OBJECTIVE: To systematically review the clinical efficacy of total ankle arthroplasty (TAA) and ankle arthrodesis (AA) in the treatment of end-stage ankle arthritis. METHODS: The PubMed, EMBASE and Cochrane Library databases were searched for articles published in the treatment of end-stage ankle arthritis with AA or TAA from the establishment of the database to June 2021. Bias risk tool was used to evaluate the quality of the literature. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale(AOFAS), visual analog scale (VAS), ankle osteoarthritis scale(AOS), gait analysis (pace, frequency, stride), range of motion (ROM), satisfaction, complications and reoperation rate were analyzed by meta-analysis between AA and TAA groups by RevMan 5.3 software. RESULTS: A total of 12 articles were included, including 1 050 patients in the AA group and 3 760 patients in the TAA group, totaling 4 810 patients. Meta-analysis showed that the total score of AOFAS[MD=-3.12, 95%CI(-9.02, 2.96), P=0.31], pain score [MD=1.60, 95%CI(-1.35, 4.54), P=0.29], alignmentl score[MD=-0.04, 95%CI(-0.52, 0.44), P=0.88], VAS[MD=0.10, 95%CI(-0.49, 0.68), P=0.74], and AOS total score [MD=-4.01, 95%CI(-8.28, 0.25), P=0.06], the difference was not statistically significant (P>0.05). The score of AOFAS functional in TAA group was significantly higher than that in TAA group[MD=44.22, 95%CI(-8.01, -0.43), P=0.03]. There was no significant difference in gait analysis between the two groups (P>0.05). Postoperative ROM [MD=-4.93, 95%CI(-6.35, -3.52), P<0.000 01] and change in ROM from preoperative to follow-up[MD=-5.74, 95%CI(-8.88, -2.61), P=0.0003] between two groups, the difference was statistically significant. There was no significant difference in satisfaction between the two groups [OR=1.011, 95%CI(0.46, 2.23), P=0.98]. Complications [OR=1.61, 95%CI(1.26, 2.06), P=0.0002] and non-revision reoperation [OR=1.61, 95%CI(1.17, 2.21), P=0.003] were significantly lower in the TAA group than in the AA group. There was no significant difference in the rate of revision and reoperation(P>0.05) between the two groups [OR=1.02, 95%CI(0.37, 2.78), P=0.97]. CONCLUSION The clinical efficacy of AA is similar to that of TAA, but the non revision reoperation rate and main surgical complications of TAA are significantly reduced. Therefore, further high-quality methodological research and long-term follow-up are needed to confirm this conclusion.
Humans ; Ankle/surgery* ; Ankle Joint/surgery* ; Arthroplasty, Replacement, Ankle ; Treatment Outcome ; Osteoarthritis/surgery* ; Arthrodesis ; Retrospective Studies

Ankle Injuries ; diagnosis ; surgery ; therapy ; Ankle Joint ; surgery ; Humans ; Joint Instability ; diagnosis ; surgery ; therapy

In this special issue, several papers related to clinical application of arthroscopic surgery are published, which present the current situation of arthroscopic techniques in our country. As a technique of minimally invasive orthopedics, arthroscopy is used in examination, diagnosis and treatment of joint diseases, which is the trend of modern surgery. Arthroscopy has been widely used in surgical procedures in knee diseases, and now it expands the scope of application to other joints, such as shoulder, elbow, wrist, hip, ankle and even smaller joints. The application scope of arthroscopy has spread from arthroscopic debridement to reparative and reconstructive surgery. Some innovation has been made in extra-articular surgeries. Researchers conduct in depth study and exploration in the basic and clinical application of arthroscopy. Arthroscopic surgery has become an indispensable branch of modern orthopedics.
Ankle Joint ; surgery ; Arthroscopes ; Arthroscopy ; methods ; Elbow Joint ; surgery ; Humans ; Joint Diseases ; diagnosis ; surgery ; Knee Joint ; surgery ; Wrist Joint ; surgery

