OBJECTIVE: To investigate effectiveness of simplified all-arthroscopic Broström technique in treatment of chronic lateral ankle instability in adolescents. METHODS: A clinical data of 21 adolescent patients with chronic lateral ankle instability, who met the selection criteria and were admitted between June 2023 and May 2024, was retrospectively analyzed. There were 18 males and 3 females with an average age of 16.0 years (range, 13-18 years). There were 9 cases of left ankle joint injury and 12 cases of right ankle joint injury. Anterior talofibular ligament (ATFL) injury was diagnosed by arthroscopy in all patients. There were 11 cases of cartilage injury, 5 cases of avulsion fractures, and 6 cases of ankle impingement syndrome. The time from first sprain to operation ranged from 3-60 months (mean, 12.0 months). The ATFL was repaired and the ankle joint stability was restored by simplified all-arthroscopic Broström technique. Visual analogue scale (VAS) score, Tegner score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson ankle function scale (KAFS) score, Foot and Ankle Outcome Score (FAOS) were used to evaluate ankle pain and function. MRI was used to evaluate the ligament healing. RESULTS: All patients were followed up 8-15 months (mean, 12.6 months). After operation, 1 patient suffered from superficial peroneal nerve injury, 1 patient developed anterior scar impingement on the ankle, 2 patients had superficial wound infection, and 1 patient suffered from sprain again. The VAS score, Tenger score, AOFAS score, KAFS score, and FAOS score significantly improved when compared with the preoperative scores ( P<0.05). MRI examination showed the ligament healing and good tension. CONCLUSION For adolescent patients with chronic lateral ankle instability, using simplified all-arthroscopic Broström technique to repair ATFL can effectively alleviate ankle pain, improve stability, and achieve good effectiveness.
Humans ; Joint Instability/surgery* ; Male ; Adolescent ; Female ; Arthroscopy/methods* ; Ankle Joint/physiopathology* ; Retrospective Studies ; Ankle Injuries/surgery* ; Lateral Ligament, Ankle/injuries* ; Treatment Outcome ; Chronic Disease ; Range of Motion, Articular

OBJECTIVE: To establish foot and ankle models of different lateral collateral ligament injuries of ankle joint, and conduct finite element analysis on, and to explore the force conditions of subtalar articular cartilage during foot inversion movements under different gait stages and under different loads. METHODS: A normal ankle CT scan of a 30-year-old male healthy volunteer (heighted 175 cm and weighted 60 kg) was selected. The CT images were imported into software such as Mimics 21.0, Geomajic 2017, and Solidworks 2017 respectively, extract the normal ankle bone model. Then, the foot and ankle finite element models of different lateral collateral ligament injuries of ankle joint were constructed and divided into anterior talofibular ligament(ATFL) rupture group, ATFL and calcaneo fibular ligament (CFL) rupture group, ATFL, CFL and posterior talofibular ligament (PTFL) rupture group, and control group with intact ligament function by ANSYS 2021. Corresponding horizontal and vertical loads and torques were applied respectively on tibia and talus according to the force conditions of different phases to simulate landing phase, neutral and off-ground phase in walking gait. The changes in stress distribution area and stress peak of subtalar articular cartilage in the loading phase, neutral phase and off-ground phase gaits among four groups were observed. Simulate varus sprain action, apply different loads of 600, 1, 800, and 4, 200 N respectively, and changes in stress distribution area and the stress peak of subtalar articular cartilage among four groups of models were observed. RESULTS: In the gait simulation, the stress results of loading phase in ATFL fracture group, ATFL and CFL fracture groups, ATFL, CFL and PTFL fracture groups, and control group were 0.889 54, 0.960 89, 1.139 20, and 0.722 64 MPa, respectively. The neutral response force results were 1.250 60, 1.358 50, 1.363 70, 1.246 40 MPa respectively;the results of corresponding forces off-ground phase were 1.029 90, 1.138 70, 1.145 90 and 0.832 40 MPa respectively. In the inversion simulation, the stresses of ATFL fracture group, ATFL and CFL fracture groups, ATFL, CFL and PTFL fracture groups, and control group under load of 600 N were 2.191 3, 2.208 5, 2.215 7, and 2.156 6 MPa respectively. The stresses under a load of 1 800 N were 7.134 7, 9.715 2, 10.064 0, and 7.107 0 MPa respectively;the stresses under a load of 4 200 N were 17.435 0, 25.309 0, 26.119 0 and 16.010 0 MPa respectively. CONCLUSION The lateral collateral ligament of ankle joint plays an important role in the stability of the subtalar joint, especially CFL plays an important role in restricting calcaneal varus. If these ligaments are damaged, it will cause instability of the subtalar joint and further lead to lesions in the subtalar articular cartilage. Relevant exercises should be reduced or the ligament injuries should be treated in a timely manner.
Humans ; Finite Element Analysis ; Male ; Adult ; Cartilage, Articular/physiopathology* ; Ankle Injuries/physiopathology* ; Ankle Joint/physiopathology* ; Biomechanical Phenomena ; Subtalar Joint/injuries* ; Tomography, X-Ray Computed

