scan was performed to evaluate the repaired ATFL.Results: A total of 51 patients with chronic ankle instability were included in this study. Among them, 20 patients accepted a one-anchor repair procedure (one-anchor group), and the other 31 patients accepted a two-anchor repair procedure (two-anchor group). At the final follow-up, there was no significant difference in the AOFAS score between the one-anchor group and the two-anchor group (90 ± 9 vs 91 ± 10; ns). However, the mean Karlsson score of the two-anchor group (88 ± 12) was significantly higher than that of the one-anchor group (80 ± 14) (p = 0.04). There was a significant difference in activity level as measured by the Tegner activity score (5 ± 1 vs 4 ± 1; p < 0.001) between the two-anchor group and the one-anchor group after surgery. Patients in the two-anchor group (68%) had a significantly higher percentage of sport participation compared to those in the one-anchor group (30%) (p = 0.01).Conclusion: Compared with a one-anchor repair, a two-anchor repair of the lateral ankle ligament produced better functional outcomes. Arthroscopic ATFL repair with two anchors provided a minimally invasive technique with a higher rate of return to sports than repair with one anchor. The present study showed its clinical relevance by maintaining the advantage of ATFL repair using two anchors regarding the clinical function.Level Of Evidence: III. [ABSTRACT FROM AUTHOR] more...- Published
- 2020
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12. Lateral ankle ligament anatomic reconstruction for chronic ankle instability: Allograft or autograft? A systematic review.
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Brambilla, L., Bianchi, A., Malerba, F., Loppini, M., and Martinelli, N.
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AUTOGRAFTS , *HOMOGRAFTS , *EXERCISE , *MUSCLE strength , *ORTHOPEDICS , *ANKLE surgery , *LIGAMENT surgery , *CHRONIC diseases , *SYSTEMATIC reviews , *PATIENT satisfaction , *ANKLE , *ANKLE injuries , *JOINT hypermobility - Abstract
Background: To investigate if there is any evidence in favour of autograft or allograft use for anatomic reconstruction of lateral ankle ligaments in patients with symptomatic chronic ankle instability.Methods: A literature search was performed in PubMed MEDLINE, Cochrane Library, EMBASE and Google Scholar databases, over the years 1994-2017, to identify the studies presenting clinical results of anatomic lateral ankle ligaments reconstruction using various combinations of the keywords "lateral ankle ligaments reconstruction", "anatomic reconstruction", "chronic ankle instability", "allograft", "autograft". The surgical procedure was considered anatomic if consistent with the description of lateral ankle ligaments made by Burks and Morgan in 1994.Results: Among the 89 papers matching the search terms, only 12 could be included in which 357 anatomic lateral ankle ligaments reconstructions were performed. One was a comparative case series (level of evidence III - LOE III) while other papers were retrospective case series (LOE IV), the mean Modified Coleman Methodology Score (MCMS) was fair: 56.7 (SD±5.2). Due to the low level of evidence of the available literature only a qualitative analysis was performed. The limited evidence from the studies analysed suggests that there is no difference in graft survivorship, graft-dependent variables, patient's satisfaction, clinical outcome measures and radiographic results between allograft and autograft.Conclusions: Given the low number of studies, their poor methodology score and their low level of evidence it is not possible to determine if allograft is better or safer than autograft.Level Of Evidence: Level IV, review paper of level III and level IV studies. [ABSTRACT FROM AUTHOR] more...- Published
- 2020
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13. Modified arthroscopic Broström procedure using a soft anchor for chronic lateral ankle instability: Short-term follow-up results
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Bertan Cengiz and Ramin Moradi
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Adult ,Joint Instability ,Male ,medicine.medical_specialty ,Lateral ankle ,Visual analogue scale ,medicine.medical_treatment ,Follow up results ,Broström procedure ,Arthroscopy ,Young Adult ,lateral ankle ligaments ,medicine ,Humans ,Orthopedics and Sports Medicine ,arthroscopic reconstruction ,Retrospective Studies ,soft anchor ,business.industry ,Rehabilitation ,Ankle instability ,Surgery ,medicine.anatomical_structure ,Chronic ankle instability ,Ligament ,Original Article ,Female ,Ankle ,Complication ,business ,Follow-Up Studies - Abstract
Objectives This study aims to examine the clinical outcomes and complications of lateral ligament reconstruction performed using soft anchors according to the arthroscopic modified Brostrom technique (MBT) for the treatment of chronic ankle instability (CAI) and to evaluate the frequency of return to sports. Patients and methods A total of 14 patients with CAI (9 males, 5 females; mean age: 30.1±4.6 years; range, 22 to 38 years) who underwent the MBT with soft anchors between January 2015 and December 2019 were retrospectively analyzed. Ankle function was evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale and Karlsson Ankle Function Score (Karlsson/Peterson, K/D score), while pain was evaluated using the Visual Analog Scale (VAS) after a minimum follow-up of 12 months. Results The mean follow-up was 23.6±7.7 months. The mean overall AOFAS score was 74.0±2.6 preoperatively, which improved to 96.2±1.9 in the postoperative period (p=0.001). The mean pre- and postoperative K/P scores were 72.4±3.1 (range, 68 to 78) and 95.3±2.2 (range, 92 to 98), respectively (p=0.001). The mean preoperative VAS score was 2.4±0.9 (range, 1 to 4) and showed a significant improvement to 0.6±0.5 (range, 0 to 1) in the postoperative period (p=0.001). Nine (64.3%) patients returned to sports activities after surgery at a mean period of 9±2.1 months. Conclusion In the treatment of CAI, arthroscopic MBT performed with soft anchors provides successful outcomes in short-term follow-up. In addition to being a minimally invasive technique, MBT is a reliable and safe approach with low complication rates and significant functional improvement. However, the low ratio of return to sports should be considered as a failure of this technique. more...
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- 2021
14. Activity Level and Function 2 Years After Anterior Talofibular Ligament Repair: A Comparison Between Arthroscopic Repair and Open Repair Procedures.
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Li, Hong, Hua, Yinghui, Li, Hongyun, Ma, Kui, Li, Shengkun, and Chen, Shiyi
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ANKLE surgery , *LIGAMENT surgery , *ARTHROSCOPY , *CHI-squared test , *COMPARATIVE studies , *JOINT hypermobility , *LONGITUDINAL method , *MAGNETIC resonance imaging , *PATIENTS , *PHYSICAL diagnosis , *PROBABILITY theory , *RESEARCH funding , *STATISTICS , *SURGERY , *T-test (Statistics) , *TIME , *STATISTICAL power analysis , *DATA analysis , *BODY mass index , *TREATMENT effectiveness , *PHYSICAL activity , *DATA analysis software , *FUNCTIONAL assessment , *DESCRIPTIVE statistics , *MANN Whitney U Test , *INTRACLASS correlation ,RESEARCH evaluation - Abstract
Background: The open modified Broström anatomic repair technique is widely accepted as the reference standard for lateral ankle stabilization. Despite recent increases in publications regarding arthroscopic repair of the anterior talofibular ligament (ATFL) for treatment of chronic ankle instability, research is lacking that compares the functional outcomes between arthroscopic repair and open repair procedures for chronic ankle instability. Purpose: To compare function and activity level after arthroscopic repair versus open repair of the ATFL in patients with lateral ankle instability. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent arthroscopic or open surgical Broström repair of the ATFL between January 2012 and August 2014 were invited to participate in this study. All of the patients had consented for arthroscopic repair if feasible. In cases in which arthroscopic repair was impossible, the open modified Broström procedure was performed after arthroscopy. Patients accepted a systematic rehabilitation program postoperatively. American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner activity score were used to evaluate ankle function preoperatively and at a minimum follow-up of 2 years. Magnetic resonance imaging (MRI) was performed to evaluate the signal to noise ratio (SNR) of the repaired ATFL. Results: A total of 60 patients were included in this study. They were assigned to 1 of 2 groups according to their surgical procedure: 23 patients underwent arthroscopic repair (arthroscopic group) and 37 patients underwent open repair (open group). No patient in either group had ankle instability at follow-up postoperatively. After surgery, the AOFAS score (P < .001), KAFS (P < .001), and Tegner activity score (P < .001) increased significantly in both groups. However, no significant difference was found in AOFAS score (93.3 ± 8.9 vs 92.4 ± 8.6; P = .7), KAFS (90.3 ± 12.5 vs 89.4 ± 10.6; P = .75), and Tegner score (5 ± 2 vs 5 ± 2; P = .61) between the arthroscopic group and the open group, respectively. As well, no significant difference was found in the mean SNR value of ATFL between the arthroscopic group and the open group (9.1 ± 2.7 vs 8.8 ± 2.3; P = .39, respectively). Conclusion: When compared with open lateral ankle repair, arthroscopic repair of lateral ankle ligament when feasible produced similarly favorable outcomes. Arthroscopic ATFL repair, as a minimally invasive technique, provided favorable outcomes. [ABSTRACT FROM AUTHOR] more...
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- 2017
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15. Die laterale OSG Instabilität- Wann und Wie operieren?
