Lateral Ligament, Ankle/injuries* ; Ankle Joint

PURPOSE: To investigate the clinical effects of arthroscopically artificial ligament reconstruction with tensional remnant-repair in patients who are obese, and/or with demand for highly intensive sports, and/or with poor-quality ligament remnants. METHODS: A retrospective case series study was performed on patients treated by arthroscopically anterior talofibular ligament (ATFL) reconstruction with tensional remnant repair technique from January 2019 to August 2021. General data, including demographics, surgical time, and postoperative adverse events, were recorded. The American Orthopaedic Foot and Ankle Society score (AOFAS), foot and ankle ability measure (FAAM), visual analog scale (VAS), and anterior talar translation were measured preoperatively and at 6 weeks, 3 months, and 2 years postoperatively. Ultrasonography examination was performed preoperatively and 2 years postoperatively to evaluate the ATFL. Data were analyzed using SPSS 19.0. F test was used to analyze the pre- and postoperative VAS, FAAM, and AOFAS scores. The significance was set at p < 0.05. RESULTS: There were 20 males and 10 females among the patients with a mean age of (30.71 ± 5.81) years. The average surgical time was (40.21 ± 8.59) min. No adverse events were observed after surgery. At 2 years postoperatively, the anterior talar translation test showed grade 0 laxity in all patients. VAS score significantly decreased from preoperatively to 6 weeks, 3 months, and 2 years postoperatively (p < 0.001). Improvement of FAAM score and the AOFAS score from preoperatively to 6 weeks, 3 months, and 2 years postoperatively was statistically significant (p < 0.001). At 3 months postoperatively, most patients (23/30) could return to their pre-injured activities of daily living status. At 2 years postoperatively, all patients were able to return to their pre-injured activities of daily living status, and almost every patient (18/19) who expected highly intensive sports returned to sports with only 1 obese patient failing to achieve the goal. The ultrasonography examination at 2 years postoperatively showed that there was a linear band structure of soft tissue on the tension-rich fiber tape image from the fibular to the talar attachment sits of ATFL. CONCLUSION The novel arthroscopically artificial ligament reconstruction with tensional remnant-repair technique for ATFL achieved satisfactory clinical outcomes in the short and medium term after operation, and allowed early return to pre-injured activities, which could be a reliable option for patients with chronic lateral ankle instability.
Male ; Female ; Humans ; Young Adult ; Adult ; Ankle Joint/surgery* ; Retrospective Studies ; Activities of Daily Living ; Ankle Injuries/surgery* ; Lateral Ligament, Ankle/surgery* ; Joint Instability/surgery* ; Ligaments ; Obesity ; Arthroscopy/methods*

BACKGROUND: Ankle inversion sprain is a common musculoskeletal injury due to an inward foot twist. It results in pain, swelling, limited movement, instability, and tenderness of the injured ankle. Standard physical therapy (PT) for acute ankle inversion sprain involves cryotherapy, range of motion, balance, and strengthening exercises. Biomechanical Taping (BMT) is an adjunct to PT. OBJECTIVES: To identify the short-term effects of BMT and PT on pain and function of individuals with acute ankle inversion sprains. METHODS: Two licensed physiotherapists screened the participants. Eligible participants were treated 3x/week with BMT and PT, with a day of home exercises in between treatments. Participants answered the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM). Friedman Test was used to determine differences in prepost measurements of VAS and FAAM. RESULTS: 17 participants (10 males: 7 females) with unilateral acute ankle inversion sprains were included in the study with a mean (95% CI) age of 21 (20-22) years. BMT and PT (a) decreased VAS mean rank scores at Treatments 3 and 5 (p<0.05); (b) improved FAAM-ADL mean rank scores in Treatments 1 and 3 (p<0.05); (c) improved FAAM-Sports mean rank scores in all Treatments (p<0.05); and (d) improved in VAS, FAAM ADL and Sports scores between Treatment 1, Treatment 2 and Treatment 3 (p<0.00001). CONCLUSION BMT may be an effective adjunct to PT in improving pain and function of participants with acute ankle inversion sprains. The increased stability created by BMT may underpin the improved pain and function of participants.
Ankle Injuries ; Fascia ; Lateral Ligament, Ankle ; Pain