Ankle sprains are the most common lesion of the ankle joint which might result in chronic ankle instability (CAI). Significant strides have been taken to enhance our comprehension of the underlying mechanisms of CAI, as the exploration of novel surgical techniques and the identification of previously unrecognized anatomical components. The present review aims to provide an extensive overview of CAI, encompassing its pathophysiology, epidemiology, clinical assessment, treatment, and rehabilitation. Treatment of CAI requires a multifaceted algorithm, involving historical analysis, clinical evaluations, and diagnostic imaging. Surgical interventions for CAI primarily involve the anatomical and/or non-anatomical reconstruction and/or repair of the anterior talofibular ligament. Anatomical repair has exhibited superior functional outcomes and a reduced risk of secondary osteoarthritis compared to non-anatomical repair. Non-anatomical approaches fall short of replicating the normal biomechanics of the anterior talofibular ligament, potentially leading to postoperative stiffness. This review seeks to academically review and up-to-date literature on this issue, tailored for clinical practice, with the intent of aiding surgeons in staying abreast of this critical subject matter.
Humans ; Joint Instability/physiopathology* ; Ankle Joint/physiopathology* ; Chronic Disease ; Ankle Injuries/therapy*

Bosworth ankle fracture-dislocation is rare, known to be an irreducible type of ankle injury, with a high incidence of complication. We present two cases of even rarer variants of Bosworth ankle fracture-dislocation. The first case is a type of supination external rotation adduction, and the second case is a type of supination external rotation adduction. These types have not been described before. In both of the cases we failed to achieve close reduction, and therefore proceeded with emergency surgeries, with open reduction and internal fixation. Both of the cases were performed with a postero-lateral approach to reduce the dislocations, and fix the fractures successfully. Unfortunately in one of the cases, acute compartment syndrome developed post-surgically. However, both cases showed good functional outcomes.
Acute Disease ; Ankle Fractures ; physiopathology ; surgery ; Ankle Injuries ; physiopathology ; surgery ; Compartment Syndromes ; Fracture Dislocation ; physiopathology ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Male ; Open Fracture Reduction ; methods ; Postoperative Complications ; Recovery of Function ; Rotation ; Supination ; Treatment Outcome ; Young Adult

Ankle sprains are orthopedic clinical common disease, accounting for joint ligament sprain of the first place. If treatment is not timely or appropriate, the joint pain and instability maybe develop, and even bone arthritis maybe develop. The mechanism of injury of ankle joint, anatomical basis has been fully study at present, and the diagnostic problem is very clear. Along with the development of science and technology, biological modeling and three-dimensional finite element, three-dimensional motion capture system,digital technology study, electromyographic signal study were used for the basic research of sprain of ankle. Biomechanical and kinematic study of ankle sprain has received adequate attention, combined with the mechanism research of ankle sprain,and to explore the the biomechanics and kinematics research progress of the sprain of ankle joint.
Ankle Injuries ; physiopathology ; Ankle Joint ; physiopathology ; Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Sprains and Strains ; physiopathology

OBJECTIVETo evaluate biomechanical properties in different methods of internal fixation combined with distal tibiofibular syndesmosis injury, in order to provide a theoretical basis for clinical choice.

METHODSSix lower limbs specimens were collected and divided into 5 groups, including normal group, distal tibiofibular syndesmosis injury (injury group), 3 cortexes group, 4 cortexes group and hook-plate fixation group. Neutral position, plantar flexion position (30°), dorsiflexion (20°) supination external rotation position of foot movement were simulated on universal materials tester. Strength, stiffness and stability of ankle joint in 4 kinds of motion conditions were measured.