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Plaass, Christian, Claassen, Leif, Ettinger, Sarah, Yao, Daiwei, Lerch, Matthias, and Stukenborg-Colsman, Christina
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Zusammenfassung Bandverletzungen des Sprunggelenkes sind eine der häufigsten Unfallfolgen. In der Mehrzahl der Fälle ist der laterale Bandapparat betroffen. Die funktionelle konservative Therapie ist ohne Begleitverletzungen die Behandlungsmethode der Wahl. Dennoch haben 10-30% der Patienten Restbeschwerden und – instabilitäten. Mechanische Instabilitäten sollten operativ behandelt werden. Die anatomische Bandnaht ist hierbei initial Methode der Wahl und hat gute Ergebnisse. Augmentationen mit ortsständigen Gewebe, Allografts oder Fremdmaterial können sinnvoll sein, bzw. nötig werden bei einer globalen Instabilität des Rückfusses. Arthroskopische Techniken entwickeln sich zunehmend, konnten aber noch keine Überlegenheit bei der Behandlung zeigen. Abstract Ligamentous injuries of the ankle joint are one of the most common injuries. Mostly the lateral ligament complex is injured. A conservative functional therapy is initial recommended in most patients. Despite the generally good results 10 to 30% have residual symptoms after a sprain and often show a chronic ankle instability. Ligamentous instabilities should be treated operatively. The anatomic primary reconstruction of the ligaments with local tissue, possibly with augmentation with local tissues, allografts or suture tapes might be indicated in selected cases. Arthroscopic techniques for chronic ankle instability are still evolving but did not show superiority to open techniques, yet. [ABSTRACT FROM AUTHOR] more...
- Published
- 2018
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16. Ultrasound Analysis of Lateral Ankle Ligaments in Functional Ankle Instability
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Susanne Rein, Thorben Sterling-Hauf, and Khosrow Siamak Houschyar
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Adult ,Joint Instability ,Male ,Acoustics and Ultrasonics ,Biophysics ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Clinical investigation ,Talar tilt ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Calcaneofibular ligament ,Ankle instability ,Ultrasonography ,Radiological and Ultrasound Technology ,business.industry ,Ultrasound ,Anterior talofibular ligament ,030229 sport sciences ,Anatomy ,Lateral ankle ligaments ,medicine.anatomical_structure ,Female ,Stress conditions ,Lateral Ligament, Ankle ,business ,Ankle Joint - Abstract
The anterior talofibular ligament and the calcaneofibular ligament were sonographically investigated in 16 patients with functional ankle instability (FAI) and 16 controls under neutral and standardized stress conditions of 15 kp with a TELOS device. Clinical investigation revealed a significantly higher rate of a positive anterior drawer and talar tilt (p0.001, respectively), significantly increased supination (p = 0.047) of the right ankle joint and increased plantarflexion (p = 0.009) of the left ankle joint in the FAI group compared with controls. Significantly higher rates of inhomogeneity and hypo-echogenicity were sonographically observed in both ligaments in the FAI group (p0.05, respectively). The anterior talofibular ligament was significantly longer under stress conditions, and the calcaneofibular ligament was significantly longer under both neutral and stress conditions in the FAI group (p0.05, respectively). Peritendinous edema of the peroneal tendons was found in 22% of the FAI group and 6% of controls. more...
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- 2020
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17. Varus talar tilt combined with an internal rotation pivot stress assesses the supination instability vector in lateral ankle ligaments’ injury — cadaver study
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Tiago Mota Gomes, Nuno Corte-Real, Francisco Guerra-Pinto, José Guimarães Consciência, Mark Glazebrook, and Xavier Martin Oliva
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Joint Instability ,Rupture ,Orthodontics ,Consensus ,business.industry ,Internal rotation ,Anterior talofibular ligament ,Supination ,Instability ,Talus ,Lateral ankle ligaments ,Tilt (optics) ,medicine.anatomical_structure ,Cadaver ,Talar tilt ,medicine ,Humans ,Orthopedics and Sports Medicine ,Calcaneofibular ligament ,Ankle Injuries ,Lateral Ligament, Ankle ,business ,Ankle Joint - Abstract
Background The lack of consensus on the relevance of the varus talar tilt test (VTTT) might be due to the divergence between the insufficiency vector of lateral ankle instability and the direction of this clinical test. Our hypothesis is that the VTTT is more accurate to diagnose lateral ankle ligaments rupture when it's applied with a pre-positioning of the foot in internal rotation (IR). Methods We compared, in 12 cadaver ankles, the varus opening during a classic VTTT with the same test starting in an IR pivot, using a new arthrometer. Results The classic VTTT caused a 13° tilt after ATFL section and 23,8° after ATFL and CFL section. The application of a VTTT with an IR prepositioning caused a 21,2° tilt after ATFL section (p = 0,002) and 29,5° after ATFL and CFL section (p = 0,006). Conclusion The VTTT is better to identify lateral ankle ligaments' insufficiency when it's applied with a pre-positioning of the foot in internal rotation. The resulting vector is similar to the supination trauma. more...
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- 2020
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18. Activity Level and Function After Lateral Ankle Ligament Repair Versus Reconstruction.
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Matheny, Lauren M., Johnson, Nicholas S., Liechti, Daniel J., and Clanton, Thomas O.
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LIGAMENTS , *HOMOGRAFTS , *ANKLE surgery , *PATIENT satisfaction , *QUESTIONNAIRES , *LIGAMENT surgery , *ACTIVITIES of daily living , *LONGITUDINAL method , *PLASTIC surgery , *TREATMENT effectiveness , *RETROSPECTIVE studies , *FUNCTIONAL assessment - Abstract
Background: Few studies have compared outcomes of Broström-Gould repair and allograft reconstruction. Hypothesis/Purpose: The purpose of this study was to compare outcomes and revision rates after Broström-Gould lateral ankle ligament repair versus anatomic allograft reconstruction in patients with lateral ankle instability. The hypothesis was that patients who underwent lateral ankle ligament repair would have outcomes and revision rates similar to those of patients who underwent anatomic allograft reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent surgical repair or reconstruction of the anterior talofibular ligament and/or the calcaneofibular ligament by a single surgeon between September 2009 and February 2013 were included in this study. Patients completed a subjective questionnaire at minimum 2 years after ankle surgery. Outcomes measures included the Foot and Ankle Disability Index (FADI), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Lysholm score, Western Ontario and McMaster Universities Arthritis Index (WOMAC), Short Form–12 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores, Tegner activity scale, and patient satisfaction with outcome. Detailed surgical data and intraoperative findings were documented at the time of surgery. All data were collected prospectively and reviewed retrospectively. Results: A total of 86 patients were included in this study: 45 men and 41 women (mean age, 38 years; range, 19-68 years) with a mean body mass index of 26.5 (range, 17.5-47.1). There were 61 (71%) patients in the repair cohort and 25 (29%) in the reconstruction cohort. There was no significant difference in age or sex between cohorts. Seventy-six (88%) patients had minimum 2-year follow-up (mean follow-up, 3.0 years; range, 2.0-5.3 years). There was no significant difference in FADI (87 vs 91; P = .553), AOFAS (77 vs 82; P = .372), Lysholm score (83 vs 87; P = .110), Tegner activity scale (6 vs 4; P = .271), patient satisfaction (9 vs 10; P = .058), WOMAC (8 vs 5; P = .264), or Short Form–12 PCS (51.3 vs 54.6; P = .169) or MCS (54.8 vs 51.5; P = .239) score between the repair cohort and the reconstruction cohort, respectively. No patient in either cohort underwent revision lateral ligament surgery. Conclusion: When compared with lateral ankle repair, anatomic allograft reconstruction produced similarly favorable outcomes, including high patient satisfaction, high function and activity levels, and no revision surgeries in either cohort. [ABSTRACT FROM AUTHOR] more...
- Published
- 2016
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19. 3D MRI evaluation of morphological characteristics of lateral ankle ligaments in injured patients and uninjured controls
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Kota Watanabe, Atsushi Teramoto, Hiroaki Shoji, Yoshihiro Akatsuka, Yuzuru Sakakibara, Toshihiko Yamashita, and Hiroyuki Takashima
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Adult ,Male ,Adolescent ,Young Adult ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Calcaneofibular ligament ,Ankle Injuries ,Child ,Aged ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Anterior talofibular ligament ,Magnetic resonance imaging ,Anatomy ,Middle Aged ,Magnetic Resonance Imaging ,Sagittal plane ,Hyperintensity ,Lateral ankle ligaments ,medicine.anatomical_structure ,Case-Control Studies ,Ligament ,Female ,Surgery ,Ankle ,Lateral Ligament, Ankle ,business ,030217 neurology & neurosurgery - Abstract
Background With ultrasonography or 2D magnetic resonance imaging (MRI) of the lateral ankle ligament, it is particularly difficult to show the entire calcaneofibular ligament (CFL). The purpose of this study was to evaluate the morphological characteristics of the lateral ankle ligaments in injured patients and uninjured controls using 3D MRI. Methods A total of 64 ankles of 59 healthy volunteers and lateral ligament injury patients (mean age of 32.4 years) were examined. The 64 ankles included a healthy group of 11 ankles, an acute injury group of 12 ankles that underwent MRI a month after injury, and a chronic injury group of 41 ankles that underwent MRI more than 3 months after injury. Using a 3.0-T MRI system, imaging was done with fast imaging employing steady-state acquisition cycled phases. Oblique sagittal images that most clearly depicted the entire anterior talofibular ligament (ATFL) and CFL were prepared manually and evaluated using a workstation. Results In the healthy group, both the ATFL and CFL were clearly and entirely visualized. The mean width in the central portion was 4.0 ± 1.0 mm in the ATFL and 4.8 ± 0.6 mm in the CFL. 3D MRI in the acute injury group showed findings of diffuse swelling with hyperintensity in the ATFL of all patients. The CFL in 7 of 12 ankles showed findings of diffuse swelling with hyperintensity. In the chronic injury group, morphological abnormalities of the ATFL were seen in 19 of 41 ankles. The ligament signal disappeared in 2 ankles, thinned in 4 ankles, and showed swelling in 13 ankles. Morphological abnormalities of the CFL were seen in 17 of 41 ankles. The ligament signal disappeared in 1 ankle, thinned in 2 ankles, and showed swelling in 14 ankles. Conclusion 3D MRI may be a useful modality to visualize both the ATFL and the CFL. more...
