Chronic Ankle Pain Research Articles

Chronic Ankle Pain - Cross-country Athlete

Chronic Ankle Pain - Cross-country Athlete

Clinical comprehensive of microfracture, autologous chondrocyte implantation, and periosteum-covered iliac bone grafting for Hepple stage IV-V lesions.

Chronic ankle pain significantly impairs daily activities and athletic performance with osteochondral lesions of the talus (OLT) in Hepple stages IV and V, which are often causative factors. This study aimed to assess the efficacy and safety of autologous osteochondral transplantation (AOT) for the treatment of these conditions. This retrospective study was conducted from May 2020 to May 2023 at Cangzhou Traditional Chinese and Western Medicine Combined Hospital, including patients with a diagnosis of Hepple stage IV or V OLT confirmed by magnetic resonance imaging (MRI) and arthroscopy. Surgical interventions involved arthroscopic debridement, followed by AOT or limited arthrotomy based on the location and size of the lesion. Preoperative and postoperative evaluations used the Visual Analog Scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale, MRI-Based Cartilage Repair Tissue Scoring, and the International Knee Documentation Committee Knee Evaluation Form. Statistical analysis was conducted using paired-sample t tests to compare the preoperative and postoperative data. Twenty patients were included, revealing significant postoperative improvements in Visual Analog Scale, American Orthopedic Foot and Ankle Society, and MRI-based cartilage repair tissue scores (P < .05). The radiographic findings suggested effective cartilage regeneration. No adverse effects were observed in the donor knee sites, as confirmed by the stable pre- and postoperative International Knee Documentation Committee Knee Evaluation Form scores. Recovery of physical abilities was achieved on average within 7.3 weeks for daily activities and 13.4 weeks for sports activities. AOT effectively treats Hepple stage IV-V OLT, improves ankle function, promotes cartilage regrowth, and allows quick resumption of daily and athletic activities without compromising donor-site integrity.

Relationship Between Ankle Ligamentous Injuries and Osteochondral Lesions in a Saudi Arabian Population: A Retrospective Cohort Study.

Objectives This study aimed to investigate the relationship between ankle ligamentous injuries and osteochondral defects (OCDs) and to determine the incidence of these conditions within the Saudi Arabian population. Methods This retrospective cohort study included 215 patients (110 males and 105 females) who sought medical advice for an ankle injury at our institute from January 2017 to August 2022. The patients were divided according to age, sex, presence and type of ligamentous injury, and status of OCDs. Patients' ages were categorized into three groups: younger than 30 years (48 patients), 30-60 years (145 patients), and older than 60 years (22 patients). The patients were assessed for ligamentous ankle sprains, tears, and OCDs by reviewing their magnetic resonance imaging reports from radiology records. The exclusion criteria included ankle fracture, ankle surgery, osteoarthritis of the ankle joint, inflammatory arthritis, and congenital deformity of the ankle. The data were collected using a simple questionnaire created via Google Forms. Results Of the 24 patients with OCD, 23 had OCD of the talus. Anterior talofibular ligament (ATFL) injury was the most common injury (75 patients), whereas posterior talofibular ligament (PTFL) injury was the least common. The only significant relationship between ligamentous injury and OCD was observed between PTFL injury and OCD of the talus (P = 0.041). Conclusions In patients with an ankle injury, the most common OCDs occur at the talus, whereas the most injured ligament is the ATFL. Nevertheless, a significant relationship was observed between PTFL injury and OCD of the talus. The findings underscore the importance of considering specific ligament injuries when diagnosing and managing OCDs, especially in patients with chronic ankle pain.

