anatomical reconstruction; anterior talofibular ligament; arthroscopy; chronic ankle instability. Lateral ankle sprains are one of the most common injuries sustained during sport or physical activity. The 218 patients received tendon allograft reconstruction of the lateral ligament. Patients typically suffer from pain, recurrent ankle sprains and swelling of the ankle. All operations were carried out successfully, and both the anterior ankle drawer test and the varus stress test were negative under anesthesia after surgery. Injuries of the hindfoot. Method of checking LB stability. Allograft reconstruction may be especially useful in revision procedures. They . Epub 2019 Mar 27. Please enable scripts and reload this page. . Federal government websites often end in .gov or .mil. Arch Orthop Trauma Surg 1988;107:3268. This test was performed with the ankle held plantar-flexed at 15 degrees. Of the 112 cases of CLAI plus concurrent LB injury, 62 patients (55.4%) were men, and 50 (44.6%) were women. The procedure usually involves ankle arthroscopy along with tightening of the lateral ankle ligaments. Chronic ankle instability is usually caused by an ankle sprain that has not healed properly. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Repeated ankle sprains are a common cause of this syndrome. Pre- and postoperative values (AOFAS ankle-hindfoot scores, VAS scores, Karlsson ankle scores, and radiologic measurements) of measurement. The patients with signs of swelling in the region of the LB. 2022 Oct 20;17(1):459. doi: 10.1186/s13018-022-03354-4. Exclusion criteria: combined medial (deltoid ligament) and lateral ankle instability; local infection of the ankle joint; fracture of the tibia, fibula, talus, or calcaneus (except for the ankle avulsion of small bones). Proprioception is essential for neuromuscular control in relation to sport injury and performance. The APC is seen on the lateral view, but is projected over the talus. Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence Diagnosis and Treatment of Chronic Lateral Ankle Instability: Review of Our Biomechanical Evidence Authors Song Ho Chang 1 , Brandon L Morris , Jirawat Saengsin , Yves Tourn , Stephane Guillo , Daniel Guss , Christopher W DiGiovanni Affiliation Ankle sprains involve up to 30% of all sport injuries. Arthroscopic treatment of lateral ankle ligament instability; Chronic lateral ankle instability; Modified Brostrm procedure; Suture tape augmentation for lateral ankle ligament instability. During arthroscopy, osteophytes were encountered and resected in 14 patients in Group A and eight patients in group B. Gould N, Seligson D, Gassman J. China (e-mail: [emailprotected]). They were then supplied with a detailed physiotherapy program and were discharged a day after surgery. We aim to describe a treatment algorithm for chronic lateral ankle instability based on the arthroscopic findings of the calcaneofibular ligament (CFL). Moreover, the ATFL was incised, pulled distally, and attached with the CFL using the same anchor sutures. Radiology 1956;67:38690. Treatment Non . Chronic ankle instability most commonly occurs as a result of repeated ankle sprains. 2. Outcomes of the Modified Brostrm Procedure Augmented With Suture-Tape for Ankle Instability in Patients With Generalized Ligamentous Laxity. To reduce missed or delayed diagnosis of LB injury, CLAI patients should be thoroughly examined, and the LB should be treated via the method appropriate for the type of LB injury. Nevertheless, its value in chronic ligament tears is debatable. Unable to load your collection due to an error, Unable to load your delegates due to an error. The sensitivity and specificity of MRI in detecting CFL ruptures were 46.7% and 87%, respectively. This can lead to persistent ankle instability in the lateral ankle ligaments. Patients achieved satisfactory results after treatment with LB repair and reconstruction with an allograft, and achieved mechanical stability without serious complications. Gegenbaurs Morphol Jahrb 1981;127:792831. Sixty-eight of the 112 patients underwent LB repair, and 8 underwent LB reconstruction using allogeneic tendon grafts. Manual therapy is effective in promoting soft tissue repair. Hermans JJ, Wentink N, Beumer A, Hop WC, Heijboer MP, Moonen AF, Ginai AZ. An ankle inversion injury is the most common type of ankle sprain to occur. Nielsen S, Agnholt J, Christensen H. Radiologic findings in lesions of the ligamentum bifurcatum of the midfoot. Unable to load your collection due to an error, Unable to load your delegates due to an error, [Article in Rarely, operative management is indicated in the setting of syndesmosis injury with tibiofibular diastasis or chronic ankle instability with recurrent sprains. Clin Sports Med 2015;34:67988. During the 24-month review, we used the Clinical Rating System for the Ankle Hindfoot (AOFAS) and Tegner Activity Level Score for the clinical assessment and patient activity evaluation, respectively. Chronic instability can lead to loose ankle ligaments, loss of joint cartilage, and tendon injury. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Orthopaedics Department, Medical School, University of Patras, Patras, GRC, 4 81974338/the National Natural Science Foundation, xywm2015I34/the Xiangya-PKU Weiming Research Fund, 2017zzts238/the Fundamental Research Funds for the Central Universities of Central South University. Disclaimer, National Library of Medicine Stress ultrasound provides an ideal and immediate evaluation of the ligament integrity in the office. Both groups demonstrated significant improvement in their Tegner (p = 0.009) and AOFAS scores (p = 0.001) during their 24 months follow-up. For LB reconstruction, the tendon was fixed to the calcaneus, the cuboid, and the navicular bones in turn at the LB attachment area with 5.0-mm resorbing screws (Depuy Mitek, MA) (Fig. Synovitis and scar tissue formation were more common in group A (p = 0.011). All content published within Cureus is intended only for educational, research and reference purposes. Epub 2014 Dec 15. A total of 37 patients were put in group A and 30 in group B. Radiologic examinations were performed preoperatively and during final follow-up. The treatment options of immobilization and functional management are discussed. Weng PW, Chen CY, Tsuang YH, Sun JS, Lee CH, Cheng CK. Foot Ankle Int 2000;21:996-1003. Patients were given a comprehensive physiotherapy program and were discharged on the day of surgery with instructions to ambulate with partial weight-bearing. Clipboard, Search History, and several other advanced features are temporarily unavailable. Of the patients who underwent excision of the fracture fragment, the surgical result was rated as excellent by 1/32 (3.1%) patients, good by 11/32 (34.4%) patients, and fair by 20/32 (62.5%) patients. Chronic Lateral Ankle Instability - Everything You Need To Know - Dr. Nabil Ebraheim 218,176 views Dec 14, 2016 Dr. Ebraheims animated educational video describing the condition of. The https:// ensures that you are connecting to the Lee K, Jegal H, Chung H, Park Y. The diagnosis of LB injury can be missed or delayed. Even though ankle sprains are mostly inconsequential, some may recur as chronic occurrences. 991-996. . For chronic lateral ankle instability, we also need to look for other conditions such as peroneal tendon pathology, fractures, joint lesions . Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Song and G. Zhang of the Department of statistics and applications for their kind assistance. All analyses were carried out using SPSS Version 21 (IBM Corp., Armonk, NY, USA). However, recent data demonstrated that modified Brostrm-Gould reconstruction offered satisfactory results even in groups of professional ballet dancers, recreational artists, high-demand athletes, and military personnel [26-28]. Failure after strict rehabilitation may be an indication for surgery. This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. Please enable it to take advantage of the complete set of features! Purpose Treatment of chronic lateral ankle instability (CLAI) with poor remnant quality is challenging. All of the above are associated with poor postoperative outcome and higher risk for ankle arthritis. Anatomic reconstruction with an autograft or allograft should be considered when the torn ligaments are not adequate. Arthroscopic treatment for anterolateral impingement of the ankle: Systematic review and exploration of evidence about role of ankle instability. Yi G, Fu S, Yang J, Wang G, Liu Y, Guo X, Shi J, Zhang L. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. Lindner HO, Kaufner HK. Functional outcomes of all-inside arthroscopic anterior talofibular ligament repair with loop suture versus free-edge suture. We assessed 67 patients who were treated for chronic lateral ankle instability. HHS Vulnerability Disclosure, Help [4]. Accessibility Chronic ankle instability. Before Symptoms Pain, usually on the outer side of the ankle, may be so intense that you have difficulty walking or participating in sports. Valderrabano V, Hintermann B, Horisberger M, Fung TS. This site needs JavaScript to work properly. [9]. The test was considered positive for angles greater than 10 degrees or when the tibiotalar angle difference was more than 6 degrees. sharing sensitive information, make sure youre on a federal The right side was affected in 39 (39/67; 58.2%) cases and the left side in 28 (23/67; 41.8%) cases. The Mann-Whitney test was used for unpaired samples. Objectives: Brostrm technique; Brostrm-Gould technique; Evans technique; anatomic reconstruction; anatomic repair; ankle; ankle instability; arthroscopy; internal brace. Read all about the symptoms, causes, diagnosis and latest treatment methods 0207 078 3800 For Mark Davies, Matthew Solan & James Davis at St John & St Elizabeth Hospital and OneWelbeck 0207 403 4162 With myriad procedures described for chronic lateral ankle instability, there is little consensus on optimal treatment outcome or a truly "ideal" operation. The reconstruction technique described by Brostrm [11] is considered the cornerstone of anatomic repair. Wainright WB, Spritzer CE, Lee JY, Easley ME, DeOrio JK, Nunley JA, DeFrate LE. We accepted arthroscopy as the gold standard for assessing the integrity of the ATFL and CFL [13]. Vega J, Pea F, Golan P. Does antero-lateral ankle impingement exist? Clinical assessment of acute lateral ankle sprain injuries (ROAST): 2019 consensus statement and recommendations of the International Ankle Consortium[J]. . As the calcaneocuboid joint is part of Chopart joint line, we also performed dorsoplantar, lateral, and stress radiographs with about 20 kp varus stress at the level of the calcaneocuboid joint to measure the calcaneocuboid angle.