Lateral process fractures of talus are rare injuries with a potential to cause significant morbidity if misdiagnosed. The appropriate management of these fractures is still controversial and only a few reports are avai- lable on this subject. We presented a case of a 37-year-old male with neglected fracture on the lateral process of talus which was misdiagnosed at the time of injury. The patient presented to 7 months after misdiagnosis with a chronic ankle pain. Our case is unique in the sense that it is a rare case of neglected fracture on the lateral process of talus which presented as a loose body in sinus tarsi. However, a surgery with an excision of the loose body presented a satis- factory outcome along with 2 years' follow-up. To our knowledge, it ought to be the first case reported in the English literature. Through this case report, we highlight the importance of high index of suspicion for such rare bony injuries while evaluating trauma to the lateral side of ankle and discuss the principles of management of these fractures.
Ankle Fractures ; Ankle Injuries ; surgery ; Ankle Joint ; surgery ; Diagnostic Errors ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; Talus ; injuries

OBJECTIVE: To explore the clinical efficacy of reconstruction the anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon for the treatment of chronic lateral ankle instability. METHODS: The clinical data of 42 patients with chronic lateral ankle instability treated by anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament with autologous peroneus brevis tendon from July 2016 to July 2019 was retrospectively analyzed. Including 30 males and 12 females, age ranged from 25 to 46 years old with an average of (37.6±12.4) years. There were 15 cases of left foot and 27 cases of right foot, the time from injury to operation was 3 to 12 months with a mean of (7.4±2.8) months. And 14 patients had tenderness in lateral collateral ligament area, 28 patients complained of multiple ankle sprains while walking on the flat ground. At 12 months after operation, the talar tilt angle and visual analogue scale(VAS)were observed, ankle joint varus stress and anterior drawer test were performed to check the mechanical stability of the ankle joint, American Orhopaedic Foot and Ankle Society(AOFAS) was used to score the ankle and hindfoot functions and evaluate the curative effect. RESULTS: Forty patients were followed up for 12 to 48 months with an average of (28.3±10.0) months, 2 cases were lost. The VAS decreased from(4.50±0.93) scores before surgery to (1.10±0.30) scores at 12 months after surgery;the talar tilt angle was reduced from (12.26±1.13)° before operation to (4.60±0.45)° at 12 months after operation;the AOFAS score increased from (65.10±7.50)scores before surgery to (84.40±3.95) scores at 12 months after surgery;all the differences were statically significant(P<0.05). According to the AOFAS score, 27 cases got excellent results, 7 good, 5 fair, and 1 poor. One patient had the symptoms of sural nerve injury after operation, and the symptoms were relieved after oral Mecobalamin for 3 months. The remaining patients had no complications such as nerve injury, infection, and skin necrosis. There was no instability of ankle joint, and both ankle varus stress test and drawer test were negative. CONCLUSION Autologous peroneal brevis tendon with double bone channel pass through the tendon (modified Chrisman-Snook operation) can anatomically reconstruct the anterior talofibular ligament and the calcaneofibular ligament, restore the stability of the patient's ankle joint, reduce postoperative complications, and restore ankle joint function well.
Adult ; Ankle ; Ankle Joint/surgery* ; Female ; Humans ; Joint Instability/surgery* ; Lateral Ligament, Ankle/surgery* ; Male ; Middle Aged ; Retrospective Studies ; Tendons