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- 2020
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20. The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments
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Francesc Malagelada, Maria Cristina Manzanares, Miki Dalmau-Pastor, Jordi Vega, and James D. F. Calder
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Adult ,Male ,Posterior talofibular ligament ,medicine.medical_specialty ,Arthroscopy ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Calcaneofibular ligament ,Fibula ,Aged ,030222 orthopedics ,business.industry ,Dissection ,Anterior talofibular ligament ,030229 sport sciences ,Anatomy ,Middle Aged ,musculoskeletal system ,Lateral ankle ligaments ,medicine.anatomical_structure ,Orthopedic surgery ,Ligament ,Female ,Surgery ,Ankle ,Lateral Ligament, Ankle ,business ,human activities ,Ankle Joint - Abstract
A deep knowledge of lateral ankle ligaments is necessary to understand its function, pathophysiology and treatment options. The ankle lateral collateral ligament is formed by the anterior talofibular ligament (ATFL), the calcaneofibular (CFL) and the posterior talofibular ligament (PTFL). Although previous studies have reported connections between these ligaments on its lateral side, no studies have specifically assessed connections on the medial side. The aim of this study was to assess the morphology and consistency of the medial connections between the components of the lateral collateral ligament complex of the ankle. Forty fresh-frozen ankle specimens were dissected to look for connections between the three lateral ankle ligaments. After visualization of the lateral ligaments was achieved, the fibula was amputated and ligament insertions were released at the talar and calcaneal insertion points. Observation of the connections and video analysis of the dynamic relationships of ligament connections were performed. Connections were found in all cases between the ATFL and PTFL, the ATFL and CFL, and the CFL and PTFL. Connections between ATFL and PTFL were not homogeneous. Although connections between the ATFLif and PTFL were noted in all cases (40), only 17 ankles (42.5%) had connections between the ATFLsf and PTFL. The amount of fibres of connection was also variable. Connections between the three components of the lateral collateral ligament of the ankle may be observed from the medial aspect of the ankle, and this may have important implications for arthroscopic lateral ligament repair. more...
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- 2019
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21. Independent Attachment of Lateral Ankle Ligaments: Anterior Talofibular and Calcaneofibular Ligaments - A Cadaveric Study
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Atsushi Tsuchiya, Tetsuji Moriizumi, Norimi Sumitomo, Nanae Fukushima, Yusuke Mori, and Akira Kakegawa
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Male ,medicine.medical_specialty ,Talus ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Calcaneofibular ligament ,Fibula ,Aged ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Anterior talofibular ligament ,030229 sport sciences ,Anatomy ,Surgery ,Lateral ankle ligaments ,Calcaneus ,medicine.anatomical_structure ,Ligament ,Female ,Ankle ,Lateral Ligament, Ankle ,business ,Cadaveric spasm ,Ankle Joint - Abstract
Anatomic knowledge of lateral ligaments around the lateral malleolus is important for repair or reconstruction of ankle instability. The detailed structure of the connective fibers between the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) is unknown. To clarify the anatomic structure of ATFL and CFL and the connective fiber between the 2 ligaments, the lateral ligament was dissected in 60 ankles of formalin-fixed cadavers, and the distance was measured between bony landmarks and fibular attachment of ATFL and CFL using a digital caliper. All ankles had connective fibers between ATFL and CFL. The structure of connective fibers consisted of a thin fiber above the surface layer of ATFL and CFL; it comprised thin fibrils of the surface layer covering the lower part of ATFL and the front part of CFL. Both ATFL and CFL were independent fibers, and both attachments of the fibula were isolated. Single bands of ATFL were noted in 14 of 60 (23.3%) ankles, double bands that divided the superior and inferior bands were observed in 42 of 60 (70.0%) ankles, and multiple bands were observed in 4 of 60 (6.7%) ankles. A cord-like and a flat and fanning type of CFL was noted in 22 (36.7%) and 38 (63.3%) of the 60 ankles, respectively. Distances between ATFL/CFL and articular and inferior tips of the fibula were 4.3 ± 1.1 mm/7.6 ± 1.6 mm and 14.3 ± 1.9 mm/7.4 ± 1.7 mm, respectively (mean ± standard deviation). The results of this study suggest that knowledge of more anatomic structures of ATFL, CFL, and connective fiber will be beneficial for surgeons in the repair or reconstruction of the lateral ligament of the ankle. more...
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- 2019
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22. Surgical Management of Lateral Ankle Instability in Athletes
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L. Daniel Latt, Yu Deng, Z Roward, and Luis Camacho
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Joint Instability ,medicine.medical_specialty ,Lateral ankle ,Physical Therapy, Sports Therapy and Rehabilitation ,Ankle ligaments ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,Orthopedic Procedures ,Orthopedics and Sports Medicine ,Ankle Injuries ,030222 orthopedics ,biology ,Athletes ,business.industry ,Current Concepts ,030229 sport sciences ,General Medicine ,biology.organism_classification ,Lateral ankle ligaments ,medicine.anatomical_structure ,Athletic Injuries ,Ankle ,Lateral Ligament, Ankle ,business ,Ankle Joint - Abstract
Ankle sprains are common injuries involving the lateral ankle ligaments and affect athletes of all levels. Most patients heal uneventfully, but those with symptoms persisting past 3 months should be evaluated for chronic ankle instability and its associated conditions as well as for the presence of varus malalignment. Chronic ankle instability is initially treated nonoperatively, with surgical management reserved for those who have failed to improve after 3 to 6 months of bracing and functional rehabilitation. Anatomic repair using a modification of the Broström procedure is the preferred technique for initial surgery. Anatomic reconstruction with tendon graft should be considered when repair is not possible, as it maintains physiological joint kinematics. Nonanatomic reconstructions are seldom indicated. Arthroscopic repair or reconstruction of the lateral ankle ligaments is a promising new technique with results similar to those of open surgery. more...
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- 2019
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23. Chronic Ankle Instability (Medial and Lateral).
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Knupp, Markus, Horn Lang, Tamara, Zwicky, Lukas, Lotscher, Patrick, and Hintermann, Beat
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The article offers information on chronic ankle instability (CAI), focusing on its diagnosis, operative treatment, and symptoms. Topics discussed include the history and clinical findings on patients with CAI, the common diagnostic measures including the magnetic resonance imaging (MRI), and the anatomy of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). more...
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- 2015
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24. Biomechanical Analysis of an Arthroscopic Broström Ankle Ligament Repair and a Suture Anchor--Augmented Repair.
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Giza, Eric, Whitlow, Scott R., Williams, Brady T., Acevedo, Jorge I., Mangone, Peter G., Haytmanek, C. Thomas, Curry, Eugene E., Turnbull, Travis Lee, LaPrade, Robert F., Wijdicks, Coen A., and Clanton, Thomas O. more...
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Background: Secondary surgical repair of ankle ligaments is often indicated in cases of chronic lateral ankle instability. Recently, arthroscopic Broström techniques have been described, but biomechanical information is limited. The purpose of the present study was to analyze the biomechanical properties of an arthroscopic Broström repair and augmented repair with a proximally placed suture anchor. It was hypothesized that the arthroscopic Broström repairs would compare favorably to open techniques and that augmentation would increase the mean repair strength at time zero. Methods: Twenty (10 matched pairs) fresh-frozen foot and ankle cadaveric specimens were obtained. After sectioning of the lateral ankle ligaments, an arthroscopic Broström procedure was performed on each ankle using two 3.0-mm suture anchors with #0 braided polyethylene/polyester multifilament sutures. One specimen from each pair was augmented with a 2.9-mm suture anchor placed 3 cm proximal to the inferior tip of the lateral malleolus. Repairs were isolated and positioned in 20 degrees of inversion and 10 degrees of plantarflexion and loaded to failure using a dynamic tensile testing machine. Maximum load (N), stiffness (N/mm), and displacement at maximum load (mm) were recorded. Results: There were no significant differences between standard arthroscopic repairs and the augmented repairs for mean maximum load and stiffness (154.4 ± 60.3 N, 9.8 ± 2.6 N/mm vs 194.2 ± 157.7 N, 10.5 ± 4.7 N/mm, P = .222, P = .685). Conclusions: Repair augmentation did not confer a significantly higher mean strength or stiffness at time zero. Clinical Relevance: Mean strength and stiffness for the arthroscopic Broström repair compared favorably with previous similarly tested open repair and reconstruction methods, validating the clinical feasibility of an arthroscopic repair. However, augmentation with an additional proximal suture anchor did not significantly strengthen the repair. [ABSTRACT FROM AUTHOR] more...
