Ankle Ligament Reconstruction Research Articles

Ankle ligament reconstruction-return to sport after injury scale and return to sports after ankle ligament reconstruction or repair-A systematic review.

To systematically review existing literature regarding the ankle ligament reconstruction-return to sport after injury (ALR-RSI) scale and to assess its correlation with Return to sport and functional outcomes as well as feasibility, reliability and consistency. A systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was conducted using PubMed, Embase and Cochrane Library. Studies that evaluated psychological readiness to return to sport after ankle ligament reconstruction or repair for the treatment of chronic lateral ankle instability using the ALR-RSI scale were included. The results from each study were pooled, and weighted means and overall rates were calculated. In total, 157 patients (53.2% male, mean age: 34.2 years) from three articles were included. Overall, 85.0% of patients reported successful return to sport, but only 48.9% of patients returned to the preoperative sporting level. All studies reported a significant difference in psychological scores between patients who returned to sport and those who did not. Pooled mean patient-reported outcome measures, reported as the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS, three studies) Score and Karlsson-Peterson Score (three studies), were 82.7 (range: 29-100) and 81.7 (range: 25-100), respectively. The ALR-RSI scale demonstrated strong correlations with the AOFAS Score and Karlsson-Peterson Score. Patients who returned to sport after ankle ligament reconstruction or repair exhibited higher psychological readiness compared to those who did not. The ALR-RSI scale showed strong correlations with ankle function. Evaluation of psychological readiness using the ALR-RSI scale may provide an additional tool in the assessment of patients who underwent ankle ligament reconstruction or repair. Level III, systematic review.

Racial Disparities in the Utilization of Lateral Ankle Ligament Reconstruction for Chronic Ankle Instability in the United States

Background: Previous studies have reported on the impact of race and ethnicity on access to orthopaedic procedures in the United States. However, there are few studies evaluating racial disparities in elective foot and ankle surgeries. Recognizing and addressing disparities in the access of health resources are steps to improve care rationing. Our study specifically investigated potential racial disparities with utilization and perioperative metrics of lateral ankle ligament reconstruction. Methods: A retrospective study was performed using the National Surgical Quality Improvement Program (NSQIP) database. Current Procedural Terminology ( CPT) code 27698 was used to identify patients who underwent LALR from 2011 to 2020. Sixty-one percent of these patients had available race/ethnicity data and were included in the study. Designations of race and ethnicity were standardized as White non-Hispanic, Black non-Hispanic, Hispanic, Asian American and Pacific Islander, and Other. Race/ethnicity stratifications of NSQIP patients were compared to 2010 and 2020 census data from the United States (US) Census Bureau. Thirty-day postoperative complications and total length of hospital stay, for all complications, were also compared between White patients and all other patients combined. Independent t tests, χ2, and Fisher exact tests were performed to compare differences including age, gender, and postoperative complications. Results: Overall, 1295 patients were included in the study. White non-Hispanic patients underwent 3.3 times more LALR than all other patients during the study period. This finding shows a higher prevalence of surgery on White non-Hispanic patients than all others reported in the US Census Bureau data for 2010 and 2020, where the ratio of White non-Hispanic vs all others were 1.9 and 1.5-fold, respectively. White patients were marginally older with a mean age of 38 years, compared with 36 years for Black patients ( P < .05). There were no differences in 30-day complication rates or total length of hospital stay based on race and ethnicity. Conclusion: Our study found that there was increased utilization of LALR for White non-Hispanic patients compared with all other racial/ethnic groups. These numbers do not mimic the current population trends based on the national census data. Despite this discrepancy, no differences in postoperative complications and length of stay were found based on race and ethnicity. These results suggest that there may be barriers for patients who are not White non-Hispanic to undergo care for LALR. Level of Evidence: Level III, retrospective cohort study.