Ankle sprain is one of the most common musculoskeletal injuries. Although most ankle sprains respond well to conservative measures, chronic instability following an acute sprain has been reported to occur in 20% to 40% of patients. Some individuals are eventually indicated for a lateral ankle ligament reconstruction due to persistent ankle instability. More than 80 surgical procedures have been described to address lateral ankle stability. These range from direct repair of the anterior talofibular ligament (ATFL) and of the calcaneofibular ligament (CFL) to reconstructions based on the use of autograft or allograft tissues. However, the best surgical option remains debatable. The modified Broström procedure is most widely used for direct ligament repair, but not always possible because of the poor ATFL or CFL quality or deficiency of these ligaments, which prevents effective shortening imbrication. Furthermore, the importance of a CFL reconstruction has been emphasized recently. On the other hand, it is difficult to achieve an efficient CFL reconstruction during the Broström procedure. Others have reported that an anatomic reconstruction of injured ligaments restores the normal resistance to anterior translation and inversion without restricting subtalar or ankle motion, and as a result, anatomic reconstructions for lateral ankle instability utilizing an autograft or allograft tendon have gained popularity.
Allografts ; Ankle Injuries ; Ankle* ; Autografts ; Hand ; Humans ; Lateral Ligament, Ankle ; Ligaments* ; Sprains and Strains ; Tendons*

Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures. However, diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation. We present the case of a 21-years old female treated with excision after radial head fracture, resulting in elbow instability. The patient underwent revision surgery after four weeks. We believe that ligament reconstruction without radial head substitution is a safe alternative choice for Mason III radial head fractures accompanied by complex ligament lesions.
Adult ; Elbow Joint ; injuries ; Female ; Fracture Fixation ; Humans ; Joint Instability ; therapy ; Lateral Ligament, Ankle ; surgery ; Radius Fractures ; complications ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

PURPOSE: Anterior drawer and varus stress radiographs are commonly to diagnose chronic lateral ankle instability. We compared the preoperative stress radiographs with the intraoperative radiographs under anesthesia to determine the accuracy and efficacy of stress radiographs in an outpatient clinical environment. MATERIALS AND METHODS: Data was collected from patients who underwent a modified Broström operation for painful chronic unilateral lateral ankle instability between January 2014 and June 2016. Subjects were divided into three groups—complete tear, partial tear, and instability without rupture—according to the status of preoperative MRI findings of the anterior talofibular ligament. The anterior drawer and varus stress radiographs were taken preoperatively and intraoperatively under anesthesia. RESULTS: Ninety-six patients, with a mean age of 29.63 years, were enrolled. There were 39, 46, and 11 patients in the complete tear, partial tear, and instability without rupture groups, respectively. On the anterior drawer and varus stress radiographs of the affected limb, talar anterior translation and varus tilting were significantly increased by 2.56 mm and 2.0°. The gaps between the unaffected limbs were also increased by 2.47 mm and 1.32° after anesthesia. Although the stress radiographs were taken under anesthesia, the results were often smaller than the diagnostic value. CONCLUSION: Stress radiographs for painful chronic lateral ankle instability taken at the outpatient clinic might be inaccurate for diagnosis.
Ambulatory Care Facilities ; Anesthesia* ; Ankle Injuries ; Ankle* ; Diagnosis ; Extremities ; Humans ; Lateral Ligament, Ankle ; Ligaments ; Magnetic Resonance Imaging ; Outpatients ; Rupture ; Tears

OBJECTIVETo compare clinical outcomes between two suturing methods using non absorbable materials through drilling the bone and suturing anchors for the treatment of complete rupture of the deltoid ligament.

METHODSFrom January 2009 to January 2013, 58 hospitalized patients with ankle fracture combined with complete rupture of the deltoid ligament were treated with suturing using non absorbable materials through drilling the bone or suturing anchors. There were 29 patients who received suturing treatments using non absorbable materials through drilling the bone (Group A), including 18 males and 11 females, with an average age of (39.76 +/- 11.81) years old. According to the Lauge-Hansen classification, 12 patients had supination external rotation (SER) injuries with IV degree, 5 patients had pronation external rotation (PER) injuries with III degree, 10 patients had PER injuries with IV degrss, and 2 patients had pronation abduction injuries with III degree. There were 29 patients who received treatments with suturing using anchors (Group B), including 14 males and 15 females, with an average age of (41.79 +/- 13.28) years old. According to the Lauge-Hansen classification,9 patients had SER injuries with IV degree, 6 patients had PER injuries with III degree,13 patients had PER injuries with IV degree, and 1 patient had pronation abduction injuries with III degree. All the patients were treated with open reduction and internal fixation, as well as reconstruction of deltoid ligaments to restore the stability of the medial ankle structures. The clinical examination, imaging evaluation, American society for ankle surgery (AOFAS) ankle-hindfoot score and visual analogue scale (VAS) were used to evaluate the clinical results after operation, and the results of the two groups were compared and analyzed statistically.