[1315]. The rationale of anatomic reconstruction is to restore anatomy with direct repair of the identified ruptures and imbrication of the lateral ligaments. The chi-square test was used to compare dichotomous variables. Clin Orthop Relat Res 1977;28. 2017 Mar;38(3):324-330. doi: 10.1177/1071100716674997. Patients with an intact CFL were placed in group A while those with CFL tears in group B. Concomitant intra-articular pathologies, if present, were treated arthroscopically. Of the 67 patients, 29 left ankles and 38 right ankles were included in this study. Initial treatment is conservative, either with bracing or neuromuscular training. The mean age was 29.9 6.4 years (range: 13-50 years). J Med Imaging Radiat Oncol, 2008, 52(6): 559- 563. Federal government websites often end in .gov or .mil. Southern California Orthopedic Institute Sports Medicine and Arthroscopy Fellowship receives institutional support from Depuy Mitek and Smith & Nephew. In the present study, the LB was examined as described by Gellman[18] (Fig. Clipboard, Search History, and several other advanced features are temporarily unavailable. At 14 days postoperatively, the sutures were removed, and plaster fixation was applied for 4 weeks. Calcaneofibular ligament may act as a tensioner of peroneal tendons as revealed by a contactless three-dimensional scan system on cadavers. Fengqi Zhang designed the study; Yaning Sun, Yuchao Tang, Mingming Zhao, and Huijuan Wang inquired the EMR for variables of interest; Shiji Qin searched relevant literature and analyzed and interpreted the data; Yaning Sun and Huijuan Wang wrote the manuscript, and Fengqi Zhang approved the final version of the manuscript. The Kolmogorov-Smirnov test was utilized for normality analysis of the quantitative variables. The use of either strapping or bracing was recommended during rehabilitation, since both provide ankle support and hence decrease the risk of re-injury. Ankle sprain is often combined with LB damage. may email you for journal alerts and information, but is committed [3]. Our proposed algorithm offers a reliable method for accurate evaluation and successful treatment of chronic lateral ankle instability. Diagnostic and Therapeutic Centre of Athens - Hygeia issued approval JAK20200409P. Do not disregard or avoid professional medical advice due to content published within Cureus. A P-value of <.05 was considered to indicate a statistically significant difference. However, if symptoms persist and the ligaments on the outside of the ankle are elongated or torn, surgery is usually considered. Patients were asked to rate their overall satisfaction with the surgical results as excellent, good, fair, or poor (Table 1). 8600 Rockville Pike osteoarthritis subtalar joint pathologies In the long run, 20 30% of chronic ankle instability . This study aimed to report our institution's experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury. The ankle should be in neutral or slight plantar flexion to help align ATFL and CFL. The timely introduction of physical therapy speeds up the healing process. Inter-rater reliability for CFL tears was moderate on clinical examination (k = 0.514) and fair on MRI, in conjunction with ankle arthroscopy (k = 0.357). Chronic lateral ankle instability: Results of two-staged approach, correlation with magnetic resonance imaging findings, and incidence of associated pathologies - A 4-year follow-up study Shaival Dalal 1, Geralt Morgan 1 1 Department of Trauma and Orthopaedics, Princess of Wales Hospital, Glamorgan, United Kingdom Treatment The majority of ankle sprains will heal with time and are treated with rest, and physical therapy including peroneal muscle strengthening with proprioception and range of motion of the ankle. Roos KG, Kerr ZY, Mauntel TC, et al. The anterior talo-fibular ligament reconstruction in surgical treatment of chronic lateral ankle instability. Eversion strength and surface electromyography measures with and without chronic ankle instability measured in 2 positions. Careers. government site. It also prevents the ankle ligaments from weakening. We found that many patients with ankle instability also had Chopart lateral joint instability. Orthop Traumatol Surg Res 2016;102:65761. Following a lateral ankle sprain, 40% of individuals develop chronic ankle instability (CAI), characterized by recurrent injury and sensations of giving way. Bachman S, Johnson SR. Torsion of the foot causing fracture of the anterior calcaneal process. Epub 2016 Dec 20. Eils E, Demming C, Kollmeier C, Thorwesten L, Volker K, Rosenbaum D. Ankle taping and bracing for proprioception. 2022 Nov 18. doi: 10.1007/s00167-022-07211-z. Numerous surgical procedures have been described for the treatment of chronic lateral ankle instability beginning with Elmslie, in 1934, who first reported using fascia lata graft to reconstruct the lateral ankle ligaments. Postoperatively, some patients still had clinically detectable signs (discoloration, tenderness, and swelling) at the point of the LB. The mean number of recurrent inversion injuries per patient was 1.0 2.1 (range: 1-10), whereas the median duration of symptoms (interval between first injury and surgery) was 23 months (range: 6-168 months). government site. I wish to designate a dual first authorship by D. G. Economopoulos and I. K. Triantafyllopoulos. During a sprain, the ligaments in your ankle may have been stretched or torn, and when they healed it resulted in weaker and "stretched out" ligaments. PMC 42 In the clinical setting, orthotics are commonly prescribed for many reasons: to alter the rearfoot motion in the gait cycle, assist . Consent was obtained or waived by all participants in this study. Reconstruction of lateral ligaments of the ankle with allogeneic tendon grafts. An epidemiological observational study of midtarsal joint sprain showed that the most frequent trauma mechanism was foot inversion (76% of cases), followed by plantar hyperflexion (21%), dorsal hyperflexion (2%), and foot eversion (1%)[6,18,2124] (Fig. Whole-body vibration (WBV) has the potential to address the neurophysiologic deficits accompanied by CAI and . Three patients from group B complained of skin irritation. What is the best surgical treatment for this patient? Hence, the ATLF is the first ligament to be injured followed by the CFL and PTFL [10]. 2016 consensus statement of the International Ankle Consortium: prevalence, impact and long-term consequences of lateral ankle sprains[J]. [17] Outcomes were assessed by comparison of pre- and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale (VAS) pain scores, and Karlsson scores. [11]. Functional results of modified Mason-Allen suture versus horizontal mattress suture in the arthroscopic Brostrm-Gould procedure for chronic ankle instability. Open anatomic reconstruction is an effective method of stabilization. After 4 weeks, the weight of the brace was partially loaded for 4 weeks. LB = ligamentum bifurcatum. Epub 2020 Mar 2. The purpose of this meta-analysis was to compare different surgical techniques for management of chronic lateral ankle instability. The commonly occurring lateral ankle sprain, also called an inversion sprain, can be the precursor to painful and disabling chronic ankle instability. Ankle arthroscopy was performed in all patients. Postoperative follow-up was conducted for 12-24 (15.643.17) months. Twenty patients had tenderness and clinically detectable swelling at the point of the LB, but the degree of ankle pain was significantly reduced compared with preoperatively. Ligaments of the transverse tarsal joint complex: MRI-anatomic correlation in cadavers. The lateral component was comprised with the medial calcaneocuboid ligament, which extends anteriorly and anchored on the dorsomedial aspect of the cuboid. Clinicians should closely examine the LB in cases of CLAI, and should surgically repair or reconstruct the LB when necessary. Ankle instability and arthroscopic lateral ligament repair. Learn more about chronic ankle instability courtesy of Brace Direct. Arthroscopic debridement and double-bands anatomical reconstruction of the ATFL's fibular enthesis for the treatment of CLAI gains beneficial short-term effects for its minimal invasion and quick recovery. Katakura M, Odagiri H, Charpail C, Calder J, Guillo S; Ankle Instability Group. Get into a half-kneeling position on the floor with the ankle you are stretching in front Make sure your front foot flat on the floor and facing straight forward Shift your weight forward while keeping the heel firmly on the ground Keep the inner edge of the knee aligned with the big toe to prevent flaring in or outward Non-Operative Treatment. Thus, the absence of scar tissue could be indicative of a lower healing potential in patients with CFL tears and may justify the need for further ligament reconstruction. Walking exercise was permitted 10 weeks after the removal of auxiliary support, and patients were permitted to jog from 12 weeks postoperatively. Postoperative routine nursing and standardized rehabilitation exercise were recommended. An official website of the United States government. Inclusion criteria: history of CLAI for >6 months with pain, repeated episodes of ankle collapse, and swelling; positive anterior drawer test on physical examination; evidence of ankle instability on clinical or radiographic examination.