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- 2015
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25. Dimensions and attachments of the ankle ligaments: evaluation for ligament reconstruction.
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Wenny, Raphael, Duscher, Dominik, Meytap, Emmy, Weninger, Patrick, and Hirtler, Lena
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LIGAMENT injury treatment , *ANKLE surgery , *LIGAMENT surgery , *TIBIA , *FIBULA - Abstract
For operative reconstruction, precise anatomic information on the dimensions of the ankle ligaments is important and can help to optimize these procedures. The purpose of this study was to investigate the length and width dimensions of the ankle ligaments and to contrast the results with the published literature. Seventeen non-paired adult, formalin-fixed ankle specimen were dissected to expose the capsuloligamentous structures. The following ligaments were investigated: tibiofibular syndesmosis (anterior and posterior tibiofibular ligament/ATiFL and PTiFL), lateral ankle ligaments (anterior and posterior talofibular ligament, calcaneofibular ligament/ATFL, PTFL and CFL), medial ankle ligaments (deltoid ligament, anterior and posterior tibiotalar ligament/ATTL and PTTL). After identification of the ligaments, the dimensions were measured with a ruler and a sliding caliper. Additionally, the attachment area and the center of insertion (COI) were evaluated. The dimensions of the ligaments were recorded. Measurements were calculated and discussed according to the existing literature. The tibial COI of the ATiFL was situated 8.35 ± 2.05 mm from the inferior articular surface of the tibia and 5.04 ± 1.32 mm from the fibular notch. Its fibular COI was situated 25.45 ± 5.84 mm from the tip of the lateral malleolus and 3.12 ± 1.01 mm from the malleolar articular surface. The calcaneal COI of the CFL was situated 20.63 ± 3.56 mm anterior and 5.73 ± 1.89 mm plantar to the superior edge of the calcaneal. Its fibular attachment of the CFL was directly at the tip of the lateral malleolus, dorsal to the fibular attachment of the ATFL. Studies of the therapeutic options in severe ankle ligament injuries have shown better results in anatomical reconstructions compared to other operative treatments. To optimize these procedures, exact anatomical information on the dimensions of the ankle ligaments should be beneficial. [ABSTRACT FROM AUTHOR] more...
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- 2015
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26. Arthroscopic Ankle Lateral Ligament Repair for Chronic Lateral Ankle Instability.
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Takao, Masato and Glazebrook, Mark
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Minimally Invasive lateral ligament repair of the ankle has been developed in recent years. These repairs involve threading sutures to the remnant and can be classified into three types. These include arthroscopy-assisted mini-open procedure, arthroscopic with percutaneous procedure, and all-inside arthroscopic procedures. The all-inside arthroscopic procedure is the most minimally invasive procedure because all steps are performed arthroscopically through one portal. Further, since it is possible to suture the ligament with a direct arthroscopic view all-inside arthroscopic procedures can be performed anatomically. In this chapter, the authors provide the history of arthroscopic lateral ankle ligament repair and a recommended procedure for all-inside arthroscopic ankle lateral ligament repair using a modified lasso-loop stitch technique. [ABSTRACT FROM AUTHOR] more...
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- 2022
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27. Anatomical Reconstruction of the Lateral Ligament of the Ankle (AntiRoLL) for Chronic Lateral Ankle Instability.
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Takao, Masato and Glazebrook, Mark
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Recently, anatomic reconstruction procedures for chronic lateral ankle instability (CLAI) using arthroscopic and percutaneous minimally invasive technique has been described with the goal of improving clinical outcomes of open non-MIS techniques. In this chapter we describe the history of reconstruction for CLAI and a new anatomical reconstruction of the lateral ankle ligament (AntiRoLL) MIS techniques. [ABSTRACT FROM AUTHOR] more...
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- 2022
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28. Arthroscopic Surgical Technique for Lateral Ankle Ligament Instability
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Peter G. Mangone and Jorge I. Acevedo
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Orthodontics ,Joint Instability ,030222 orthopedics ,Lateral ankle ,medicine.diagnostic_test ,business.industry ,Arthroscopy ,Cosmesis ,030229 sport sciences ,Brace ,Lateral ankle ligaments ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Ligament ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Ankle Injuries ,Ankle ,business ,Lateral Ligament, Ankle ,Ankle Joint - Abstract
In the past several years, arthroscopic repair of the lateral ankle ligaments has grown because it has shown comparable results with the traditional open Brostrom-Gould procedure. In addition, arthroscopic repair allows reduced swelling and cosmesis. This article discusses the authors' technique for lateral ankle instability, with published data supporting biomechanical equivalency to the standard open Brostrom-Gould procedure. An optional internal brace can provide further strength to the repair and lead to a quicker recovery. Arthroscopic repair both with and without the internal brace have shown positive clinical outcomes for patients as well as high satisfaction rates. more...
- Published
- 2021
29. Comparing Tendinous and Ligamentous Ankle Pathology in Atraumatic Overweight and Nonoverweight Patients: A Comprehensive MRI Review.
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Galli, Melissa M., Protzman, Nicole M., Mandelker, Eiran M., Malhotra, Amit, Schwartz, Edward, and Brigido, Stephen A.
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With the increased prevalence of obesity, there has been a parallel rise in musculoskeletal disorders. However, the effect of body mass index (BMI) on pathology of the hindfoot and ankle is scarcely understood. The purpose of the present report was to compare the number of tendinous and ligamentous pathologies within the hindfoot and ankle between overweight (BMI ≥ 25.00 kg/m2) and nonoverweight (BMI < 25.00 kg/m2) atraumatic patients. We hypothesized that overweight patients would demonstrate more tendinous and ligamentous pathologies compared with their nonoverweight counterparts. Five hundred consecutive magnetic resonance images were reviewed. One hundred eight patients met the inclusion and exclusion criteria. Sixty-six patients were overweight and 42 patients were nonoverweight. Ninety-eight percent of overweight patients demonstrated pathology of a tendinous or ligamentous nature, whereas 62% of nonoverweight patients demonstrated pathology of a tendinous or ligamentous nature. Thus, the prevalence of pathology was 1.59 times higher among overweight patients compared with nonoverweight patients. Moreover, controlling for age, overweight patients demonstrated approximately twice as many tendinous and ligamentous pathologies compared with nonoverweight patients (adjusted mean ± SD = 4.44 ± 2.14 vs 1.98 ± 2.07, respectively), which was statistically significantly different (P < .001). To definitively assess causation and the clinical evolution of hindfoot and ankle pathology, prospective, longitudinal cohort studies are warranted.Level of Evidence: Diagnostic, Level III: Case series [ABSTRACT FROM PUBLISHER] more...
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- 2014
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30. Comparison of the effects of reconstruction of the lateral ankle ligaments using peroneus longus and peroneus brevis tendon graft
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Liang Cui, Lin Liu, Sentian Li, Zongyu Yang, Junshui Zuo, Fei Liu, and Heda Liu
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Adult ,Joint Instability ,Male ,medicine.medical_specialty ,Comparative Effectiveness Research ,Radiography ,Observational Study ,Arthroplasty ,Tendons ,03 medical and health sciences ,0302 clinical medicine ,chronic lateral ankle instability ,medicine ,Peroneus longus ,Humans ,030212 general & internal medicine ,Retrospective Studies ,biology ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,biology.organism_classification ,musculoskeletal system ,Peroneus brevis tendon ,Surgery ,Tendon ,peroneus brevis tendon ,peroneus longus tendon ,Lateral ankle ligaments ,Valgus ,medicine.anatomical_structure ,Treatment Outcome ,030220 oncology & carcinogenesis ,lateral ankle ligament reconstruction ,Female ,Ankle ,business ,Lateral Ligament, Ankle ,Ankle Joint ,Research Article - Abstract
Peroneus longus and peroneus brevis tendon grafts have been frequently used to reconstruct the lateral ankle ligaments. However, there is no literature comparing the effect of the 2 methods. The purpose of this study was to compare the effects of 2 autologous tendon transplants on ankle joint activity. This retrospective study included 100 adult patients with chronic lateral ankle instability (CLAI) who underwent surgery from January 2014 to December 2017. Group A (50 patients): Reconstruction of the lateral ankle ligaments using the anterior half of peroneus longus tendon graft; Group B (50 patients): Using the anterior half of peroneus brevis tendon graft. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment included talar tilt and anterior talar translation. A sensitive dynamometer was used before and after surgery to assess inversion, valgus, plantarflexion, and dorsiflexion strength to evaluate changes in muscle strength in the patients feet. Postoperatively, 88 patients were followed up for 12 to 24 months, including 46 cases in group A and 42 in group B. No severe complications were recorded in the 2 groups. There were significant pre- to post-operative differences between the groups. No significant differences were observed in the postoperative scores and muscle strength changes between the groups. However, the number of patients with decreased valgus strength in group B was statistically significant compared with group A. Both methods can improve the stability of the ankle joint, but the peroneus longus tendon has little effect on the postoperative muscle strength of the foot and should be used as the preferred surgical treatment for the treatment of CLAI. more...