OBJECTIVE: To explore clinical effects of single-tunnel pullout structure fixation and anatomical reconstruction of lateral ligament complex in treating chronic lateral ankle instability. METHODS: From January 2016 to December 2018, clinical data of 23 patients with chronic lateral malleolus instability who underwent anatomical reconstruction of lateral malleolus ligament complex with single-tunnel pullout structure fixation, were retrospectively studied. Among them, including 7 males and 16 females, aged from 17 to 33 years old with an avergae of (26.0±4.3) years old;16 patients classified to grage 0, and 7 patients classified to gradeⅠaccording to Kellgren-Lawrence(K-L) grading;the time of sprain ranged form 2 to 15 with an average of (5.7±2.9) times;the time from injury to operation ranged to 4 to 18 months with an average of (9.0±3.3) months. The range of movement of operative and uninjured ankle joints were measured at 24 months after opertaion, visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate ankle joint function and improvement of pain, K-L grading and MRI scoring of osteoarthritis of ankle (MSOA) were used to evaluate degree of cartilage degeneration of ankle joint. RESULTS: All patients were followed up from 24 to 48 months with an average of (33.4±6.7) months. All the anterior talofibular ligaments and calcaneofibular ligaments were dissected and reconstructed by single-tunnel pullout structure fixation. The range of motion of dorsiflexion, plantarflexion, varus, and valgus on the operative side of ankle joint were smaller than those on the healthy side. There were no statistically differences in dorsiflexion and eversion between operative side and healthy side of ankle joint ( CONCLUSION Treatment of chronic lateral ankle instability with reconstruction of lateral ligament complex with single-tunnel pullout structure fixation could provide better tendon and bone healing conditions, improve surgical safety and could achieve satisfactory clinical outcomes.
Aged ; Ankle ; Ankle Joint/surgery* ; Female ; Humans ; Infant ; Joint Instability/surgery* ; Lateral Ligament, Ankle/surgery* ; Male ; Retrospective Studies

OBJECTIVE: To explore clinical effect of repairing anterior talofibular ligament with knot-free anchors under total ankle arthroscopy in treating chronic lateral ankle instability. METHODS: From April 2018 to August 2021, 24 patients with chronic lateral ankle instability were treated with knot-free anchors under total ankle arthroscopy to repair anterior talofibular ligament, including 16 males and 8 females, aged from 22 to 42 years old with an average of(28.6±5.8) years old;the time from injury to opertaion ranged from 6 to 10 months with an average of(7.7±1.3) months. Preoperative and postoperative American Orhopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), talar tilt, anterior talar translation(ATT) were recorded and compared. RESULTS: All patients were followed up from 10 to 12 months with an average of (10.2±1.14) months. Incision were healed at stageⅠ, and no infection, nerve injury and lateral ankle instability occurred. AOFAS score improved from(52.79±8.96) before opertaion to (93.00± 4.01) at 6 months after operation, 23 patients got excellent result and 1 good;VAS decreased from (5.50±0.98) before opertaion to (1.04±0.80) at 6 months after operation(P<0.05);talar tilt decreased from(9.16±2.09)° to (3.10±1.72)° at 3 months after operation(P<0.05);ATT decreased from(8.80±2.55) mm to (2.98±1.97) mm at 3 months after operation(P<0.05). Twenty-four patients drawer test and varus-valgus rotation wer negative. CONCLUSION Repairing anterior talofibular ligament with knot-free anchors under total ankle arthroscopy for the treatment of chronic lateral ankle instability has advantages of less trauma, less complications safe and reliable, and good recovery of ankle joint function.
Female ; Male ; Humans ; Young Adult ; Adult ; Ankle Joint/surgery* ; Ankle ; Arthroscopy ; Lateral Ligament, Ankle/surgery* ; Joint Instability/surgery*