RESULTSThe follow-up duration of the 58 patients ranged from 23 to 40 months,with an average of 27.3 months. All the patients had fracture union, and the mean healing time was 12.3 weeks (ranged, 10 to 17 weeks). There were no incision complications and ankle instability. There were no significant differences between two groups in AOFAS (P=0.666) and the VAS (P=0.905).

CONCLUSIONTreatments of complete rupture of the deltiod ligaments with the two suturing methods get similar good clinical effects, but the suturing using non absorbable materials through drilling the bone has several advantages such as reducing the financial burden of patients, saving social medical resources and avoiding the shortcoming in difficult removal of anchor suture.

Adolescent ; Adult ; Ankle Fractures ; surgery ; Ankle Injuries ; surgery ; Ankle Joint ; surgery ; Case-Control Studies ; Female ; Fracture Fixation, Internal ; Humans ; Lateral Ligament, Ankle ; injuries ; surgery ; Male ; Middle Aged ; 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

Ankle sprain is one of the most common musculoskeletal injuries, nearly half of all ankle sprains occur during athletic activity. With a high incidence, as many as 40% of patients may experience residual discomfort including pain and instability, underscoring the importance of proper treatment and effective strategies for prevention. The stability of the ankle joint is maintained by both bony structure and ligamentous complex. The anterior talofibular ligament is the primary restraint of internal rotation and adduction of the talus with the ankle joint unloaded, while both bony mortise structure and calcaneofibular ligament restrict adduction of the talus with the ankle joint loaded. Plantar flexion and inversion is the most common mechanism of ankle sprains, which lead to injury of the anterior talofibular ligament followed by calcaneofibular ligament. Ligament injuries are classified according to three grades based on the extent of rupture and the severity of clinical features. Associated injuries with lateral ankle sprain include peroneus tendon rupture, osteochondral fracture, deltoid ligament injury, syndesmosis injury, and nerve traction injuries.
Ankle Injuries* ; Ankle Joint ; Ankle* ; Epidemiology* ; Humans ; Incidence ; Lateral Ligament, Ankle ; Ligaments ; Rupture ; Sports ; Talus ; Tendons ; Traction

OBJECTIVETo investigate the changes between pressure of trochlea of talus surface and distribution of area after anterior lower tibiofibular ligament rupture, and provide basis for treating anterior lower tibiofibular ligament rupture.

METHODSSix fresh adult ankle joint specimens (4 males and 2 females, ranging age from 25 to 60 years, with an average of 44.6 years) were adopted. The specimens were removed from skin and muscles, remained ankle joint capsule, medial and lateral ligaments and anteroinferior tibiofibular ligament. The ankle joint was fixed with a special fixture in neutral position. Pressure sensitive film (700 N axial load ) was respectively used to measure mean pressure, peak pressure and stress distribution area of the upper articular facet of talar trochlea of the normal ankle joint and the ankle joint with anterioinferior tibiofibular ligament rupture.

RESULTSThe stress distribution areas of the control group and the ruptured group were respectively (367.8 +/- 54.0) mm2 and (386.0 +/- 53.7) mm2; the mean pressures were respectively (1.40 +/- 0.12) MPa and (1.70 +/- 0.35) MPa; the peak pressures were respectively (2.60 +/- 0.33) MPa and (3.20 +/- 0.32) MPa. The experimental results showed that the change in stress distribution area after anterioinferior tibiofibular ligament rupture was not significant (t = 0.021, P = -0.983). When stress distribution changed, the region of stress concentration transferred to poster lateral,and mean pressure (t = 4.140, P = 0.020) and peak pressure (t = 3.169, P = 0.010) increased significantly.

CONCLUSIONWhen anterior lower tibiofibular ligament rupture occurs, mean pressure,peak pressure and stress distribution of pressure of trochlea of talus surface is changed, which may cause traumatic arthritis, and surgical treatment is considerably used to restore normal anatomy.

Adult ; Ankle Injuries ; Biomechanical Phenomena ; Female ; Fibula ; Humans ; Lateral Ligament, Ankle ; injuries ; Male ; Mechanical Phenomena ; Middle Aged ; Rupture ; Stress, Mechanical ; Tibia