Peroneus brevis split rupture is underreported on magnetic resonance imaging of the ankle in patients with chronic lateral ankle pain

IntroductionPeroneus brevis split rupture poses a diagnostic challenge, often requiring magnetic resonance imaging (MRI), yet splits are missed in initial radiological reports. However, the frequency of reported peroneus brevis split rupture in clinical MRI examinations is unknown. AimThis study aimed to investigate underreporting frequency of peroneus brevis split rupture in patients with lateral ankle pain. MethodsWe re-evaluated 143 consecutive MRI examinations of the ankle joint, conducted in 2021 in our region, for patients experiencing ankle pain persisting for more than 8 months. Two musculoskeletal radiologists, with 12 and 8 years of experience respectively, assessed the presence of peroneus brevis split rupture. Patients with recent ankle trauma, fractures, postoperative changes, or MRI artifacts were excluded. The radiologists evaluated each MRI for incomplete or complete peroneus brevis split rupture. The consensus between the raters was used as the reference standard. Additionally, raters reviewed the original clinical radiological reports to determine if the presence of peroneus brevis split rupture was noted. Agreement between raters' assessments, consensus, and initial reports was evaluated using Gwet’s AC1 coefficients. ResultsInitial radiological reports indicated 23 cases (52.3 %) of peroneus brevis split rupture, meaning 21 cases (47.7 %) were underreported. The Gwet’s AC1 coefficients showed that the agreement between raters and initial reports was 0.401 (standard error 0.070), 95 % CI (0.261, 0.541), p<.001, while the agreement between raters in the study was 0.716 (standard error 0.082), 95 % CI (0.551, 0.881), p<.001. ConclusionPeroneus brevis split rupture is underreported on MRI scans of patients with lateral ankle pain.

Fracture of Stieda Process with Posterior Ankle Impingement Syndrome: A Case Report

Ankle impingement syndromes, prevalent among athletes, result in significant pain and limited joint mobility. Using imaging techniques (such as radiographs, CT, MRI, and ultrasound) not only assists in diagnosis but also helps in understanding the anatomical cause of the impingement, directing therapeutic injections, and pre-surgery planning. This article presents a case of a 36-year-old female with a two-year history of chronic ankle pain, associated with recurrent swelling and decreased mobility who underwent a radiographic imaging and MRI revealing a fracture of the Stieda process as a cause of posterior ankle impingement (PAI) syndrome. The diagnosis of ankle impingement syndromes mainly depends on comprehensive clinical examination and patient's medical history, but MRI was proved crucial for diagnosing syndromes affecting the posterior areas and excluding other causes of ankle pain.

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.

Concerns beyond ankle symptoms predominate healthcare professionals’ views of patients with ankle osteoarthritis: A qualitative study

ObjectivesExplore healthcare professionals’ perspectives on the main problems that their patients with ankle osteoarthritis experience and to propose health-related domains. MethodsA qualitative study using semi-structured interviews was conducted with an international multidisciplinary group of healthcare professionals identified as ankle experts. Eligibility criteria were aged ≥18 years, and a certified healthcare professional with ≥ 5-year experience post-qualification in working with ankle osteoarthritis and/or chronic ankle pain. Interviews were recorded, transcribed verbatim and thematically analysed. ResultsTwenty-one healthcare professionals (20 males; mean (range) age 49 (34–72) years) from four professions (orthopaedic surgeons (n = 9), athletic trainers (n = 5), physiotherapists (n = 4) and podiatrists (n = 3)) were interviewed. Four main themes were identified: 1) people with ankle osteoarthritis have difficulty with weight-bearing activities; 2) symptoms of pain and stiffness predominate, alongside swelling, instability, weakness and poor balance; 3) chronic pain in ankle osteoarthritis has psychosocial consequences; and 4) the loss of activities of daily living and independence compromises quality of life. We proposed 15 health-related domains that emerge from the interview data. ConclusionHealthcare professionals recognise that ankle osteoarthritis patients have difficulty in physical, sporting, and occupational weight-bearing activities, and they live with persistent ankle pain, stiffness and other symptoms that have physical and psychosocial consequences. The health-related domains derived from interviews with expert healthcare professionals will contribute to the development of a core domain set for ankle osteoarthritis.

Unusual presentation of talonavicular joint pigmented villonodular synovitis: a case report

BackgroundPigmented villonodular synovitis is a rare yet locally invasive disorder impacting synovial tissues. This case report delineates the atypical manifestation of pigmented villonodular synovitis in the talonavicular joint, detailing its diagnostic complexity and successful management.Case presentationA 56-year-old Iranian patient with a 4-year history of chronic ankle pain, initially diagnosed with degenerative joint disease post-trauma based on imaging, underwent talonavicular fusion surgery. An unexpected pigmented villonodular synovitis mass was encountered during the procedure. Subsequent interventions encompassed tumor resection, talonavicular joint fusion, and allograft bone grafting. Despite the initial intervention, persistent pain and nonunion necessitated a secondary procedure, involving joint surface curettage and autograft bone grafting. At the 12-month follow-up, the patient remained pain-free without tumor recurrence.ConclusionThis case report highlights the significance of considering pigmented villonodular synovitis as a crucial differential diagnosis in chronic ankle pain, even when there is evidence of degenerative joint disease and a history of trauma. Magnetic resonance imaging serves a crucial role in accurate diagnosis. Treatment necessitates precise tumor removal, appropriate bone grafting techniques and secure fixation.Level of evidence: IV.

Minimally Invasive Peroneal Tenodesis Assisted by Peroneal Tendoscopy: Technique and Preliminary Results.

Introduction: Peroneal disorders are a common cause of ankle pain and lateral instability and have been described in as much as 77% of patients with lateral ankle instability. Clicking, swelling, pain, and tenderness in the peroneal tendons track are frequent symptoms, but they can be confused with other causes of lateral ankle pain. The management of peroneal disorders can be conservative or surgical. When the conservative treatment fails, surgery is indicated, and open or tendoscopic synovectomy, tubularization, tenodesis or tendon transfers can be performed. The authors present a surgical technique of tendoscopy associated to minimally invasive tenodesis for the treatment of peroneal tendon tears, as well as the preliminary results of patients submitted to this procedure. Methods: Four patients with chronic lateral ankle pain who were diagnosed with peroneal brevis pathology were treated between 2020 and 2022 with tendoscopic-assisted minimally invasive synovectomy and tenodesis. Using a 2.7 mm 30° arthroscope and a 3.0 mm shaver blade, the entire length of the peroneus brevis tendon and most parts of the peroneus longus tendon can be assessed within Sammarco's zones 1 and 2. After the inspection and synovectomy, a minimally invasive tenodesis is performed. Results: All patients were evaluated at least six months after surgery. All of them reported improvement in daily activities and in the Foot Function Index (FFI) questionnaire (pre-surgery mean FFI = 23.86%; post-surgery mean FFI = 6.15%), with no soft tissue complications or sural nerve complaints. Conclusion: The tendoscopy of the peroneal tendons allows the surgeon to assess their integrity, confirm the extent of the lesion, perform synovectomy, prepare the tendon for tenodesis, and perform it in a safe and minimally invasive way, reducing the risks inherent to the open procedure.

Arthroscopic Management of Posterior Ankle Impingement Syndrome - A Case Series.

Posterior ankle impingement is a common cause of chronic ankle pain. Although nonoperative treatment is initially preferred, there are surgical options if the symptoms are persistent. Minimally invasive arthroscopic procedures reduce surgical trauma and enable an early return to routine activities. We conducted a study including 6 patients who underwent arthroscopic decompression for posterior ankle impingement. Five of them were female patients and one was a male patient. The pathology varied; one had os trigonum (OT), two had stieda processes (SP), and three had OT with posterior osteophyte complex as part of ankle arthritis. In this paper, we discuss the required clinical approach, preoperative investigations, surgical indications, functional outcomes, and complications of arthroscopic treatment. The patients were followed up for a minimum of 6 months and evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and range of movement (ROM) pre and post-operatively. All the patients reported a significant reduction of pain and an improved ROMs and functional scores at the operated ankles compared to the opposite side. However, one of the patients developed post-operative tingling and numbness at the plantar aspect of the forefoot. Another one developed tingling at the lateral plantar aspect of the foot. One of the patients with SP, had an incomplete excision of the lesion. Ankle arthroscopy is an effective and minimally invasive surgery that has a significant role in managing chronic ankle pain due to posterior impingement that does not respond to conservative management and provides good functional outcomes with minimal complications.

Chronic ankle pain: could it be osteonecrosis of the talus

Chronic ankle pain: could it be osteonecrosis of the talus

Ankle Plica, is it a Myth? Report of Two Cases and Review of Literature

Introduction: Chronic ankle pain in active adults is associated with disability, pain, and giving way, undermining sports and leisure activities. The aetiology is multi factorial. Material and methods: Two adult active and fit patients presented with chronic ankle global pain, stiffness and occasional giving way. History of ankle sprain was present in both patients. Ankle arthroscopy revealed ankle plica across the gutters, with no other anomaly. Excision of the plica arthroscopically cured the problem with no recurrence after a year of follow-up. Conclusion: Ankle plica, does seem to exist and cause disability; it should be put in the differential diagnosis in patients otherwise having good ankle movement and relatively normal investigations. Arthroscopy, will identify the problems and cure it by excision. The plica finding on ankle arthroscopy should be considered as a pathological lesion needing excision in symptomatic patients

Imaging modalities for non-acute pathologies of the foot and ankle

Chronic foot and ankle pain, in contrast to acute traumatic injuries, presents a diagnostic challenge due to its diverse underlying causes. Accurate diagnosis often necessitates the utilization of various imaging modalities, emphasizing the importance of selecting the most appropriate one. The intricate structure of the foot, composed of multiple bones and supported by soft tissues like ligaments and plantar fascia, gives rise to a spectrum of mechanical disorders, including stress fractures, plantar fasciitis, Morton’s neuroma, and more. In addition to mechanical issues, non-acute abnormalities encompass inflammatory diseases affecting tendons and joints, benign tumors, tumor-like lesions, vascular abnormalities, and others. This article reviews the indispensable role of imaging in the assessment of these conditions, with a focus on plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine studies, tailored to the specific clinical presentation. By providing insights into the selection and interpretation of imaging modalities, this article aims to assist clinicians in achieving accurate diagnoses and optimizing patient care for nonacute foot and ankle pathologies.

Updated Role Of Ultrasonography In Comparison With Magnetic Resonance Imaging In Evaluation Of Various Causes Of Chronic Ankle Pain

Updated Role Of Ultrasonography In Comparison With Magnetic Resonance Imaging In Evaluation Of Various Causes Of Chronic Ankle Pain

Brodie's Abscess of the Ankle Presenting as a Tumor: A Summary of Five Cases.

A Brodie's abscess is a form of subacute osteomyelitis that is often considered in the differential diagnosis of other benign and malignant bone lesions. The authors summarize the findings of five cases of Brodie's abscesses in the distal tibia initially thought to be tumors by the referring physicians. All five cases were presented to the referring physicians with a chief complaint of ankle pain. All patients complained of chronic ankle pain and swelling that was aggravated by activity without constitutional symptoms. On physical examination, all patients presented with point tenderness over the distal tibia/malleolar regions. Three out of the five cases had a full range of ankle motion; the other two had limited dorsiflexion secondary to pain. All inflammatory laboratory values were within normal limits or only slightly elevated. All initial radiographs of the cases described demonstrated a well-defined radiolucent lesion within the distal tibia. In all cases, patients were treated with curetting, with or without bone graft. Bacterial and fungal cultures were negative in all five patients and no long-term post-operative antibiotics were administered. In this report, we discuss the clinical, radiographic, and pathologic features of this relatively rare condition in the distal tibia. The distinct clinicopathologic features of the disease process are presented to distinguish Brodie's abscess from a bone tumor.

Pain alleviation improves balance control and muscular coordination of lower limbs in patients with chronic ankle instability during sinusoidal perturbations

BackgroundIt is well established that individuals with chronic ankle instability manifest deficits in balance control and muscle activation. Given the prevalence of pain as a prominent symptom in this population, there is a need for in-depth investigation of its role in contributing to these impairments. MethodsA Stewart platform was used to generate translational sinusoidal perturbations in the antero-posterior direction. Eighteen individuals with chronic ankle instability and concurrent ankle pain were recruited. They were instructed to assume a central stance on the support surface with open eyes both before and 30 min after local analgesia. Data of center of pressure and electromyography of the tibialis anterior and medial gastrocnemius were recorded. Statistical analysis was performed to make comparisons pre- and post-analgesia using two-tailed paired t-test for the continuous variables. FindingsPain intensity was significantly decreased after local anesthetic injections. Antero-posterior center of pressure parameters significantly decreased following the injection. Also, there was an increase in the regularity of the center of pressure pattern. The electromyographic pattern of the tibialis anterior and medial gastrocnemius exhibited various activation patterns. After pain alleviation, the characteristic electromyographic response of the tibialis anterior and medial gastrocnemius was reciprocal contraction and relaxation that corresponded with the sinusoidal pattern of the perturbations. InterpretationIndividuals who had chronic ankle instability and ankle pain demonstrated impaired balance control during sinusoidal perturbations. Mitigating pain improved their balance performance, evident in the center of pressure pattern and the coordination of lower limb muscles.