OBJECTIVE: To investigate the mid-to-long-term efficacy of patients with chronic ankle instability combined with posterior impingement syndrome after 3-9 years of follow-up, and to analyze the influencing factors. METHODS: From February 2010 to December 2015, 46 patients underwent concurrent lateral ankle ligament repair with posterior ankle arthroscopic surgery at the Institute of Sports Medicine, Peking University Third Hospital. The patient was first placed in a prone position and underwent arthroscopic debridement for the posterior impingement. After finishing the posterior arthroscopy, the surgeon and assistants first translated the patient to the affected side, then turned to the healthy side, and changed the position to the supine position. During the turning over, another assistant held the arthroscope and the instrument to ensure that it was sterile and could be used without replacement. The anterior ankle arthroscopy was operated if necessary and the lateral ankle ligament repair was anatomic repaired with anchors. The 42 patients were followed up, including 26 males and 16 females. The average age was (28.9±10.0) years. The patient's clinical symptoms, joint stability, mobility and motor function were compared by questionnaire and physical examination. The preoperative and postoperative visual analogue scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Tegner scores were compared, and the clinical scores and the patient age, gender, height and weight were compared. The correlations between body mass index (BMI), preoperative duration, surgery duration, and cartilage injury were analyzed. RESULTS: The mean follow-up time was (71.8±22.8) months. The postoperative VAS scores (1.0 vs. 5.0, P<0.001), AOFAS scores (92 vs. 80, P<0.001), and Tegner scores (6.5 vs. 2, P<0.001) were significantly superior to the preoperative levels. The excellent and good rate was 97.6%. The postoperative VAS score (t=2.719, P=0.10), AOFAS score (t=-2.853, P=0.10), Tegner score (t=-3.443, P=0.001) and time to return exercise (t=2.814, P=0.008) were negatively correlated with the patient age, and the postoperative VAS score was negatively correlated with cartilage injury (Z=-2.195, P=0.028). CONCLUSION The mid-to-long-term clinical outcomes of the chronic ankle ligament instability combined with the posterior impingement were good. The age of the patients was negatively correlated with the clinical outcome. The combined cartilage injury could aggravate the postoperative pain.
Adolescent ; Adult ; Ankle ; Ankle Joint ; Arthroscopy ; Female ; Humans ; Joint Instability/surgery* ; Lateral Ligament, Ankle/surgery* ; Male ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the clinical effect of arthroscopic excision of the os subfibulare in anterior-lateral ankle pain.

METHODSFrom December 2005 to Augest 2014, 16 patients suffering from pain associated with an os subfibulare in the anterior-lateral side of their ankles were reviewed. Among the patients,11 patients were male and 5 were female, with a mean age of (33.5 ± 15.6) years old. The mean maximum diameter of os subfibulare was (0.70 ± 0.26) cm. All the patients underwent excision of the osseous fragments, and had anatomic reconstruction of the anterior talofibular ligament if the anterior-lateral ankle was instable. The average follow-up period was (18.0 ± 4.5) months. To analyze the surgical outcome, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot pain and function scales,visual analogue scale (VAS) and Tegner activity scale were assessed preoperatively and postoperatively.

RESULTSAOFAS scales were preoperative 60.15 ± 14.52 and postoperative 92.35 ± 5.73. There was a significant difference between them (t = -8.251, P = 0.000). The mean VAS score were preoperative 7.35 ± 0.46 and postoperative 2.45 ± 0.98. Statistical significance was also notable (t = 18.105, P = 0.000). Tegner score was significantly increased from preoperative 2.87 ± 1.12 to postoperative 5.78 ± 1.06 (t= -7.548, P = 0.000).

CONCLUSIONIrrespective of the size of os subfibulare, in patients with pain or instability associated with the os subfibulare, arthroscopic excision combined with reconstruction of ther anterior talofibular ligament or not was effective in restoring ankle function and eliminating pain.

Adult ; Ankle Injuries ; surgery ; Ankle Joint ; surgery ; Arthroscopy ; methods ; Female ; Fibula ; surgery ; Humans ; Lateral Ligament, Ankle ; surgery ; Male ; Middle Aged

Arthroscopic treatment of ankle impingement syndrome (AIS) is a minimally invasive surgical procedure used to address symptoms caused by impingement in the ankle joint. This syndrome occurs when there is abnormal contact between certain bones or soft tissues in the ankle, leading to pain, swelling, or limited range of motion. Traditionally, open surgery was the standard approach for treating AIS. However, with advancements in technology and surgical techniques, arthroscopic treatment has become a preferred method for many patients and surgeons. With improved visualization and precise treatment of the arthroscopy, patients can experience reduced pain and improved functionality, allowing them to return to their daily activities sooner. In this paper, we reviewed the application and clinical efficacy the of arthroscopic approach for treating AIS, hoping to provide a reference for its future promotion.
Humans ; Ankle Joint/surgery* ; Ankle ; Joint Diseases/etiology* ; Treatment Outcome ; Arthroscopy/methods* ; Pain