THE IMPORTANCE OF REHABILITATION AFTER ANKLE SPRAINS IN CHRONIC ANKLE INSTABILITY PREVENTION

Chronic ankle instability occurs in 20–40% of patients with a history of ankle sprain and as late as 6.5 years following the injury. The main causes are considered to be lateral ankle ligament laxity, peroneal muscle weakness and ankle proprioceptive deficits. These sequelae are usually met if the rehabilitation program was not correctly applied (both length and also quality execution). Limiting the apparition of chronic ankle instability by following a physical therapy program correctly established, in cases where there are no other chronic ankle pain and/or chronic ankle instability causes (like coexistent fractures, arthropathy, midfoot or subtalar sprains, subtalar instability, ankle impingement syndrome, sinus tarsi syndrome, peroneal tendinopathy, reflex sympathetic dystrophy, ankle and foot arthrosis). The treatment depends on the injury mechanism (the most typical is inversion) and on grade of the sprain (mild, moderate, severe) and includes three phases (acute, subacute and the rehabilitative phase). The physical therapy program begins during the subacute phase and is continued during the rehabilitative phase, which can last up to three weeks. Surgical reconstruction of the lateral ankle ligaments is rarely necessary. It is important to point out to our patients the fact that returning to daily activities (such as work and sports) prior to adequate healing and rehabilitation may result in chronic pain and/or functional or mechanical instability. Keywords: ankle sprain, chronic ankle instability, physical therapy.

Indications, Associated Procedures, and Results of Ankle Plafond-Plasty for Varus Ankle Osteoarthritis: A Systematic Review and Meta-Analysis.

Plafond-plasty is a joint-preserving procedure to treat varus ankle osteoarthritis (OA) with asymmetrical joint involvement. The aim of this systematic review and meta-analysis was to evaluate indications, different surgical techniques, associated procedures, and results of plafond-plasty in varus ankle OA and to analyze the level of evidence (LOE) and quality of evidence (QOE) of the included studies. A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Five studies evaluating 99 ankles were included. A non-rigid varus ankle deformity and an ankle OA Takakura stage 3b or less were the most recommended pre-operative indications. Meta-analysis showed a significant post-operative improvement in clinical and radiological parameters. Many associated surgical procedures have been reported, the most frequent being medial additional supramalleolar osteotomy and lateral ankle ligament reconstruction. The level of evidence and methodological quality assessment of the included studies showed an overall low quality. Plafond-plasty seems to be a promising surgical option when managing varus ankle OA with asymmetrical joint involvement, extending the indications for joint sparing surgery. Additional associated procedures should be carefully evaluated case-by-case. IV.

The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) is a valid and reliable measure to assess psychological readiness before returning to sport following peroneal tendon pathology surgery.

The objective of this study was to validate a scale that could help surgeons evaluate patients' psychological readiness to return to sport (RTS) after peroneal tendon pathology surgery. The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) scale, which had previously been validated in ankle ligament reconstruction patients, was adapted to evaluate the psychological preparedness for RTS in athletic patients who underwent peroneal tendinopathy surgery. The Foot and Ankle Outcome Score (FAOS) and Foot Ankle Ability Measurement (FAAM) scores were employed as patient-related outcome measurement (PROM) instruments. This study included 57 patients. There was a strong correlation between ALR-RSI and both FAOS and FAAM (r = -0.68 and 0.74, respectively). ALR-RSI was considerably higher in patients who returned to sports than in those who did not. The mean score was 72.9 ± 19.0 in patients who returned to the same preinjury level, 48.5 ± 24.0 in those who returned to a lower leveland 53.6 ± 31.1 in patients who changed their athletic activity (p < 0.0001). Furthermore, ALR-RSI showed at least a similar discrimination ability when compared to FAOS and FAAM. The test-retest intraclass correlation coefficient was 0.95. The Cronbach's α statistic used to measure the internal consistency was high (0.95). A Youden index of 0.65 was observed for a cut-off score of 68 points. ALR-RSI is a valid instrument for assessing psychological readiness to RTS in an athletic population following peroneal tendon surgery. When compared to the most commonly used PROMs, it was strongly correlated and demonstrated at least similar discrimination capacity. This could assist surgeons in identifying athletes who will have poor postoperative results and advising them on their capability to RTS. Level III.

MRI Assessment of Tendon Graft After Lateral Ankle Ligament Reconstruction: Does Ligamentization Exist?