- Published
- 2020
31. A new minimally invasive method for anatomic reconstruction of the lateral ankle ligaments with a Tightrope system
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Yuan Hong, Yongxing Cao, Yang Xu, and Xiangyang Xu
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Adult ,Joint Instability ,Male ,medicine.medical_specialty ,Percutaneous ,Adolescent ,Visual Analog Scale ,Visual analogue scale ,Radiography ,Hamstring Muscles ,03 medical and health sciences ,Arthroscopy ,Young Adult ,0302 clinical medicine ,Allograft ,medicine ,Minimal invasive ,Humans ,Minimally Invasive Surgical Procedures ,Transplantation, Homologous ,Orthopedics and Sports Medicine ,Displacement (orthopedic surgery) ,Ankle Injuries ,Ligament ,030222 orthopedics ,business.industry ,030229 sport sciences ,General Medicine ,Middle Aged ,Surgery ,Lateral ankle ligaments ,medicine.anatomical_structure ,Arthroscopy and Sports Medicine ,Tightrope ,Fibula ,Patient Satisfaction ,Orthopedic surgery ,Chronic Disease ,Female ,Ankle ,Anatomy ,business ,Lateral Ligament, Ankle ,Ankle Joint - Abstract
Background Several minimally invasive anatomic reconstruction techniques of the lateral ligaments have been introduced for the treatment of chronic lateral ankle instability. However, these strategies may not always follow accurate ligament anatomic attachments, especially in the construction of the fibular bone tunnels. Objectives This study reported a new percutaneous technique for reconstruction of the ligaments of lateral ankle anatomically with a Tightrope system. Methods From April 2016 to August 2016, 25 ankles of 24 patients with chronic ankle instability underwent our new percutaneous anatomic reconstruction of the lateral ligaments with a Tightrope system. The operation was performed through several small incisions. The fibular tunnel was made obliquely from the anteromedial side of lateral malleolus tip towards retro-malleolar cortex. The graft was fixed in the tunnel with the help of a Tightrope system. The calcaneal tunnel and talar tunnel were made as our previous method. The mean final follow-up was 12.2 months (range 10–14). Visual Analogue Scale for pain, American Orthopaedic Foot and Ankle Society score, and patients’ subjective satisfaction were used to measure clinical outcomes. Preoperative and postoperative stress tests were performed and radiographic parameters were measured. Results The Visual Analogue Scale decreased from 3.0 ± 1.4 to 1.3 ± 0.8 at the last follow-up (p more...
- Published
- 2018
32. Changes in surgeries for lateral ankle instability in Japan and the current situation
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Kazuya Sugimoto, Shinji Isomoto, and Yasuhito Tanaka
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030222 orthopedics ,medicine.medical_specialty ,Lateral ankle ,business.industry ,Optimal treatment ,Physical Therapy, Sports Therapy and Rehabilitation ,030229 sport sciences ,Reconstruction surgery ,Surgery ,Lateral ankle ligaments ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Ligament repair ,Chronic ankle instability ,medicine ,Ligament ,Orthopedics and Sports Medicine ,business - Abstract
Summary The type of treatment used for lateral ankle instability has changed over the years. This paper reviews how the treatment of lateral ankle instability in Japan has changed and describes current trends. In Japan, at one point, a fresh injury was proactively treated with surgery. From 1990, conservative therapy was widely reported to provide good results for fresh injuries. The more accurate diagnosis of severity in future will enable the optimal treatment to be selected. Chronic lateral ankle instability is an indication for ligament repair, provided that sufficient fibrous ligament tissue remains. Until the 1980s, chronic ankle instability had been treated by tenodesis. Anatomical studies of the lateral ankle ligaments conducted in Japan in the 1990s led to proposals for reconstruction surgery techniques based on the anatomical isometric point. Arthroscopic lateral ankle ligament surgery has become a major topic in recent years, and it is now a common subject for Japanese medical conferences. more...
- Published
- 2019
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33. The jump shot – A biomechanical analysis focused on lateral ankle ligaments
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Lindner, M., Kotschwar, A., Zsoldos, R.R., Groesel, M., and Peham, C.
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- *
BIOMECHANICS , *ANKLE injuries , *LIGAMENTS , *SPORTS competitions , *MECHANICS (Physics) , *PHYSIOLOGIC strain , *PREVENTION - Abstract
Abstract: Handball is one of the top four athletic games with highest injury risks. The jump shot is the most accomplished goal shot technique and the lower extremities are mostly injured. As a basis for ankle sprain simulation, the aim of this study was to extend the ankle region of an existing musculoskeletal full-body model through incorporation of three prominent lateral ankle ligaments: ligamentum fibulotalare anterius (LFTA), ligamentum fibulotalare posterius (LFTP), ligamentum fibulocalcaneare (LFC). The specific objective was to calculate and visualise ligament force scenarios during the jumping and landing phases of controlled jump shots. Recorded kinematic data of performed jump shots and the corresponding ground reaction forces were used to perform inverse dynamics. The calculated peak force of the LFTA (107N) was found at maximum plantarflexion and of the LFTP (150N) at maximum dorsiflexion. The peak force of the LFC (190N) was observed at maximum dorsiflexion combined with maximum eversion. Within the performed jump shots, the LFTA showed a peak force (59N to 69N) during maximum plantarflexion in the final moment of the lift off. During landing, the force developed by the LFTA reached its peak value (61N to 70N) at the first contact with the floor. After that, the LFTP developed a peak force (70N to 118N). This model allows the calculation of forces in lateral ankle ligaments. The information obtained in this study can serve as a basis for future research on ankle sprain and ankle sprain simulation. [Copyright &y& Elsevier] more...
- Published
- 2012
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34. Lateral ankle ligaments: MR arthrography with anatomic correlation in cadavers
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Boonthathip, Mayura, Chen, Lina, Trudell, Debra, and Resnick, Donald
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- *
ANKLE abnormalities , *ANKLEBONE , *MAGNETIC resonance imaging , *STATISTICAL correlation , *INTRA-articular injections , *DEAD , *MEDICAL imaging systems - Abstract
Abstract: Objective: The purpose of our study was to use magnetic resonance (MR) imaging and MR arthrography to demonstrate the anatomy of the lateral ankle ligaments using standard and oblique imaging planes in cadavers. Material and methods: MR imaging of ten cadaveric ankles was performed before and after intra-articular administration of contrast solution. Proton-density MR images were acquired in standard and oblique imaging planes. MR imaging was correlated with anatomic sections. Measurements using oblique imaging planes were obtained to characterize the morphology of the lateral ligaments. Results: The anterior talofibular ligament (ATFL) had a variable number of bands in all specimens, separated by fat signal oriented obliquely parallel to the long axis of the ligament. The fibular attachment of ATFL was located in close proximity to the fibular attachment of the distal band of the anterior tibiofibular ligament (AITFL). The angle formed by the calcaneofibular ligament (CFL) and the fibular shaft varied with different ankle positions. Special axial oblique plane best demonstrated the CFL. The posterior talofibular ligament (PTFL) was multi-fasciculated in appearance. Dorsiflexion of the ankle joint helped elongate the PTFL and best depicted this ligament in its entirety in the axial plane. Conclusion: Oblique imaging planes parallel to the long axis of the individual ligaments may improve visualization of the anatomy of the lateral ankle ligaments. The orientation of the lateral ankle ligaments is affected by the position of the talocrural and subtalar joints. Understanding the morphology of the lateral ankle ligaments can help radiologists diagnose abnormalities of these ligaments. [ABSTRACT FROM AUTHOR] more...
- Published
- 2011
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35. Advanced conservative treatment of complete acute rupture of the lateral ankle ligaments: Verifying by stabilometry
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Azriel Benaroya, Jana Řezaninová, Dagmar Moc Králová, Luboš Hrazdira, and Zdeněk Svoboda
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Adult ,Joint Instability ,Male ,medicine.medical_specialty ,Lateral ankle ,Full weight bearing ,Adolescent ,medicine.medical_treatment ,Musculoskeletal ultrasound ,Conservative Treatment ,Weight-Bearing ,Immobilization ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Ankle Injuries ,Hyaluronic Acid ,Ultrasonography ,Rupture ,Wound Healing ,030222 orthopedics ,Rehabilitation ,Viscosupplements ,business.industry ,030229 sport sciences ,Sagittal plane ,Conservative treatment ,Lateral ankle ligaments ,Casts, Surgical ,medicine.anatomical_structure ,Acute Disease ,Athletic Injuries ,Postural stability ,Physical therapy ,Female ,Lateral Ligament, Ankle ,business - Abstract
Background The aim of this study was to investigate the result of the specific conservative treatment of acute lateral ankle ligaments rupture and verify the effect of this therapy by stabilometry. Methods 17 young athletes were examined after acute lateral ankle sprain (grade III). Diagnosis was based on musculoskeletal ultrasound examinations. Pressure plate evaluated postural stability after conservative treatment at regular intervals during 1year. Results There were no significant differences in postural stability in double-leg stance between limbs. In single-leg stance, COP confidence ellipse (p=0,011) and COP excursion in sagittal plane (p=0,000) were significantly higher for the injured leg when compared with the uninjured leg only one week after removing the cast. Conclusions After conservative treatment of grade III injuries with STABHA, immobilization with full weight bearing on the injured leg for 6 weeks and rehabilitation, stabilometry results showed that none of the patients had impaired postural stability or were at risk of functional ankle instability in the monitored period. more...