Particulated autologous cartilage transplantation for the treatment of osteochondral lesion of the talus: can the lesion cartilage be recycled?

AimsOsteochondral lesions of the talus (OLT) are a common cause of disability and chronic ankle pain. Many operative treatment strategies have been introduced; however, they have their own disadvantages. Recently lesion repair using autologous cartilage chip has emerged therefore we investigated the efficacy of particulated autologous cartilage transplantation (PACT) in OLT.MethodsWe retrospectively analyzed 32 consecutive symptomatic patients with OLT who underwent PACT with minimum one-year follow-up. Standard preoperative radiography and MRI were performed for all patients. Follow-up second-look arthroscopy or MRI was performed with patient consent approximately one-year postoperatively. Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) score and International Cartilage Repair Society (ICRS) grades were used to evaluate the quality of the regenerated cartilage. Clinical outcomes were assessed using the pain visual analogue scale (VAS), Foot Function Index (FFI), and Foot Ankle Outcome Scale (FAOS).ResultsAll patients had ICRS grade IV cartilage lesions, except for one (ICRS grade III). The paired MOCART scores significantly improved from 42.5 (SD 1.53) to 63.5 (SD 22.60) (p = 0.025) in ten patients. Seven patients agreed to undergo second-look arthroscopy; 5 patients had grade I (normal) ICRS scores and two patients had grade II (nearly normal) ICRS scores. VAS, FFI, and all subscales of FAOS were significantly improved postoperatively (p ≤ 0.003).ConclusionPACT significantly improved the clinical, radiological, and morphological outcomes of OLT. We consider this to be a safe and effective surgical method based on the short-term clinical results of this study.Cite this article: Bone Jt Open 2023;4(12):942–947.

A MEDIUM-TERM REVIEW OF THE OUTCOMES OF TALAR OSTEOCHONDRAL LESIONS TREATED WITH MATRIX-ASSOCIATED STEM CELL TRANSPLANTATION

IntroductionOsteochondral lesions (OCLs) of the talus are a challenging and increasingly recognized problem in chronic ankle pain. Many novel techniques exist to attempt to treat this challenging entity. Difficulties associated with treating OCLs include lesion location, size, chronicity, and problems associated with potential graft harvest sites. Matrix associated stem cell transplantation (MAST) is one such treatment described for larger lesions &gt;15mm2 or failed alternative therapies. This cohort study describes a medium-term review of the outcomes of talar lesions treated with MAST.MethodsA review of all patients treated with MAST by a single surgeon was conducted. Preoperative radiographs, MRIs and FAOS outcome questionnaire scores were conducted. Intraoperative classification was undertaken to correlate with imaging. Postoperative outcomes included FAOS scores, return to sport, revision surgery/failure of treatment and progression to arthritis/fusion surgery.Results58 MAST procedures in 57 patients were identified in this cohort. The mean follow up was 5 years. There were 20 females and37males, with a mean age of 37 years (SD 9.1). 22 patients had lateral OCLS were and 35 patients had medial OCLs. Of this cohort 32patients had previous surgery and 25 had this procedure as a primary event. 15 patients had one failed previous surgery, 9 patients had two, four patients had three previous surgeries and three patients had four previous surgeries. 12 patients had corrective or realignment procedures at the time of surgery. In terms of complications 3 patients of this cohort went on to have an ankle fusion and two of these had medial malleolar metal work taken out prior to this, 5 patients had additional procedures for arthrofibrotic debridements, 1 patient had a repeat MAST procedure, 1 additional patients had removal of medial malleolar osteotomy screws for pain at the osteotomy site, there were 2 wound complications one related to the ankle and one related to pain at the iliac crest donor site.ConclusionMAST has demonstrated positive results in lesions which prove challenging to treat, even in a “ failed microfracture” cohort.RCT still lacking in field of orthobiologics for MAST. Longer term follow up required to evaluate durability.