Background: No description exists in the literature about the normal evolution of tendon graft after a lateral ankle ligament (LAL) reconstruction. Purpose: To assess the magnetic resonance imaging (MRI) characteristics and the evolution of the tendon graft during different moments in the follow-up after an endoscopic reconstruction of the LAL. Study Design: Cohort study; Level of evidence, 3. Methods: This prospective study included 37 consecutive patients who underwent an endoscopic reconstruction of the LAL with an autograft using the gracilis tendon to treat chronic ankle instability (CAI) resistant to nonoperative treatment (CAI group) and 16 patients without ankle instability (control group). All patients in the CAI group underwent a postoperative assessment at 6, 12, and 24 months using the Karlsson score and MRI examination. Only patients with good and excellent results were included in the study. Graft assessment consisted of qualitative measurements and quantitative evaluations of the reconstructed anterior talofibular ligament (RATFL) and reconstructed calcaneofibular ligament (RCFL), including signal-to-noise quotient (SNQ) and contrast-to-noise quotient (CNQ) measurements in proton density–fat suppressed (PD-FS) and T1-weighted sequences. The analysis of variance test was used to compare the SNQ and the CNQ at different time points for each sequence. Results: The MRI signal at 6 months was increased compared with that of the control group. Next, a significant signal decrease from 6 to 24 months was noted on PD-FS and T1-weighted images. SNQ measurements on PD-FS weighted images for both the RATFL and the RCFL demonstrated a significantly higher signal (P < .01 and P = .01, respectively) at 6 months compared with that of the control group. Subsequently, the signal decreased from 6 to 24 months. Similarly, CNQ measurements on PD-FS weighted images for both the RATFL and the RCFL demonstrated a significantly higher signal (P < .01 and P < .01, respectively) at 6 months compared with that of the control group. Subsequently, the signal decreased from 6 to 24 months. Conclusion: The present study demonstrated an evolution of the MRI characteristics, suggesting a process of graft maturation toward ligamentization. This is important for clinical practice, as it suggests an evolution in graft properties and supports the possibility of creating a viable ligament.

A Review of Chronic Lateral Ankle Instability and Emerging Alternative Outcome Monitoring Tools in Patients following Ankle Ligament Reconstruction Surgery.

Ankle sprains are exceedingly common injuries in both athletes and the general population. They account for 10 to 30% of all sports injuries. Although the vast majority of lateral ankle ligament injuries respond successfully to conservative management, the absolute number of those that progress to chronic lateral ankle instability (CLAI) remains considerably important. This condition is characterized by persistent symptoms and may be associated with short-term and long-term complications and functional deficits. There is still a lack of ideal postoperative management of CLAI patients. Furthermore, an evidence-based rehabilitation phasing does not exist and most of the published studies regarding this subject suggest some protocols based on a wide variety of functional assessment scores and other modalities that are not accurate enough. Moreover, the literature that assesses the ability to return to work (RTW) and return to sport (RTS) in the general population and athletes operated for CLAI most commonly shows aggregated results with global rates of RTW or RTS without describing a detailed timeline based on the readiness of patients to return to each level of activity. Although stress radiographs and MRI have been assessed as potential tools to improve postoperative management of CLAI patients, the first modality is limited by its low sensitivity to detect laxity and the second one by its static character and its inability to predict neither the healing process phase nor the mechanical properties of the repaired/reconstructed ligaments. Bioelectrical impedance, mechanical impedance and near-infrared spectroscopy are non-invasive methods of measurement that could be potential assessment tools to help surgeons improve the postoperative management of patients after CLAI surgery.

A Re-look at chrisman-snook: A narrative review and technique guide for lateral ankle ligament reconstruction with tendon allograft

Chronic ankle instability is a pathology arising from one of the most common orthopedic injuries, lateral ankle sprains. The gold standard surgical procedure for lateral ankle instability is repair of the anterior talofibular and calcaneofibular ligaments with imbrication of the inferior extensor retinaculum. The senior author's indications for a modified Brostrom versus a modified Chrisman-Snook have evolved over the past decade. Indications for a modified Chrisman-Snook include: revision reconstruction, generalized laxity, collagen vascular disease, BMI greater than 35, and significant hindfoot varus or midfoot cavus. The primary aim of this report is to provide a narrative review of the Chrisman-Snook procedure and overview of our modified technique.