RESULTSThere was significant differences in strength and stiffness of ankle joint between injury group and normal group in 4 different kinds of motion conditions (P<0.05). Strength and stiffness of ankle joint in 3 cortexes group, 4 cortexes group and hook-plate fixation group were improved obviously in 4 different kinds of motion conditions, and biomechanical indexes were recovered normally or better than normal group. Stiffness of the three fixation groups were better than normal group,but there was no significant differences among three groups (P > 0.05), while stiffness of hook-plate fixation group was closed to normal group.

CONCLUSIONFor distal tibiofibular syndesmosis injury, 1 screw with 3 cortexes, 4 cortexes and hook-plate had a positive impact on strength, stiffness and stability of distal tibiofibular syndesmosis injury stress,and could restore the normal stabllity of ankle joint after reconstruction. While fixing by screw fixation would limit the rototary motion of ankle joint,ankle mortise could not adapt to changes of talus bone, thus induces screw breakage and traumatic arthritis. Hook-plate fixation is more suitable than 3 cortexes or 4 cortexes fixation for bilmechanical properties,and its' stress is more balance and can reduce postoperative complcations.

Ankle Injuries ; physiopathology ; surgery ; Biomechanical Phenomena ; Fibula ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; physiopathology ; prevention & control ; Reconstructive Surgical Procedures ; methods ; Tibia ; injuries ; surgery

OBJECTIVETo explore rest, cold compress and elevate (RICE) with rest, compress and elevate (RCE) without cold for the treatment of acute ankle sprain, in order to clear mid-term clinical effects.

METHODSEighty-nine patients with acute ankle sprains were collected from January 2013 to March 2014,including 30 males and 59 females aged from 18 to 60 years old with an average of 36 years old; the time from injury to hospital ranged from 3 to 24 h with an average of 9 h. All patients were divided into two groups according to visiting sequence. There were 45 patients in RICE group, and 45 patients in RCE groups. The main therapeutic effect index was evaluated by Karlsson scoring, and secondary therapeutic effect index was pain and satisfactory VAS scores. Safety index evaluated by adverse event.

RESULTSOn the 2nd weeks after injury, Karlsson score in RICE group was 44.66 ± 11.58, and 46.67 ± 8.52 in RCE group, while there was no statistical significance between two groups in Karlsson scores (P > 0.05). Karlsson score of two groups after treatment were higher than before treatment. There was no significantly meaning in pain and satisfactory VAS scores between two groups (P > 0.05). No adverse reaction were occurred between two groups.

CONCLUSIONCold compress did not receive much more final gains, and no evidence showed cold compress could affect recovery of joint function.

Acute Disease ; Adolescent ; Adult ; Ankle Injuries ; physiopathology ; therapy ; Case-Control Studies ; Cold Temperature ; Female ; Humans ; Male ; Middle Aged ; Sprains and Strains ; physiopathology ; therapy

OBJECTIVETo compare the efficacy difference of analgesia and detumescence on ankle sprain among acupuncture at Xiaojie point combined with tendon regulation manipulation, acupuncture at Xiaojie point and tendon regulation manipulation.

METHODSSixty cases of ankle sprain were randomized into a combined therapy group, a Xiaojie point group and a tendon-regulation manipulation group, 20 cases in each one. The combined therapy of acupuncture at Xiaojie point and tendon regulation manipulation, the acupuncture at Xiaojie point and the simple application of tendon-regulation manipulation were applied respectively in the three groups, once a day, 3 treatments were required. The symptom score such as pain, ecchymosis, swelling and motor dysfunction and the total score were observed before and after treatment in the three groups. The different values of pain and swelling scores were compared before and after treatment in the three groups. The efficacy was compared among the groups.

RESULTSThe total effective rate was 100.0% (20/20) in each group. But the curative rate was 85.0% (17/20) in the combined group, 65.0% (13/20) in the Xiaojie point tion manipulation group. After treatment, the symptom scores of pain, ecchymosis, swelling and motor dysfunction and the total score were all improved as compared with those before treatment in the three groups (P < 0.01, P < 0.05). The pain score in either the combined therapy group or Xiaojie point group was lower than that in the tendon-regulation manipulation group after treatment (0.20 -/+ 0.41, 0.15 +/- 0.37 vs 0.60 +/- 0.50, both P < 0.05). Swelling score in the Xiaojie point group was different significantly from that in the tendon-regulation manipulation 0.49 vs 06.4 vs. 20+0.41, P < 0.05). The different value of pain score in either the combined therapy group or Xiaojie point group was higher than that in the tendon-regulation manipulation group before group after treatment (0.65 bined therapy group or Xiaojie point group was higher than that in the tendon-regulation manipulation group before and after treatment (2.35 +/- 0.59, 2.45 +/- 0.51 vs 2.00 +/- 0.46, both P < 0.05). The different value of swelling score in the tendon-regulation manipulation group was higher than that in the Xiaojie point group before and after treatment (2.30 +/- 0.57 vs 1.60 +/- 0.60, P < 0.05).