FOOTPRINT ANALYSIS OF THE LATERAL LIGAMENTS OF THE ANKLE: A NEW APPROACH

AbstractThe lateral ligaments of the ankle composed of the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular ligaments (PTFL), are amongst the most commonly injured ligaments of the human body. Although treatment methods have been explored exhaustively, healing outcomes remain poor with high rates of re-injury, chronic ankle instability and pain persisting. The introduction and application of tissue engineering methods may target poor healing outcomes and eliminate long-term complications, improving the overall quality of life of affected individuals. For any surgical procedure or tissue-engineered replacement to be successful, a comprehensive understanding of the complete anatomy of the native structure is essential. Knowledge of the dimensions of ligament footprints is vitally important for surgeons as it guides the placement of bone tunnels during repair. It is also imperative in tissue-engineered design as the creation of a successful replacement relies on a thorough understanding of the native anatomy and microanatomical structure. Several studies explore techniques to describe ligament footprints around the body, with limited studies describing in-depth footprint dimensions of the ATFL, CFL and PTFL. Techniques currently used to measure ligament footprints are complex and require resources which may not be readily available, therefore a new methodology may prove beneficial.ObjectivesThis study explores the application of a novel technique to assess the footprint of ankle ligaments through a straightforward inking method. This method aims to enhance surgical technique and contribute to the development of a tissue-engineered analogue based on real anatomical morphometric data.MethodsCadaveric dissection of the ATFL, CFL and PTFL was performed on 12 unpaired fresh frozen ankles adhering to regulations of the Human Tissue (Scotland) Act. The ankle complex with attaching ligaments was immersed in methylene blue. Dissection of the proximal and distal entheses of each ligament was carried out to reveal the unstained ligament footprint. Images of each ligament footprint were taken, and the area, length and width of each footprint were assessed digitally.ResultsThe collective area of the proximal entheses of the ATFL, CFL and PTFL measures 142.11 ± 12.41mm2. The mean areas of the superior (SB) and inferior band (IB) of the distal enthesis of the ATFL measured 41.72 ± 5.01mm2 and 26.66 ± 3.12mm2 respectively. The footprint of the distal enthesis of the CFL measured 146.07 ± 14.05mm2, while the footprint of the distal PTFL measured 126.26 ± 8.88mm2. The proximal footprint of the ATFL, CFL and PTFL measured 11.06 ± 0.69mm, 7.87 ± 0.43mm and 10.52 ± 0.63mm in length and 8.66 ± 0.50mm, 9.10 ± 0.92mm and 14.41 ± 1.30mm in width on average. The distal footprint of the ATFL (SB), ATFL (IB), CFL and PTFL measured 10.92 ± 0.81 mm, 8.46 ± 0.46mm, 13.98 ± 0.93mm and 11.25 ± 0.95mm in length and 7.76 ± 0.59mm, 7.51 ± 0.64mm, 18.98 ± 1.15mm and 24.80 ± 1.25mm in width on average.ConclusionsThis methodology provides an effective approach in the identification of the footprint of the lateral ligaments of the ankle to enhance surgical precision and accuracy in tissue-engineered design.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Chronic instability in a malformed tibiofibular syndesmosis associated with osteochondral lesion of the talus: a case report

Surgical treatment of tibiofibular syndesmosis (TFS) with chronic instability aims to obtain a solid and stable joint to avoid ankle arthritis. Osteochondral lesions of the talus (OLT) may be associated in up to 24% of cases and must be treated concomitantly. We present a 27-year-old male patient with chronic ankle pain and a history of recurrent sprains since childhood. Imaging exams showed malformation of TFS associated with an OLT. He was submitted to surgical treatment with open repair, TFS fixation with suture-button, and osteochondroplasty of the OLT with collagen membrane through arthroscopy. At 13 months follow-up, he was asymptomatic and fully active.