12-MONTH CLINICAL OUTCOMES OF ARTHROSCOPIC LATERAL ANKLE LIGAMENT RECONSTRUCTION FOR CHRONIC ANKLE INSTABILITY: A PROSPECTIVE CASE SERIES

IntroductionChronic ankle instability is a common condition that can be effectively treated with arthroscopic lateral ankle ligament reconstruction to restore ankle stability and function. The aim of this study was to assess the functional outcomes of arthroscopic lateral ligament reconstruction using the MOXFQ, VAS, and EQ5D patient-reported outcome measures (PROMs).MethodsThis prospective series included 38 patients who underwent arthroscopic lateral ligament reconstruction for chronic ankle instability between December 2019 and April 2022. All patients completed the MOXFQ, VAS, and EQ5D PROMs preoperatively, as well as at6, and 12 months postoperatively. The MOXFQ is a disease-specific PROM that assesses foot and ankle function, while the VAS measures pain and the EQ5D evaluates health-related quality of life.ResultsAt the 12-month follow-up, the mean MOXFQ Index score had improved significantly from 53.3 ± 23.1 preoperatively to 16.0 ±21.1 (p &lt; 0.001). Similarly, the mean VAS score had improved from 36.2 ± 22.4 preoperatively to 14.7 ± 15.0 (p &lt; 0.001), and the meanEQ5D score had improved from 0.55 ± 0.26 preoperatively to 0.87 ± 0.12 (p &lt; 0.001). No major complications were observed.ConclusionArthroscopic lateral ligament reconstruction is an effective treatment for chronic ankle instability, with significant improvements in clinical and health-related quality of life outcomes.

Arthroscopic Assisted, Lateral Ligament Reconstruction with Suture Tape Augmentation and Knotless All Suture Anchors: A Technique Guide

More than 30,000 ankle sprains occur each day in the United States, and the majority of ankle sprains involve the anterior talofibular ligament. Up to 30% of patients develop functional ankle instability and chronic pain after a severe ankle sprain. When nonoperative measures are unsuccessful, operative reconstruction of the lateral ankle ligaments is recommended. To further strengthen the repair, accelerate rehabilitation, and allow for a quicker return to sport, augmentation with suture tape has recently become an alternative among surgeons in the reconstruction of the lateral ankle ligaments. Moreover, the advent of knotless all-suture anchors decreases the number of knots required in the procedure and, in theory, reduces lateral soft tissue irritation and accentuates recovery after surgery. Here we present our technique for arthroscopic assisted, lateral ligament reconstruction with suture tape augmentation and knotless all suture anchors.

The Distal Fascicle of the Anterior Inferior Tibiofibular Ligament: A Potential Landmark for Lateral Ankle Ligament Reconstruction.

A reliable landmark and precise distances from the ligament attachments are needed for lateral ankle stabilization surgery. The distal fascicle of the anterior inferior tibiofibular ligament (AITFL) has been used to locate the anterior talofibular ligament (ATFL) or calcaneofibular ligament (CFL) centers on the fibula. However, there is no anatomic study to validate the distal fascicle of the AITFL as a landmark of lateral ankle ligament stabilization, and more importantly, the exact distances from the ATFL or CFL attachments to the distal fascicle of the AITFL are unknown. Sixteen frozen cadaveric specimens (8 paired specimens) with no previous history of ankle injury were used in this study. Whether the distal fascicle of AITFL was present in each specimen was confirmed. Then, the distances from the most distal insertion of the AITFL's distal fascicle to the footprint centers of the ATFL and CFL on the fibula were measured. All measurements were performed by 2 observers, and the intraobserver and interobserver reliabilities were analyzed by intraclass correlation coefficients (ICCs). The distal fascicle of the AITFL was found in all specimens (100%). The mean distance from the most distal insertion of the AITFL's distal fascicle to the footprint centers of the ATFL, CFL, and the intersection center of the 2 ligaments on the fibula was 6.0 to 7.1 mm, 11.5 to 13.2 mm, and 9.0 to 10.0 mm, respectively. Excellent interobserver and intraobserver agreement (all ICCs > 0.9, P < .01) was shown in the anatomic measurements of these distances. In this cadaveric study, we found that the distal fascicle was a constant structure of the AITFL in the lateral ankle. The distances from the most distal insertion of the AITFL's distal fascicle to the ligamentous footprint centers were reliable and may be used to identify the origins of the ATFL and CFL for lateral ankle ligament reconstruction. This anatomic study validates the AITFL's distal fascicle as a potential landmark and, more importantly, determines the range of distances from AITFL's distal fascicle to the attachment centers of lateral ankle ligaments by anatomic measurements. The data may be used to identify the ATFL and CFL for lateral ankle stabilization surgery and become particularly valuable for endoscopic or arthroscopic techniques.

Racial Disparities in the Utilization of Lateral Ankle Ligament Reconstruction for Chronic Ankle Instability in the United States

Category: Ankle; Other Introduction/Purpose: Chronic ankle instability (CAI) is a common diagnosis among people with previous ankle injuries. Once conservative treatment is exhausted, lateral ankle ligament reconstruction (LALR) is the gold standard surgical treatment for CAI. Previous studies have reported on the impact of race on access to orthopedic procedures in the United States. However, there are few studies evaluating racial disparities in elective foot and ankle surgeries, including LALR. Recognizing and addressing disparities in the access of health resources are imperative in combating systemic care rationing. Thus, our study aims to investigate racial disparities including utilization and perioperative metrics of lateral ankle ligament reconstruction. Methods: A retrospective study was performed using the National Surgical Quality Improvement Program (NSQIP) database. Patients that utilized the Current Procedural Terminology (CPT) code 27698 corresponding to LALR from 2011 to 2020 were included. 61% of these patients had available race/ethnicity data and were included. Designations of race and ethnicity were standardized as White non-Hispanic (WNH), Black non-Hispanic (BNH), Hispanic, Asian American and Pacific Islander (AAPI), and Other. Race/ethnicity stratifications of NSQIP patients were compared to 2010 and 2020 census data from the United States (US) Census Bureau. 30-day postoperative complications and length of hospital stay were also compared between WNH and all other patients combined. Independent T-tests, Chi-squared, and Fisher's exact tests were performed to compare differences including age, gender, and post-operative complications at an α = 0.05. Results: Overall, 1295 patients were included in the study. There were 3.3 times more WNH patients than all other groups who underwent LALR during the study period. This utilization exceeds what would be expected based on population statistics (1.9 times more WNH in the population in 2010 and 1.3 times more WNH in 2020). WNH patients were older with a mean age of 38 years, compared to 36 years for BNH patients (p &lt; 0.05). Amongst the WNH patients, 17.4% smoked which was significantly more than other race/ethnicities. (p=0.012). There were no differences in overall 30-day complication rate or individual types of complications based on race and ethnicity. There were also no significant differences in total length of hospital stay. Conclusion: Our study found that there was increased utilization of LALR amongst White non-Hispanics compared to all other racial/ethnic groups. These numbers do not mimic the current population trends based on the national census data. Despite this discrepancy, no differences in postoperative complications and length of stay based on race and ethnicity were found. These results suggest that there may be systemic barriers for patients to undergo care for LALR and that further research needs to be conducted on racial disparities within orthopedics.

A Novel Technique for Lateral Ankle Ligament Reconstruction in a Total Ankle Total Talus Replacement Case

In recent years, the tibial component and polyethylene bearing of a total ankle replacement have been used in conjunction with a custom total talus replacement in cases of severe talar loss with concomitant tibiotalar arthritis, referred to as total ankle total talus replacement. Multiple reports have linked ligamentous instability with poor outcomes after total ankle replacement. In the current study, we describe a surgical technique for lateral ankle ligament reconstruction in a total ankle total talus replacement case through the use of 3-dimensionally printed tunnels. Level of Evidence: Diagnostic Level V—expert opinion. See Instructions for Authors for a complete description of levels of evidence.

Rehabilitation of a lateral ankle reconstruction in a male professional football player – A narrative case report

ObjectivesLateral ankle sprains involving the ATFL and CFL are common injuries in football with a high recurrence rate. There is a lack of research to guide post-operative rehabilitation of football players following lateral ligament ankle reconstructive surgery. This narrative case report discusses the management of a lateral ligament reconstruction in a male professional football player. MethodsA 25-year-old professional footballer underwent a lateral ankle reconstruction following recurrent lateral ankle sprains leading to an unstable ankle. ResultsFollowing 11-weeks of rehabilitation the player was cleared to return to full-contact training. The player competed in his first competitive match 13-weeks post-injury and completed a 6-month full-training block, without episodes of pain or instability. ConclusionThis case report illustrates the rehabilitation process of a football player following a lateral ankle ligament reconstruction within a timeframe expected in elite sport.

Arthroscopic and Open Procedures Result in Similar Calcaneal Tunnels for Anatomical Reconstruction of Lateral Ankle Ligaments

Arthroscopic and Open Procedures Result in Similar Calcaneal Tunnels for Anatomical Reconstruction of Lateral Ankle Ligaments

Validation and Application of a Spanish Version of the ALR-RSI Scale (Ankle Ligament Reconstruction-Return to Sport after Injury) in an Active Non-Athlete Population.

The most recent scale to quantify psychological readiness before returning to sport is the ALR-RSI (Ankle Ligament Reconstruction-Return to Sport after Injury) scale. The aim of this study was the cross-cultural adaptation to Spanish and application of the ALR-RSI scale in a sample of active people who were not professional athletes, and to carry out an initial psychometric analysis of the functioning of the instrument in this sample. The sample consisted of 257 participants (161 men and 96 women) aged between 18 and 50 years. The adequacy of the model obtained in the exploratory study was confirmed, obtaining a model composed of one factor and 12 indicators in total. The estimated parameters were statistically significant (p < 0.05), and the factor loadings presented values higher than 0.5; thus, all indicators revealed a satisfactory saturation in the latent variable (convergent validity). Regarding internal consistency, the Cronbach's alpha value was 0.886 (excellent internal consistency). This study demonstrated that the ALR-RSI in Spanish is a valid and reproducible scale for evaluating psychological readiness to return to non-professional physical activity after ankle ligament reconstruction in the Spanish population.

Effect of preoperative anterior bony impingement on lateral collateral ankle ligament reconstruction

Objective: To explore whether the combination of anterior bony impingement before surgery will affect the efficacy of the lateral collateral ankle ligament reconstruction surgery in patients with chronic ankle instability (CAI). Methods: A prospective cohort study. Patients with CAI who underwent lateral collateral ankle ligament reconstruction from January 2014 to October 2017 in the Department of Sports Medicine, Huashan Hospital, Fudan University were enrolled in this study. The patients were divided into no bony impingement group (NI group) and bony impingement group (BI group) according to the presence of bone impingement in front of the ankle during the operation. Preoperative American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson ankle functional socre (KAFS), Tegner score, visual analogue scale (VAS) of pain were extracted and were reevaluated at least 2 years after surgery as well as imaging evaluation of ankle. Results: A total of 59 patients were enrolled in this study. There were 29 patients in the NI group, 23 males and 6 females with a mean age of (28.4±7.1) years. And there were 30 cases in the BI group, 28 males and 2 females with a mean age of (31.9±8.6) years. The AOFAS, KAFS and Tegner scores in NI group increased from 65.8±10.6, 65.9±10.1 and 3.0 (3.0, 4.0) before the operation to 97.5±4.3, 97.8±4.7 and 6.0(5.0,6.0) after the operation, respectively; and the VAS decreased from 3.0(3.0, 4.0) to 0(0, 0); there were significant differences in those indexes before and after the operation (all P<0.05). The scores of AOFAS, KAFS and Tegner in BI group increased from 65.2±11.0, 64.2±10.0 and 3.0(3.0, 4.0) before the operation to 97.1±4.3, 97.3±4.3 and 5.0(4.0, 6.0) post the operation, respectively; and the VAS scores decreased from 3.0(3.0, 5.0) to 0(0, 1.0); there were significant differences in up-mentioned indexes before and after the surgery (all P<0.05). There was no significant differences in baseline and preoperative clinical function scores between the two groups (all P>0.05). No significant difference was found in postoperative AOFAS, KAFS and VAS scores between the two groups (all P>0.05), while postoperative Tegner score in the NI group was significantly higher than that in the BI group [6.0(5.0, 6.0) vs 5.0(4.0, 6.0), P=0.026]. Imaging evaluation of all patients showed that the reconstructed ligament was clearly visible, and the intraarticular injuries existing before surgery showed obvious signs of healing. Conclusion: Ankle lateral collateral ligament reconstruction for CAI with or without anterior bony impingement results in similar outcomes in ankle function, stability and pain levels.

Approach to Ankle Instability in Patients With a Negative Ankle MRI: A Case Series.

Objectives Injuries to the ankle ligaments are some of the most common musculoskeletal sports injuries. Ankle magnetic resonance imaging (MRI) is the standard diagnostic procedure in today's practice, but its reliability and validity remain controversial. The aim of this study was to explore the approach for patients with negative ankle MRI who continue to have symptoms of ankle instability despite conservative therapy. Methods A total of eight patients who were 14 years or older with negative ankle MRI who continue to have symptoms of ankle instability despite conservative therapy were admitted to our institution from January 1, 2015 to December 31, 2021. Results Eight patients with a mean age of 36, and a mean body mass index (BMI) of 37.7. All patients presented with ankle pain, locking, and giving way in variable severity. All the patients had a radiograph followed by an ankle MRI, which showed normal alignment of ankle joints without abnormality. Initially, all patients were treated conservatively but did not show any improvement. After that, they underwent an operation of lateral ankle ligament reconstruction by modified Brostrom technique, followed by casting and physiotherapy. The symptoms of ankle instability resolved in all patients. The ankle pain resolved completely in six patients, improved in one patient, and did not improve in one patient. Conclusion Based on our results, we advocate reconstruction surgery by modified Brostrom technique for ligament repair in patients with clinical evidence of chronic ankle instability who have failed a trial of conservative management, even in the context of a normal ankle MRI.

The delta-snook ankle ligament reconstruction for combined deltoid insufficiency and lateral ankle instability

BackgroundAnkle sprains are one of the most common injuries amongst the general population and affect all spectrums of activity levels. While the anterior talofibular and calcaneal fibular ligaments are most prevalently injured during sprains there are instances when chronic lateral ankle instability leads to rotational ankle instability and attenuate the deltoid ligament. The few literature that exists concerning lateral and medial ankle ligament reconstruction focus on an arthroscopic approach. AimThe goal of this current work is to describe a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. Surgical TechniqueA singular semitendinosus allograft is utilized to reconstruct the anterior deltoid, anterior talofibular and calcaneofibular ligaments. Canals are reamed for anchoring of the allograft through the medial malleolus, anterior talar body, distal fibula, and midline calcaneus. The anterior talar body, distal fibula and midline calcaneus are reamed fully to allow for pull through technique of the allograft. The medial malleolus and talar neck are anchored first, followed by the anterior fibula, and lastly the lateral calcaneus. All anchoring is performed with the ankle in a neutral position. ConclusionThis work successfully describes a novel open surgical reconstruction of the lateral collateral ligaments and anterior deltoid through a coupled repair. This technique affords the surgeon greater control over the final product and allows for a repair in a neutral position. The semitendinosus allograft also allows for a more anatomic repair with less incidence of stiffening at the ankle joint. The authors’ have noted good results and return to full activity for the patients that have undergone this procedure.

Both Open and Arthroscopic All-Inside Anatomic Reconstruction With Autologous Gracilis Tendon Restore Ankle Stability in Patients With Chronic Lateral Ankle Instability

To compare the return to sports and short-term clinical outcomes between the arthroscopic all-inside and the open anatomic reconstruction with gracilis tendon autograft for chronic lateral ankle instability (CLAI) patients. From March 2018 to January 2020, 57 CLAI patients were prospectively included with arthroscopic all-inside anatomic reconstruction (n= 31) or open anatomic reconstruction (n= 26) with gracilis tendon autograft. The patients were evaluated before operation and at 3 months, 6 months, 12 months, and 24 months after surgery. The American Orthopaedic Foot and Ankle Society score (AOFAS), visual analog scale (VAS), and Karlsson-Peterson score were evaluated at each time point, and stress radiography with a Telos device was performed before surgery and at final follow-up. The time to return to full weightbearing walking, jogging, sports, and work, Tegner activity score, and complications were recorded and compared. All the subjective scores significantly improved after surgery from the preoperative level. Compared with the open group, the arthroscopic group demonstrated significantly earlier return to full weightbearing walking (8.9 vs 11.7 weeks, P < .001), jogging (17.9 vs 20.9 weeks, P= .012), and recreational sports (22.4 vs 26.5 weeks, P= .001) with significantly better AOFAS score and Karlsson score at 3 to 6 months, and better VAS score at 6 months after surgery. The 2 groups demonstrated no significant difference in the surgical duration or surgical complications. No significant difference was found in the clinical scores or stress radiographic measurements at 24 months after surgery (P > .05). Compared with the open procedure, the arthroscopic all-inside anatomic lateral ankle ligament reconstruction with autologous gracilis tendon could achieve earlier return to full weightbearing, jogging, and recreational sports with less pain and better ankle functional scores at 3 to 6 months after surgery. Similar favorable short-term clinical outcomes were achieved for both techniques at 2 years after surgery. Level I, randomized controlled trial.