[911]. . . official website and that any information you provide is encrypted After clinical examination, they were all investigated further with MRI scans and stress views. At the last follow-up, all patients were walking normally. To our knowledge, this study has the highest number of extremely active patients assessed for chronic lateral ankle instability. The LB is a double ligament with a common origin on the lateral aspect of the anterior process of the calcaneus (APC). . Ioannis K Triantafyllopoulos, Dimitrios G Economopoulos, [], and Louw van Niekerk. These results indicate that simple excision of the fracture fragment is not an ideal way to treat LB injury; it is worth mentioning that we cannot just excise the APC, as the scar tissue connection cannot compensate for LB function. The objective of this study was to compare the difference of plantar pressure distribution between surgical treatment and conservative treatment for CAI. Conversely, the greater severity of soft tissue damage and the substantial separation between the stumps of the torn ligaments in group B may be related to the lower incidence of synovitis and scar tissue. Brostrm reconstruction is associated with lower morbidity, quicker functional recovery, and no proprioception interference [23]. Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings. Gribble PA, Bleakley CM, Caulfield BM, et al. You may be trying to access this site from a secured browser on the server. In "functional" ankle instability, patients report a subjective feeling of "giving way" with provocative tests being negative. A modified Brostrm repair with transosseous fixation for chronic ankle instability: a midterm followup study in soldiers. Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. 80% patients with LB injury would present with all 3 clinical signs described above[17,19] (Fig. Patients returned for a clinical and radiologic follow-up evaluation at an average of 31 (range, 2435) months postoperatively. Highlight selected keywords in the article text. Surgical treatment of lateral ankle instability syndrome Numerous studies have shown that foot orthoses play a significant role in the treatment of lateral ankle instability, although the exact mechanism of their function is debated. "Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. One patient reported mild pain after exercise with morning stiffness, but had no difficulty walking on even ground. The posterior talofibular ligament was intact in both groups. . AOFAS scores measured during the 24-month follow-up demonstrated that most patients reported minor to no limitations regarding their fitness status (p < 0.001). Correspondence: Fengqi Zhang, Department of Foot and Ankle Surgery, The 3rd Hospital, Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang 050051, P.R. If there were discoloration, local tenderness, or swelling at this area, the supplementary imaging will be ordered, including stress x-rays and oblique views of the midfoot. Orthop Traumatol Surg Res 96:417-423 218 Arch Orthop Trauma Surg (2012) 132:211-219 123. The peroneal tendons and sural nerve were to be protected at the posterior end of the incision. Conservative management is the mainstay of treatment in chronic lateral ankle instability. We therefore recommend a treatment algorithm for chronic ankle instability depending on arthroscopic findings regarding the integrity of CFL. Inter-rater reliability for CFL tears was very high for clinical examination under anesthesia in conjunction with arthroscopy (k = 0.909), moderate between clinical examination and ankle arthroscopy (k = 0.514), and fair between MRI and ankle arthroscopy (k = 0.357). FOIA Your message has been successfully sent to your colleague. Simultaneous Treatment of Osteochondral Lesion Does Not Affect the Mid- to Long-Term Outcomes of Ligament Repair for Acute Ankle Sprain: A Retrospective Comparative Study with a 3-11-Year Follow-up. Patients suffered from repeated sprains which leaded to pain, swelling and obvious ankle relaxation. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. The paired t test and Wilcoxon signed-rank test were used to determine the differences. 2022 Nov 19;17(1):502. doi: 10.1186/s13018-022-03402-z. A key point to surgical treatment of chronic lateral ankle instability is choosing a suitable surgical procedure. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. : (anterior talofibular ligamentATFL)3~6ATFLATFL: 201512018167422517~41(12.63.2)2938ATFLXATFLATFL361224(American Orthopaedic Foot and Ankle SocietyAOFAS)(Karlsson ankle functionalKAF)(the Japanese Society for Surgery of the FootJSSF): 6752(77.6%)12(17.9%)II~III23(34.3%)IV5(7.5%)3(4.5%)212~24(15.643.17)64(95.5%)XAOFAS(94.786.37)(64.1712.43P<0.01)KAFJSSF(KAF91.0411.36 vs 59.7413.63P<0.01JSSF95.3210.21 vs 66.9214.38P<0.01): ATFL. Anterior talofibular ligament remnant quality is important for achieving a stable ankle after arthroscopic lateral ankle ligament repair. 2019. Karlsson J, Bergsten T, Lansinger O, Peterson L. The effect of modified Brostrm-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. A lateral ankle sprain occurs when the foot is twisted inward, stretching the ligaments to the point of injury. eCollection 2022. Du MZ, Su T, Jiang YF, Jiao C, Guo QW, Hu YL, Jiang D. Front Surg. It has a simple surgical approach and does not affect the talocrural and subtalar motion. Would you like email updates of new search results? 1). Giving way is considered an uncontrolled or unpredictable excessive inversion of the ankle joints that occurs at heel strike or toe-off during walking or running. Bethesda, MD 20894, Web Policies These three issues need to all be considered as part of a triad of chronic ankle instability issues. Sci Rep. 2022 Oct 5;12(1):16650. doi: 10.1038/s41598-022-21115-5. The lateral ligament repair is widely accepted as the primary operative treatment for chronic lateral ankle instability. 19 Younes C, Fowles JV, Fallaha M, et al. 2022 Nov 19;17(1):502. doi: 10.1186/s13018-022-03402-z. This test was performed with the ankle held at 15 degrees of plantar-flexion, the talus in extreme varus, and the tibia rotated internally at 10 degrees. Abbreviations: AOFAS = American Orthopaedic Foot and Ankle Society, APC = anterior process of the calcaneus, CLAI = chronic lateral ankle instability, LB = ligamentum bifurcatum, VAS = visual analog scale pain scores. [3,4] It is reported that 40.5% of patients with chronic lateral ankle instability (CLAI) have clinical signs of damage to the ligamentum bifurcatum (LB) of the midfoot[5]; missed or delayed diagnosis of LB injury is common, meaning that the true incidence of LB injury is probably higher. YS and HW have contributed equally to this work. Sun, Yaning MDa; Wang, Huijuan MDb; Tang, Yuchao MDa; Qin, Shiji MDa; Zhao, Mingming MDc; Zhang, Fengqi MDa,*, aDepartment of Foot and Ankle Surgery, the Third Hospital of Hebei Medical University, bDepartment of Histology and Embryology, Hebei Medical University. American Orthopaedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional (KAF) score, and the Japanese Society for Surgery of the Foot (JSSF) scale were used to evaluate the clinical outcomes. Surgical management for chronic lateral ankle ligament instability is useful when patients have failed nonoperative modalities. [15] (Fig. Funding support: This study was not supported by any funding. The anatomic location of the lateral ankle ligament and the LB. Rupture of calcaneocuboid ligament. CLAI occurs when functional or mechanical insufficiencies of the lateral ankle ligamentous complex persist. You may search for similar articles that contain these same keywords or you may It is the weakest ligament of the lateral ligament complex (LLC) and the first to be injured in ankle sprains [8]. [6]. Melo L, Canella C, Weber M, et al. Indeed, this modification resulted in reduced anterior talar displacement and a decreased talar internal rotation [25]. Most patients had no pain or occasionally mild pain. Foot Ankle Clin. However, as this is a retrospective study, the need for a superior level of evidence calls for the design of a prospective study with a higher number of participants and increased (more than 80%) statistical power. The minimally invasive ATFL reconstruction with partial peroneus brevis tendon has advantages of small trauma, good reconstruction a nd excellent clinical outcomes, thus, is a safe and effective method for the treatment of chronic lateral ankle instability. In such cases, the objective of operative treatment is to restore stability and decrease the risk of posttraumatic osteoarthritis. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by-nc-nd/4.0, March 2018 - Volume 97 - Issue 9 - p e0028, Diagnosis and treatment of chronic lateral ankle instability with ligamentum bifurcatum injury: An observational study, Articles in Google Scholar by Yaning Sun, MD, Other articles in this journal by Yaning Sun, MD, C5 palsy after C5/6/7 posterior foraminal decompression: A case report. Donnelly L, Donovan L, Hart JM, et al. . 8th Edition. Sammarco GJ, DiRaimondo CV. and transmitted securely. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. Chronic lateral ankle pain is recurring pain on the outer side of the ankle often develops after an injury such as a sprained ankle. Group B (capsule ligamentous reconstruction): During the first two postoperative weeks, a below-knee cast was applied. [18]. [14]. Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Thiounn A, Szymanski C, Lalanne C, et al. The work cannot be changed in any way or used commercially without permission from the journal. Finally, the lateral portion of the inferior extensor retinaculum was tagged to the periosteum of the fibula with absorbable sutures (Figures (Figures2,2, ,3).3). Toe-touch weight-bearing was allowed with the assistance of crutches. MRI is most useful for chronic ankle instability. [2] Surgical Management of Lateral Ankle Instability in Athletes. This retrospective study included 218 consecutive patients with CLAI who underwent surgery from January 2012 to December 2015. Two years after surgery, it improved to 96.6 6.84 in group A and 96.9 6.53 in group B, whereas the overall mean score was 96.9 6.54 (p < 0.001) (Table (Table11). The patients had an overnight stay for pain management. Surgical Treatement of Lateral Ankle Instability If conservative treatment fails, then surgery is a good option. If the injury does not improve with bracing and therapy over time, the best treatment is surgical ligament repair. 5). Disclosure Dr E. Ferkel discloses that he is a consultant and instructor for Arthrex and Ferring Pharmaceuticals. MAKHANI JS. Before Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. For more information, please refer to our Privacy Policy. Finally, as reports of LB injury are extremely rare, we cannot compare our method with methods used by other organizations. The patient who underwent LB reconstruction and rated the surgical result as poor was a 42-year-old man who had been involved in a motorcycle accident in which he sustained fractures of the right ankle; he returned to the hospital for open reduction and internal fixation of the calcaneal fractures, and recovered well after the second surgery. Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Sugimoto K, Takakura Y, Akiyama K, Kamei S, Kitada C, Kumai T. Surgical Considerations in the Treatment of Ankle Instability. Keywords: Of the LB reconstruction patients, the surgical result was rated as excellent by 6/7 (85.7%) patients, and poor by 1/7 (14.3%) patients. No major postoperative complications were documented regardless of the type of treatment. [5]. HHS Vulnerability Disclosure, Help Schneider W, Jurenitsch S. Sports activity level after surgical treatment for chronic anterolateral ankle instability: a multicenter study. The integrity of the CFL was evaluated clinically with the talar tilt test. Reconstruction of the lateral ankle ligaments using a split peroneus brevis tendon graft. 6). The operative procedure chosen depended on the fracture type. Disclaimer, National Library of Medicine 2012 Oct;40(10):2309-17. doi: 10.1177/0363546512455397. . treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter study. Before However, ankle stress radiography showed that the patient had achieved mechanical stability. Intraoperative arthroscopic examination of 67 patients showed inflammatory synovial hyperplasia in 52 cases (77.6%), obvious osteophyte hyperplasia in 12 cases (17.9%), talus osteochondral injury of grade II-III in 23 cases (34.3%), and cartilage injury of grade IV in 5 cases (7.5%). Type III fractures (large displaced fragment that involved the calcaneocuboid joint) underwent reconstruction with a graft. CFL tears mandated that modified Brostrm-Gould reconstruction would follow. Chronic Ankle Instability Treatment - London Foot and Ankle Centre Chronic Ankle Instability Treatment - London Foot and Ankle Centre. We searched the Cochrane Library, MEDLINE, and EMBASE. In patients with CFL tear, our algorithm mandated further treatment. Postoperatively, most patients recovered very well. This study aimed to report our institution's experience in the diagnosis and treatment of chronic lateral ankle instability (CLAI) with ligamentum bifurcatum (LB) injury. Hence, to fully support this observation, a double-blinded clinical study must be designed. Krips R, van Dijk CN, Lehtonen H, Halasi T, Moyen B, Karlsson J. Gellman M. Fracture of the anterior process of the calcaneus. Zhongguo Gu Shang. In contrast, the rationale for anatomic repair is to restore normal anatomy by imbrication of the lateral capsuloligamentous complex. 2017 Apr;38(4):405-411. doi: 10.1177/1071100716683348. Chronic Lateral Ankle Instability Full-text available Article Jan 2018 Dae-Wook Kim Ki-Sun Sung View Anatomic stabilization techniques provide superior results in terms of functional. Bennett WF. Patients with CLAI often have concurrent LB injury. Surgical management of chronic lateral ankle instability: a meta-analysis. FOIA In cases where the CFL was intact (group A) (Figure (Figure1),1), no further treatment was performed. Early and late repair of lateral ligament of the ankle. Treatment of Chronic Ankle Lateral Instability using Modified Brostrom Procedure Jae Hoon Ahn, M.D., Young-Geun Lee . Chronic ankle instability (CAI) has been defined as "repetitive bouts of lateral ankle instability resulting in numerous ankle sprains.". The site is secure. Adler H. Ligamentous injuries of the foot arch. These methods offer good results even in very active groups such as athletes and military personnel. http://creativecommons.org/licenses/by-nc-nd/4.0, Received in revised form February 7, 2018. Numerous operative techniques have been described for this type of injury. During this period, isometric and progressively active exercises commenced. Li X, Lin TJ, Busconi BD. We also demonstrated that MRI scans and clinical examination lacked sensitivity for diagnosing LLC injuries, even though clinical examination was highly specific. A modification described by Gould [17] proposed that additional mobilization and reattachment of the lateral portion of the extensor retinaculum to the fibula would offer greater talocrural and subtalar joint stability. The use of orthotics shows promise in the treatment of ankle instability, particularly in response to improving balance after injury 39 or fatigue, 40 when rearfoot motion is altered, 41 and in normal subjects. Despite their previous high level of activity, our studied population demonstrated a very low post-injury mean Tegner score of 3.62 1.29 (range: 0-10). For example, end range dorsiflexion and end range plantar flexion, which are of particular importance. If this injury is not properly treated by reducing inflammation, and by resting the affected ankle and protecting it from further trauma, it may remain stretched into a lengthened position and subsequently heal that way. Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis. Conservative management is the modality of choice for acute lateral ankle ligament injuries, and operative treatment is reserved for special cases. We evaluated our outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS clinical rating system) [15] and Tegner activity level score [16]. At the time of final follow-up, 78.6% (77/98) of patients (92 ankles) were free of pain. With a history of ankle sprain, this patient presented with pain and ankle instability months after a precipitating injury as a result of tearing of the ligaments near the ankle bone at the outside aspect of the foot/ankle. These findings agree with other studies citing that MRI has limitations in diagnosing CFL injuries [29,30]. Chronic ankle instability can result from untreated or badly managed acute lateral ankle ligament injuries. Check Now Make an appointment Foot and Ankle Conditions Adult Conditions Symptom Checker 2nd MTP Joint Instability 5th Metatarsal Base Fracture Accessory Navicular Achilles Tendon Problems [1,2] Especially in the active population, where lateral ankle sprain accounts for up to 20% of all sports-related injuries. Allograft or suture tape augmentation can be useful for patients with generalized ligamentous laxity, patients with high body mass index, and elite athletes. Epidural anesthesia was administered, and the patient was placed in supine position with a thigh tourniquet. Bookshelf The lateral capsuloligamentous complex was divided. PMC Its integrity is compromised when excessive stress is applied while the ankle is inverted and dorsiflexed. Conversely, the purpose of non-anatomic reconstruction is to regain stability through various tenodesis techniques. Its high inter-rater reliability in conjunction with ankle arthroscopy corroborates that it is a highly efficient diagnostic tool for the assessment of chronic ankle instability. Would you like email updates of new search results? 3); the extruding base of the fifth metatarsal can be palpated with the middle finger of the examiner, and the external malleolus be hold with the thumb, the marked tender point of the LB injury can be felt upon by the crooked index finger, between these 2 bones. [12] Contraindications to this surgery included congenital collagen deficiency, bodyweight >120 kg, severe heart disease, lesions affecting liver and kidney function, severe diabetes, central nervous system diseases, and other medical diseases. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Ankle sprains are common injuries that may recur as chronic conditions. The left foot was involved in 69 cases (61.6%), and the right in 43 cases (38.4%). [8]. In these cases, if instability is still present after a comprehensive nonoperative treatment, a surgical stabilization is required [5], [6], [7]. Agnholt J, Nielsen S, Christensen H. Lesion of the ligamentum bifurcatum in ankle sprain. Foot Ankle Surg. Magnetic resonance imaging (MRI) also offers valuable information for the assessment of chronic ankle instability patients [7]. Feng SM, Sun QQ, Wang AG, Chang BQ, Cheng J. Orthop Surg. Philadelphia, PA: Mosby Elsevier; 2007. Ankle sprains are common musculoskeletal injuries, especially among sportspersons and athletes. Chronic ankle instability is truly a complex of three possible issues including ligament tear and laxity, peroneal tendon tear, and possible cartilage damage. sharing sensitive information, make sure youre on a federal Similarly, LB injury may cause avulsion fractures of the APC. Its most serious complication is superficial peroneal or sural nerve injury. J Athl Train 2002;37:45862. A: Inversion-adduction is the common mechanism causing the anterior talofibular ligament and the LB injury. [16] When the anterior talofibular ligament and the calcaneofibular ligament were successfully reconstructed, the LB was checked for relaxation or complete rupture due to avulsion fracture. Failure after strict rehabilitation may be an indication of surgery. Baumbach SF, Braunstein M, Herterich V, Bcker W, Waizy H, Polzer H. Oper Orthop Traumatol. Modification of the Brstrom repair with suture anchors has been used to address chronic lateral ankle instability. Please try again soon. This is because the LB plays a very important role in maintaining the stability of the lateral transverse tarsal joint. [23]. and transmitted securely. In patients with ankle sprain, anterior talofibular ligament injury may cause avulsion fracture. No postoperative residual swelling was identified. Chronic lateral ankle instability (CLAI) is defined as recurrent sprains or repeated "giving way" resulting from trauma for at least 1 year. Some authors highlighted the role of the ATFL in rotational ankle microinstability and the need for its repair when a tear is present [18,19]. 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