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- 2018
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36. Use of three-dimensional finite element models of the lateral ankle ligaments to evaluate three surgical techniques
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Jing-Ping Bai, Cheng-Wei Wang, and Aikeremujiang Muheremu
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Adult ,Male ,Models, Anatomic ,Medicine (General) ,Finite Element Analysis ,talofibular ligament ,Biochemistry ,surgical techniques ,Tendons ,03 medical and health sciences ,R5-920 ,0302 clinical medicine ,Three-dimensional finite element model ,peroneus brevis tendon reconstruction ,medicine ,Peroneus longus ,Humans ,Computer Simulation ,Calcaneofibular ligament ,Ankle Injuries ,Orthodontics ,030222 orthopedics ,business.industry ,Biochemistry (medical) ,Anterior talofibular ligament ,Research Reports ,030229 sport sciences ,Cell Biology ,General Medicine ,Plastic Surgery Procedures ,musculoskeletal system ,peroneus longus tendon reconstruction ,Healthy Volunteers ,Finite element method ,Biomechanical Phenomena ,Tendon ,Lateral ankle ligaments ,medicine.anatomical_structure ,Ligament ,allogeneic tendon reconstruction ,Stress, Mechanical ,Ankle ,Lateral Ligament, Ankle ,Tomography, X-Ray Computed ,business ,Ankle Joint - Abstract
Objective To compare three surgical techniques for lateral ankle ligament reconstruction using finite element (FE) models. Methods A three-dimensional FE model of the left foot of a healthy volunteer and lateral collateral ligament injury models were developed. Three tendons [one-half of the autologous peroneus longus tendon (PLT), one-half of the peroneus brevis tendon (PBT), and an allogeneic tendon] were used for lateral collateral ligament reconstruction. The ankle varus stress and anterior drawer tests were performed to compare the three surgical techniques. Results The ankle varus stress test showed that the equivalent stresses of the anterior talofibular ligament (ATFL) (84.00 MPa) and calcaneofibular ligament (CFL) (27.01 MPa) were lower in allogeneic tendon reconstruction than in the other two techniques but similar to those of normal individuals (138.48 and 25.90 MPa, respectively). The anterior drawer test showed that the equivalent stresses of the ATFL and CFL in autologous PLT reconstruction (31.31 and 28.60 MPa, respectively) and PBT reconstruction (31.47 and 29.07 MPa, respectively) were lower than those in allogeneic tendon reconstruction (57.32 and 52.20 MPa, respectively). Conclusions The allogeneic tendon reconstruction outcome was similar to normal individuals. Allogeneic tendon reconstruction may be superior for lateral ankle ligament reconstruction without considering its complications. more...
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- 2017
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37. Changes in joint position sense after conservatively treated chronic lateral ankle instability.
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Kynsburg, Á., Halasi, T., Tállay, A., Berkes, I., Kynsburg, A, and Tállay, A
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PHYSICAL therapy , *PROPRIOCEPTION , *ANKLE injury treatment , *LIGAMENTS , *SPRAINS , *JOINT injuries , *SPORTS injuries , *ATHLETES , *ANALYSIS of variance , *ANKLE injuries , *JOINT hypermobility , *RANGE of motion of joints , *NONPARAMETRIC statistics , *STATISTICAL sampling , *RANDOMIZED controlled trials , *TREATMENT effectiveness , *PHYSIOLOGY - Abstract
Improvement of ankle proprioception through physiotherapy (a.k.a. proprioceptive training) is a widely accepted conservative treatment modality of chronic functional lateral ankle instability. Clinical studies provided controversial data on its proprioceptive effect. Aim of this study was to gain evidence on the efficacy of proprioceptive training on ankle joint position sense. Ten patients (five males and five females, aged 23.3±5.4 years) were treated conservatively for chronic lateral ankle instability with a special training programme over 6 weeks. For the assessment of joint position sense we used the slope-box test, first applied and described by Robbins et al. (Br J Sports Med 29:242–247, 1995). The test was performed before the start and after the end of the training programme, measuring joint position sense on 11 different slope amplitudes in four directions (anterior, posterior, lateral and medial) in random order each on both ankles. Comparisons were made between pre- and post-training results as well as versus a control-group of ten healthy athletes. Overall the proprioceptive sensory function of the studied group has improved, but this improvement was not significant in all directions. Only two patients have shown significant improvement of joint position sense in all directions (mean estimate error improvement: 2.47°), while conservative treatment was partially successful in five others (mean estimate error improvement: 0.73°). The follow-up results of these seven patients were comparable with the values measured in the control-group. Three patients did not show any improvements (mean estimate error improvement: −0.55°) (overall difference between improving and non-improving patients: P<0.0001). Mean absolute estimate error profiles of the seven improving patients became similar to the profiles of healthy athletes, while these changes could not be observed in the case of the three non-improving participants. Proprioceptive rehabilitation programme can be an effective method in order to improve impaired joint position sense function. After 6 weeks non-responding patients can be well identified, and considered for other treatment modalities. The determination of the effective length of the programme however needs further evaluation. Still, changes in the proprioceptive sensory function of the ankle plantarflectors indicate the preventive effect of the training programme. Furthermore, our results support the theory of simultaneous function of different mechanoreceptor-systems. [ABSTRACT FROM AUTHOR] more...
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- 2006
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38. Anatomy of lateral ankle ligaments and their relationship to bony landmarks.
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Taser, Figen, Shafiq, Qaiser, and Ebraheim, Nabil
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LIGAMENTS , *ANKLE , *RADIOGRAPHY , *BONES , *RADIOLOGY , *FIBULA - Abstract
This study was designed to determine and describe precise anatomy of the lateral ankle ligaments and their relationship to adjacent osseous structures. This study was performed on 42 legs of 22 adult human embalmed cadavers. The lateral ankle ligaments were carefully dissected using a 2.5× surgical loupe. Mean values for the length, width and angle of the individual lateral ankle ligaments were measured. The precise location of insertion points and course of each ligament was observed and noted with ankle placed in neutral position. The anterior talofibular and calcaneofibular ligaments were coated with radio-opaque material. Radiographs were then taken in the anteroposterior, mortise and lateral projections. The anterior talofibular ligament (ATFL) was a flat, quadrilateral ligament and it made mean angle of 25° (range 5°–45°) with horizontal plane, and a mean angle of 47° (range 45°–56°) with sagittal plane. The posterior talofibular ligament was oriented in a nearly horizontal plane. Calcaneofibular ligament (CFL) was a flat oval ligament. It made a mean angle of 40° (range 30°–58°) with horizontal plane, and mean angle of 51° (range 32°–60°) with sagittal plane. The angle between CFL and ATFL was approximately 132° (range 118°–145°). These data provides important information for diagnosing injury and reconstructing lateral ankle ligaments. [ABSTRACT FROM AUTHOR] more...
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- 2006
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39. No tunnel widening following arthroscopic anatomical reconstruction of the lateral ankle ligaments
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Ronny Lopes, Tristan Duguay, Alexandre Hardy, Sébastien Nicoules, Philippe Anract, Marie Vigan, and Elliot Kierszbaum
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Joint Instability ,medicine.medical_specialty ,Anterior cruciate ligament reconstruction ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Fibula ,Retrospective Studies ,Orthodontics ,030222 orthopedics ,Anterior Cruciate Ligament Reconstruction ,business.industry ,030229 sport sciences ,Multiplanar reconstruction ,Surgery ,Lateral ankle ligaments ,medicine.anatomical_structure ,Chronic ankle instability ,Ligament ,Calcaneus ,Ankle ,business ,Lateral Ligament, Ankle - Abstract
Introduction Arthroscopic anatomical reconstruction of the lateral ankle ligaments is an emerging technique for treating chronic ankle instability. One of the known complications of arthroscopic anterior cruciate ligament reconstruction is tunnel widening; this makes revision more complicated. The aim of this study was to look for tunnel widening in the postoperative course of arthroscopic ankle ligament reconstruction. We hypothesized that significant widening of the bone tunnels is present 1 year after anatomical ankle ligament reconstruction. Materials and methods Twenty-one patients who underwent arthroscopic anatomical reconstruction of the lateral ankle ligaments with a gracilis graft were included prospectively. A CT-scan with 1-mm thick slices with multiplanar reconstruction was done 1 year after the surgery. The size and shape of the tunnels was analyzed, and the ratio of the preoperative to postoperative diameter was calculated. Based on this ratio, the tunnels were given a grade as described by Struewer. Tunnel widening was defined as a grade III tunnel, thus a ratio ≥ 1.3. The tunnel shape was classified as described by Peyrache as cone type, cavity type, line type. Results None of the tunnels had widened 1 year after arthroscopic anatomical reconstruction of the lateral ankle ligaments. At the fibula, 81% of tunnels were grade I and 19% were grade II; 57% were cone type and 43% were line type. At the talus, 86% of tunnels were grade I and 14% were grade II. All were line type. At the calcaneus, 86% of tunnels were grade I and 14% were grade II; 57% were cone type and 43% were line type. Discussion The main finding of this study was the absence of tunnel widening 1 year after arthroscopic reconstruction of the lateral ankle ligaments. Level of evidence IV; retrospective study. more...
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- 2019
40. Effect of Early Physiotherapy after Lateral Ankle Ligament Injury on Pain and Function. Systematic Review
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Ieva Masiulytė, Vygintė Gasiulytė, and Giedrė Jurgelaitienė
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Lateral ankle ,medicine.medical_specialty ,biology ,business.industry ,Athletes ,RT1-120 ,Nursing ,General Medicine ,biology.organism_classification ,RC31-1245 ,Return to sport ,Lateral ankle ligaments ,medicine.anatomical_structure ,Physical therapy ,Ligament ,Medicine ,Ligament injury ,Effective treatment ,business ,Internal medicine ,human activities ,Economic consequences - Abstract
Background. Lateral ankle ligament injuries are most common in sports, which affects athletes in all ages. It has been found that lateral ankle ligaments are injured in 1 of 10000 physically active people. Higher sports level professional players and amateurs need to return to sport early with no physical, psychological and economic consequences. Studies search for the most effective treatment after lateral ankle ligament injuries. Research aim – to perform a systematic review and determine the effect of early physiotherapy on pain and function after lateral ankle ligament injury. Methods. We conducted literature search using the Pubmed, Ebsco, Pedro, Google scholar databases, and chose controlled trials where early physiotherapy orientated to pain and function was used. Results. In control groups where traditional immobilization with RICE method was used, pain decreased to 1.96 ± 1.33 points, in the intervention groups who had early physiotherapy and RICE method, pain decreased to 1.53 ± 1.23 points. Effect size in control groups was r = 0.55 points, in the intervention groups it was r = 0.54 points. In control groups who had traditional immobilization with RICE method, function increased to 68.67 ± 16.79 point, in the intervention groups who had early physiotherapy and RICE method, function increased to 75.61 ± 13.27 points. Effect size in control groups was r = 0.82 points, in the intervention groups r = 0.88 point. Conclusions. Early physiotherapy orientated to pain and functions after lateral ankle ligaments injury helps to reduce pain faster and increases function, and helps return back to work and sports activities.Keywords: lateral ankle ligament, injuries, early physiotherapy. more...
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- 2019
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41. Magnetic Resonance Imaging and Stress Radiography in Chronic Lateral Ankle Instability
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Joon Sang Eom, Hong Geun Jung, Na Ra Kim, Tae-Hoon Kim, and Dong-Oh Lee
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Joint Instability ,medicine.medical_specialty ,Lateral ankle ,Radiography ,Instability ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Calcaneofibular ligament ,Retrospective Studies ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Anterior talofibular ligament ,Magnetic resonance imaging ,Stress radiography ,030229 sport sciences ,Plastic Surgery Procedures ,Magnetic Resonance Imaging ,Lateral ankle ligaments ,medicine.anatomical_structure ,Surgery ,Radiology ,Lateral Ligament, Ankle ,business ,Ankle Joint - Abstract
Background: Studies regarding magnetic resonance imaging (MRI) findings of the lateral ankle ligaments in chronic lateral ankle instability and their clinical relevance for surgery are lacking. This study classified the lateral ankle ligament MRI findings of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in chronic lateral ankle instability (CLAI) and correlated these findings with ankle stress radiographs. Methods: We included 132 ankles with CLAI that underwent ligament reconstructions from 2006 to 2013. The distributions of the ATFL and CFL morphologies were evaluated using the following categories: (1) the amount of thickness: normal/thickened/attenuated/non-visualized, (2) the presence of discontinuity, (3) wavy or irregular contour, and (4) increased signal intensity on T2-weighted images. The relationships between the ligament morphologies and stress radiographs were analyzed. Results: The ATFL was normal in 5 (4%) ankles, thickened in 35 (27%), attenuated in 76 (58%), and non-visualized in 16 (12%), while the CFL was normal in 39 (30%) ankles, thickened in 42 (32%), attenuated in 44 (33%), and non-visualized in 7 (5%). Discontinuity of the ATFL or CFL was observed in 46 (35%) ankles. Wavy or irregular contours were observed in 55 (42%) ATFLs and 37 (28%) CFLs, and signal intensity of both ligaments was increased in 19 (14%) ankles. ATFL ( P < .001) and CFL thickness ( P = .007) correlated with the talar tilt angle. Conclusions: The MRI findings of CLAI showed several morphologies and specific incidences for each morphology. Attenuated, wavy appearance was the most frequent MRI pattern. Thickness was related to the degree of instability. Level of Evidence: Level IV, retrospective case series. more...
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- 2017
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42. Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children
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Yasuhito Tanaka, Nana Maeda, Manabu Maeda, and Takanori Takaoka
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030222 orthopedics ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,Cartilage ,030229 sport sciences ,Anatomy ,Occult ,Lateral ankle ligaments ,Avulsion ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Deformity ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cortical bone ,Radiology ,medicine.symptom ,Ankle ,business - Abstract
In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula. more...
- Published
- 2017
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43. Modified Arthroscopic Brostrom Procedure With Bone Tunnels
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Tun Hing Lui
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Orthopedic surgery ,030222 orthopedics ,medicine.medical_specialty ,Lateral ankle ,business.industry ,medicine.medical_treatment ,030229 sport sciences ,Lateral malleolus ,Surgery ,Broström procedure ,Lateral ankle ligaments ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Technical Note ,medicine ,Orthopedics and Sports Medicine ,Ankle ,business ,RD701-811 ,Suture anchors - Abstract
The open anatomic repair of the anterior talofibular and calcaneofibular ligaments (modified Brostrom procedure) is widely accepted as the standard surgical stabilization procedure for lateral ankle instability that does not respond to conservative measures. Arthroscopic Brostrom procedures with a suture anchor have been reported to achieve both anatomic repair of the lateral ankle ligaments and management of the associated intra-articular lesions. However, the complication rates are higher than open Brostom procedures. Many of these complications are associated with the use of a suture anchor. We report a modified arthroscopic Brostrom procedure in which the anterolateral ankle capsule is anchored to the lateral malleolus through small bone tunnels instead of suture anchors. more...
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- 2016
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44. Results of an Accelerated Rehabilitation Program after Arthroscopic Broström Ankle Ligament Repair Augmented with an Arthroscopically Applied Suture Tape
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James R. McWilliam, Andres A. Cedeno, and Jorge I. Acevedo
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Fibrous joint ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Arthroscopy ,Ankle arthroscopy ,Broström ,Article ,Surgery ,Lateral ankle ligaments ,lcsh:RD701-811 ,Accelerated rehabilitation ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Ligament repair ,Ankle Arthroscopy ,medicine ,Ankle Instability ,Ankle ,business ,Ankle instability - Abstract
Category: Arthroscopy; Ankle; Sports Introduction/Purpose: The Broström-Gould is the gold standard in repair of the lateral ankle ligaments for chronic instability and arthroscopic Broström repairs have become increasingly popular with outcomes comparable to the open procedure. Despite demonstrated success, the arthroscopic Broström, like the open procedure, does not achieve the same mechanical strength as the intact native ankle ligaments and is therefore not appropriate for early aggressive rehabilitation. Suture tape augmentation of an open Broström procedure has been shown to further strengthen the repair and produce favorable outcomes in preventing recurrent instability. Studies reporting long-term clinical outcomes of patients who undergo this procedure are lacking. This study reports clinical and functional outcomes after an arthroscopic repair with arthroscopically applied suture tape augmentation and an accelerated post-operative rehabilitation protocol. Methods: Ninety-three patients with chronic recurrent ankle instability who had failed non-operative treatment (bracing, taping, physical therapy) underwent arthroscopic lateral ligament repair augmented by a suture tape applied in a novel all-arthroscopic fashion (double stranded polyethylene tape fixed to talus and fibula with interference screws). Postoperatively patients were placed in a CAM walker and allowed to bear weight immediately. On postoperative day 8 patients were placed in a functional brace and began physical therapy to include motion, strength, and proprioceptive activities. At week 4 patients began sports specific activities and were allowed to return to unrestricted activity at week 8. Foot and Ankle Ability Measure (FAAM), Visual Analog Score (VAS), Tegner Score, and range of motion measurements were performed. Statistical analysis was done to determine averages, ranges, and standard deviations of scores. Paired t-test was utilized to find statistically significant differences in scores. Results: Eighty-five patients (42 males, 43 females; average age 30.42 years) were available at a minimum of 24 months post- operatively (range 24-68). Postoperatively, average VAS scores fell to 0.85 from 4.67, (pConclusion: The results indicate that acclerated rehabilitation after arthroscopic lateral ligament repair augmented with arthroscopically applied suture tape is a safe and effective procedure that produces favorable outcomes for patients with chronic recurrent ankle instability. more...
- Published
- 2020
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45. Anatomic Reconstruction of Lateral Ankle Ligaments and Both Peroneus Tendons After Open Fracture Dislocation of the Ankle: A Case Report
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Kenta Momii, Yasuharu Nakashima, Ryuta Sakurai, Hideki Mizu-uchi, Jun Ichi Fukushi, and Masuo Hanada
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Fibrous joint ,Open fracture ,business.industry ,Peroneal tendons ,anterior talofibular ligament ,Soft tissue ,Anterior talofibular ligament ,Case Report ,Anatomy ,musculoskeletal system ,anatomic reconstruction ,Lateral ankle ligaments ,lcsh:RD701-811 ,medicine.anatomical_structure ,soft tissue defect ,lcsh:Orthopedic surgery ,calcaneofibular ligament ,medicine ,Calcaneofibular ligament ,Ankle ,business ,peroneal tendon - Abstract
Extensive soft tissue defects of the ankle are an uncommon but challenging problem that require a combination of reconstructive options. We report the case of a complex injury involving the skin, lateral ankle ligaments, and peroneal tendons that were anatomically reconstructed. A 15-year-old girl was injured in an automobile accident resulting in extensive soft tissue defects and marked instability of her right ankle. The lower two-thirds of the anterior talofibular ligament (ATFL) had segmental defects, and calcaneofibular ligament (CFL) was completely torn, and both peroneal longus and brevis tendons were severely damaged. Initial debridement was performed on the day on injury. Two weeks after injury, the ATFL and CFL were reconstructed using a semitendinosus autograft and suture tape augmentation. Both peroneal tendons were reconstructed using a gracilis autograft. The skin defect (10 × 10 cm) was covered with an anterolateral thigh flap. After removing a short leg cast at 3 weeks postoperatively, the patient started range of motion exercises without using any brace. Weightbearing was allowed at 4 weeks. At the 24-month follow-up examination, she had returned to her preoperative level of work and sports activities. more...
- Published
- 2019
46. Lateral ankle ligament anatomic reconstruction for chronic ankle instability: Allograft or autograft? A systematic review
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Mattia Loppini, Nicolò Martinelli, Alberto Bianchi, Francesco Malerba, and L. Brambilla
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Joint Instability ,medicine.medical_specialty ,Lateral ankle ,Radiography ,MEDLINE ,Cochrane Library ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Ankle Injuries ,Autografts ,030222 orthopedics ,business.industry ,030229 sport sciences ,Evidence-based medicine ,Allografts ,Surgery ,Lateral ankle ligaments ,medicine.anatomical_structure ,Patient Satisfaction ,Chronic ankle instability ,Chronic Disease ,Ligament ,business ,Lateral Ligament, Ankle ,Ankle Joint - Abstract
Background To investigate if there is any evidence in favour of autograft or allograft use for anatomic reconstruction of lateral ankle ligaments in patients with symptomatic chronic ankle instability. Methods A literature search was performed in PubMed MEDLINE, Cochrane Library, EMBASE and Google Scholar databases, over the years 1994–2017, to identify the studies presenting clinical results of anatomic lateral ankle ligaments reconstruction using various combinations of the keywords “lateral ankle ligaments reconstruction”, “anatomic reconstruction”, “chronic ankle instability”, “allograft”, “autograft”. The surgical procedure was considered anatomic if consistent with the description of lateral ankle ligaments made by Burks and Morgan in 1994. Results Among the 89 papers matching the search terms, only 12 could be included in which 357 anatomic lateral ankle ligaments reconstructions were performed. One was a comparative case series (level of evidence III — LOE III) while other papers were retrospective case series (LOE IV), the mean Modified Coleman Methodology Score (MCMS) was fair: 56.7 (SD ± 5.2). Due to the low level of evidence of the available literature only a qualitative analysis was performed. The limited evidence from the studies analysed suggests that there is no difference in graft survivorship, graft-dependent variables, patient’s satisfaction, clinical outcome measures and radiographic results between allograft and autograft. Conclusions Given the low number of studies, their poor methodology score and their low level of evidence it is not possible to determine if allograft is better or safer than autograft. Level of evidence: Level IV, review paper of level III and level IV studies. more...
- Published
- 2018
47. Fracture Through a Distal Fibular Tunnel Used for an Anatomic Lateral Ankle Ligament Reconstruction
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L. Daniel Latt and Z Roward
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030222 orthopedics ,Lateral ankle ,business.industry ,030229 sport sciences ,Anatomy ,musculoskeletal system ,Lateral ankle ligaments ,03 medical and health sciences ,lcsh:RD701-811 ,0302 clinical medicine ,medicine.anatomical_structure ,lcsh:Orthopedic surgery ,Fracture (geology) ,Ligament ,Medicine ,business ,Ankle instability ,Tendon graft ,human activities - Abstract
Anatomic lateral ankle ligament reconstruction using free tendon graft with osseous tunnels has become a popular technique for revision reconstruction of the lateral ankle ligaments. With the procedure’s burgeoning popularity, an accompanying increase in postoperative complications is likely to occur. We report on one such complication: traumatic distal fibula fracture through the transosseous tunnels. more...
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- 2018
48. Arthroscopic anatomical reconstruction of the lateral ankle ligaments
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Frederick Michels, James D. F. Calder, Thomas W. Bauer, Stephane Guillo, Jon Karlson, and Masato Takao
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Joint Instability ,Lateral ankle ,Sports injury ,Patient Positioning ,Tendons ,Clinical study ,Arthroscopy ,03 medical and health sciences ,0302 clinical medicine ,Suture Anchors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Ankle Injuries ,Orthodontics ,030222 orthopedics ,business.industry ,030229 sport sciences ,musculoskeletal system ,Lateral ankle ligaments ,medicine.anatomical_structure ,Chronic ankle instability ,Ligament ,Surgery ,Ankle ,Presentation (obstetrics) ,Lateral Ligament, Ankle ,business - Abstract
Chronic ankle instability secondary to lateral ligament insufficiency is common after sports injury. Many surgical techniques have been described for the treatment of the lateral ankle ligament complex. They can be classified into repair or reconstruction, and non-anatomical or anatomical. A few authors have recently published innovative techniques for arthroscopic ankle ligament management. This paper describes the arthroscopic techniques enabling anatomical lateral ligament reconstruction using gracilis autograft or allograft for chronic ankle instability. This technique and the steps have been developed by the Ankle Instability Group to make this a reproducible procedure. The purpose of this presentation is to document the technique in the future with a view to a clinical study investigating the results of such surgery in a cohort of suitable patients with chronic ankle instability. Level of evidence V. more...
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- 2015
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49. A novel patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments
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Yongqing Xu, Hongwei Wang, Haotian Luo, Yong Sha, Hui Tang, Jing Ding, Jun Liu, and Chun-xiao Li
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Adult ,Joint Instability ,Male ,medicine.medical_specialty ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Calcaneofibular ligament ,Ankle Injuries ,Fibula ,Orthodontics ,030222 orthopedics ,business.industry ,Anterior talofibular ligament ,030229 sport sciences ,Plastic Surgery Procedures ,Patient specific ,Surgery ,Lateral ankle ligaments ,medicine.anatomical_structure ,Orthopedic surgery ,Ligament ,Female ,Ankle ,Lateral Ligament, Ankle ,business ,Ankle Joint ,Follow-Up Studies - Abstract
We discuss the clinical effects of anatomical reconstruction of the lateral ankle ligaments to treat chronic lateral ankle instability (CAI) by creating fibular channels with a patient-specific navigational template. From August 2010 to February 2014, 15 patients presenting with CAI were treated by creating fibular channels with a patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments. All patients were followed up for nine to 24 months postoperatively (15 months on average); no recurrent CAI was found. Pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores for patients in the calcaneofibular ligament (CFL) plus anterior talofibular ligament (ATFL) repair group were 48.3 ± 5.1 and 88.1 ± 6.7) respectively. The difference (average 39.8) showed high statistical significance (P more...
- Published
- 2015
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50. Anatomical Reconstruction of Lateral Ankle Ligaments Using Free Tendon Allografts and Biotenodesis Screws
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Min-Ho Shin, Joon-Sang Eom, Dong-Oh Lee, Sang-Hun Lee, Hong-Geun Jung, and Jong-Tae Park
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Adult ,Joint Instability ,medicine.medical_specialty ,Adolescent ,Visual Analog Scale ,Visual analogue scale ,Bone Screws ,Tendons ,Young Adult ,Patient satisfaction ,Patient age ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Prospective Studies ,Range of Motion, Articular ,Prospective cohort study ,Synovitis ,business.industry ,Middle Aged ,Allografts ,Surgery ,Tendon ,Radiography ,Lateral ankle ligaments ,medicine.anatomical_structure ,Patient Satisfaction ,Ligaments, Articular ,Semitendinosus tendon ,Ankle ,business ,Ankle Joint ,Follow-Up Studies - Abstract
Background: Lateral ankle instability is one of the most common musculoskeletal disorders and can result in ankle damage. This study reports on the results of the anatomical reconstruction of ligaments using semitendinosus tendon allograft and bioabsorbable tenodesis screws for chronic lateral ankle instability, as well as the functional and radiological results of this procedure. Methods: From February 2007 to January 2013, 70 patients (72 ankles) underwent this procedure. Six patients were lost to follow-up, and ultimately 64 patients (66 ankles) were evaluated. Visual Analog Scale (VAS) pain scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores, Karlsson-Peterson ankle scores, and patient satisfaction were evaluated at a mean of 22.1 months (range, 12-68 months) postoperatively. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views. The mean patient age at surgery was 30.1 years (range, 16-59 years). Results: The mean VAS pain score decreased from 5.5 to 1.3 ( P < .05), and the mean AOFAS improved from 71.0 to 90.9 ( P < .05). The mean Karlsson-Peterson score improved from 55.1 to 90.3, whereas talar tilt decreased from 14.8 degrees to 3.9 degrees. There was no significant difference in clinical outcomes between the pretensioned and nonpretensioned groups. Conclusion: This procedure yielded successful results, including satisfactory ankle stability and clinical outcomes, in ankles with poor lateral ligament tissues. Level of Evidence: Level IV, case series. more...
- Published
- 2015
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