CONCLUSIONAcupuncture at Xiaojie point combined with tendon-regulation manipulation achieve an apparent effect of analgesia and detumescence on ankle sprain.

Acupuncture Analgesia ; Acupuncture Points ; Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Ankle Injuries ; physiopathology ; therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Tendons ; physiopathology ; Therapy, Soft Tissue ; Young Adult

OBJECTIVETo observe the efficacy differences between electroacupuncture and physiotherapy on the proprioception of athletes with functional ankle instability (FAD.

METHODSFifty athletes with FAI were randomly divided into an electroacupuncture group and a physiotherapy group. The electroacupuncture group was treated with electroacupuncture at Jiexi (ST 41), Kunlun (BL 60), Qiuxu (GB 40) and Ashi acupoints, and the physiotherapy group was treated with low frequency electrical stimulation and infrared radiation at medial malleolus and lateral malleolus, thrice each week for consecutive 8 weeks. The Joint Position Sense: Active (JPSA), Joint Position Sense: Passive (JPSP) and Kinaesthesia (KT) were assessed at the ankle by use of Biodex System-III isokinetic dynamometer.

RESULTSThe JPSA of 11.090 +/- 3.1 degrees and the JPSP of 9.67 degrees +/- 2.8 degrees before the treatment reduced to 9.14 degrees +/- 4.0 degrees and 6.89 degrees +/- 3.3 degrees, respectively, after the treatment in the electroacupuncture group, with significant differences in JPSA and JPSP (both P < 0.05), compared with those in the physiotherary group, there were significant differences (both P < 0.05) and with no significant difference in KT (P > 0.05). There was no significant differences in the indices of JPSA, JPSP and KT in the physiotherapy group after 8 weeks than those before treatment (all P > 0.05).

CONCLUSIONElectroacupuncture can effectively improve the proprioception of athletes with FAI and achieves a superior efficacy as compared with the conventional physiotherapy.

Adult ; Ankle Injuries ; physiopathology ; therapy ; Ankle Joint ; physiopathology ; Athletes ; Electroacupuncture ; Female ; Humans ; Joint Instability ; physiopathology ; therapy ; Male ; Proprioception ; Young Adult

OBJECTIVETo explore the clinical effects of combined medial and lateral malleolus in treating severe fracture of ankle.

METHODSFrom May 2007 to January 2011,89 patients with ankle fracture who underment surgical treatment and had complete follow-up, the data were retrospectively analyzed. In this study, there were 66 males and 23 females with an average age of 30.9 years (ranged, 26 to 62 years). Cause of injury included road accidents in 52 cases,sprains from fall down in 17, construction injury in 16 and other injuries in 4. According to type of Denis-Weber, type A were in 13 cases, type B in 24, type C in 52. Operative technique was as follows. Chosen two-incision of combined medial and lateral malleolus, and reduced lateral malleolus fracture firstly, fixed it with 1/3 tubular armor plate or rebuilt-titanium plate. To chose one or two hollow screws according to the size of fracture block. If fracture of fibula was syntripsis,it can be multi-segmental fixed. If fracture line of posterior malleolus was no more than 1/3 articular surface of ankle or the bone displacement was not serious, it can be disregarded. And if the lesion level was over 1/3, or shift position more than 3 mm,it can be fixed with lag screw after reduction. Either front-to-back or back-to-front fixed direction was OK. At the third day after operation, the patients were instructed to exercise with affected limb, weight training after 6 weeks.

RESULTSEighty-nine patients were followed up from 6 to 24 months with an average of 16 months. Healing time of the fracture was 10 to 12 months. According to standard of the Baird-Jackson scoring system, 68 cases got excellent results, 18 good and 3 fair.

CONCLUSIONSurgical treatment is quite effective for severe fracture of ankle. It should be chosen correctly according to types of the fracture and degree of ligament injury. At the same time, damage degree of the ligament around the ankle should be considered and properly treated.

Adult ; Ankle Injuries ; physiopathology ; surgery ; Female ; Fracture Healing ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged