Lateral Ligament Complex Research Articles

Arthroscopic evaluation for posterolateral rotatory instability of the elbow.

The purpose of this study was to evaluate the sensitivity of three arthroscopic techniques for intraoperative assessment of posterolateral rotatory instability (PLRI). The study was performed using six fresh frozen cadaveric upper extremities. The three arthroscopic tests were the modified ulnohumeral drive through test, the annular drive through test, and proximal radioulnar joint instrumentation. Sequential soft tissue sectioning was performed to create four stages of instability: baseline, transection of the anterior half of the lateral collateral ligament complex (i.e., the radial collateral ligament), transection of the posterior half of the LCL complex (i.e., the lateral ulnar collateral ligament), and finally the release of the common extensor origin. Each test was repeated with the elbow at 90-degrees flexion in neutral rotation and at 45-degrees extension in full supination. Each test appropriately identified loss of the lateral ulnar collateral ligament. The modified ulnohumeral drive through test and the annular drive through test were most sensitive for loss of the radial collateral ligament. Elbow position did not affect test sensitivity. Each of the tests identified PLRI with high sensitivity, regardless of elbow position. The ulnohumeral and annular ligament drive through tests were more sensitive for radial collateral ligament disruption.

Functional Outcome of Cast Immobilisation and Functional Treatment in Management of Lateral Ankle Sprain (Grade 1 and 2)

Background: Pain and functional constraints from ankle sprains, which mostly impact the lateral ligamentous complex, can lead to the consumption of medical facilities and unavailability from workplace. No single technique is regarded as the most effective, despite the fact that this injury occurs frequently. This study evaluates the management modalities for lateral ankle sprain i.e. functional treatment and cast immobilization with pain and function as outcome variables.  Materials and methods: Seventy patients with lateral ankle sprains (grade 1 and 2) were included in this study. Each alternate participant was placed in a functional treatment (group A), while the other participants were placed in a cast immobilization group (group B). Every patient was assessed at a follow up of 2 and 6 weeks using Visual analog scale and Karlsson score for quantifying pain and function respectively.  Results: Thirty-two patients in the functional therapy group and twenty-eight in the cast immobilization group finished the study. The functional therapy group's mean age was 27.7 years, while the cast immobilization group's was 29.4 years. While both the right and left ankles were similarly impacted in the cast immobilization group, the dominant ankle involved in the functional treatment group was the right ankle in 19 patients and the left ankle in 16 patients. In both groups, a male preponderance was seen. By the end of the study, the mean differences between the two groups' Karlsson scores and visual analog scale scores were statistically significant.  Conclusion: Our study's findings show that a functional treatment outperforms immobilization in terms of both functional outcome and pain reduction.

Is partial excision of the radial head safe and effective in all-arthroscopic treatment of terrible triad fractures?

Our study aimed to evaluate the clinical and radiologic results of all-arthroscopic treatment of terrible triad injuries followed-up for a minimum of 5 years and investigate how arthroscopic partial excision for radial head fractures affects the results at the final follow-up. We retrospectively reviewed consecutive patients with terrible triad injuries who underwent all-arthroscopic treatment between January 2011 and June 2018. In group I, we performed conservative or arthroscopic fixation of stable radial head fractures, while in group II, arthroscopic partial excision of unstable radial head fractures involving <30%-50% of the articular surface area was performed. Clinical outcomes were measured by visual analog scale score and assessment of instability, range of motion (ROM), and Mayo Elbow Performance Score. Radiological outcomes were evaluated using x-rays, and the integrity of the repaired lateral collateral ligament complex was confirmed through magnetic resonance imaging. Thirty-two patients with an average age of 49.5±16.2 years met the inclusion criteria and were followed-up for a mean of 82.7±22.2 months. Twenty patients were assigned to group I and 12 patients to group II. Clinical outcomes showed no significant differences between the two groups at the final follow-up (P>0.05). On radiological evaluation, more heterotopic ossifications were found in the radial head excision group (group II, 66.7% versus group I, 35%, P=0.02); however, there was no significant difference in ROM between the two groups (P>0.05). In all-arthroscopic treatment of terrible triad injuries, arthroscopic partial excision of the radial head did not seem to have a significant impact on elbow joint stability. Level of evidence: III.

Perfect indications and how to avoid complications in lateral unicompartmental knee arthroplasty

Lateral unicompartmental knee arthroplasty (LUKA) is a favorable alternative to distal femoral osteotomy and total knee arthroplasty in patients with isolated lateral compartment knee osteoarthritis; however, it only accounts for less than 1 ​% of the total number of knee replacements documented in national joint registries.The anatomy and biomechanics of the lateral knee compartment differ from the medial side, with a greater intrinsic laxity of the lateral collateral ligament complex compared with medial structures. Indications and surgical techniques must be tailored to each unicompartmental replacement to optimize outcomes and mitigate complications. This article will discuss the clinical indications, preoperative evaluation and workup, surgical technique, and outcomes for LUKA.

Оutcome of neglected posterior elbow dislocation with gross ligamentous instability by arthrolysis combined with circumferential reconstruction of MCL, LUCL using triceps tendon fascia

Dislocation of the elbow joint, which has not been treated for more than 3 weeks, is considered outdated. Due to the high risk of complications and the uncertainty of the effectiveness of the treatment of an old dislocation of the elbow joint, it is quite a difficult task for surgeons. There are various described techniques for repairing the lateral ligamentous complex (including the LUCL) and the medial collateral ligament. Objective. To describe the author's unique technique, which consists in using one graft to restore both lateral and medial ligaments. Methods. The personal experience of treating 14 patients with chronic dislocation of the elbow joint with deformation and multidirectional instability is presented. All patients were operated on by one surgeon using the arthrolysis method in combination with MCL, LUCL reconstruction using an ipsilateral autograft of the triceps tendinous fascia. Further observation was carried out at 3, 6 and 12 weeks, as well as at 6 and 9 months. In our case, we evaluated stability, range of motion, and the presence of pain syndrome. The results. Satisfactory results were obtained in terms of pain-free full range of motion and adequate stability of the elbow joint in all cases. All patients performed their active routine exercise with minimal limitation. Conclusions. The advantage of the technique is a unique comprehensive approach that uses one circular graft to restore both the lateral and medial ligament complexes, which ensures stability and possible early rehabilitation. This leads to an excellent functional result — a quick restoration of the full range of motion in the joint and its stability.

Lateral collateral ligament complex insufficiency in recalcitrant lateral epicondylitis: MRI evaluation with arthroscopic findings.

To evaluate the concomitant pathology in recalcitrant LE using MRI with arthroscopic finding correlation. A total of 49 patients were diagnosed with chronic recalcitrant LE and divided into two: LCL complex-intact and LCL complex-involved groups by evaluating MRI as confirmed by a radiologist. Patient information for the history of steroid injection and symptom duration was extracted from the medical records. Arthroscopic images taken during arthroscopic extensor carpi radialis brevis release were evaluated to assess the quality of lateral capsule and concomitant plica. A total of 24 and 25 patients were included in the LCL-intact and LCL-involved groups, respectively. Among them, seven had complete RCL tears recorded in the LCL-involved group. Symptom duration (15 ± 9 vs. 22 ± 13, p = 0.029) and the number of steroid injections (3 ± 2 vs. 5 ± 3, p = 0.040) were significantly higher in the LCL-involved group than that in the LCL-intact group. A capsular tear was detected for 5 (20%) patients in the LCL-intact and 14 (56%) in the LCL-involved group (p = 0.027). Concomitant plica was observed in 15 (62%) patients in LCL-intact and seven (28%) in the LCL-involved group (p = 0.015). RC joint widening was observed in four patients in the LCL-involved group. The recalcitrant LE is highly a concomitant pathology including LCL complex insufficiency and pathologic elbow plica lesion. The risk factors of LCL insufficiency associated with refractory LE may include multiple steroid injections. Arthroscopic finding such as capsular tears and elbow drive-through signs can be suspected signs for LCL complex insufficiency.

Management of Elbow Terrible Triad Injuries: A Comprehensive Review and Update.

The "terrible triad" of the elbow, encompassing elbow dislocation, radial head fracture, and coronoid process fracture, remains a formidable challenge in orthopaedic practice. Typically, stabilizing structures in the elbow fail from lateral to medial through a posterolateral rotatory force after a fall onto an outstretched upper extremity. Surgery is often needed to repair the lateral ligamentous complex, replace or fix the radial head, possibly repair the anterior capsule or fix the coronoid, and consider medial repair or application of an internal versus external fixator. However, in some challenging cases persistent instability, complications, and loss of function may occur. Rehabilitation focuses on achieving early range of motion to prevent stiffness which can be common after these injuries. By integrating emerging approaches with established practices, this article aims to guide orthopaedic surgeons toward a fundamental understanding of terrible triad injuries and assist with informed management principles of these complex injuries.

The anconeus-triceps lateral flap approach in terrible triad of the elbow: good outcome in a series of ten cases.

Standard surgical management for the terrible triad of the elbow (TTE) has been established since 2004, yet postoperative complications are common and consensus on optimal management is absent. Different surgical algorithms for treating TTE and their efficacy have been reported worldwide, yet evidence from Vietnam remains limited. Ten cases diagnosed with TTE admitted to the Hospital of Traumatology and Orthopedics, a tertiary orthopedic center in Ho Chi Minh City, were presented to demonstrate the effectiveness and rate of postoperative complications following our stepwise surgical procedures using the anconeus-triceps lateral flap approach. The intraoperative "drop sign", quantitative assessment of pain and level of upper arm disability (via VAS and QuickDASH score) was mentioned to assess the algorithm's benefit. All patients' information was retrieved from medical records from August 2022 to January 2024. All 10 cases required repair of the lateral ligament complex and underwent surgery within 2 days of hospitalization. Immediate postoperative imaging revealed no drop sign, and none of the patients experienced elbow dislocation nor the need for repeated surgery, and a full range of elbow motion was demonstrated at 3-6 months follow-up. TTE is a challenging injury that almost always obligates surgical correction. The anconeus-triceps lateral flap approach, with its advantages of better visualization and preservation of certain essential stabilizing muscles of the elbow, was demonstrated to yield a high success rate and low postoperative complication rate.

Lateral elbow magnetic resonance imaging findings in patients without pain complaints

Magnetic resonance imaging (MRI) can help evaluate lateral epicondylitis; however, abnormal findings on MRI are not always consistent with the symptoms. The occurrence of such abnormal MRI findings at the lateral side of the elbow in patients without pain remains unclear. Therefore, the purpose of this study was to investigate the MRI findings of the lateral elbow joint in patients with no complaints of pain in the elbow joint. We retrospectively identified 152 patients who had undergone MRI of the area including the elbow from July 2015 to January 2022. We excluded patients with pain in the elbow area and those with diagnosis of diseases that could affect MRI findings at the lateral elbow. The presence of lateral collateral ligament complex (LCLC) and common extensor tendon (CET) lesions on MRI was assessed by two reviewers. In total, 22 patients (12 men and 10 women) were included in the analysis. The mean age of the patients was 54 years. Five patients, all ≥65 years old, had abnormal findings related to the LCLC or CET on MRI. Abnormal LCLC and CET findings on MRI can be encountered in older patients even in the absence of elbow pain.

Posterolateral Elbow Dislocation: An All-Arthroscopic Reconstruction of the Lateral Ulnar Collateral Ligament

The elbow is one of the most commonly dislocated joints. Although simple dislocations of the elbow usually resolve with conservative management, certain patients can experience residual chronic instability. Posterolateral rotational instability accounts for approximately 80% of elbow chronic instability cases. We propose an all-arthroscopic reconstruction of the posterior, or ulnar, fascicle of the lateral ligament complex using an autograft or allograft, performed with a 5-mm-thick and 8-cm-long graft. The graft is first inserted distally into the supinator crest with an Arthrex 4.75-mm SwiveLock implant and, finally, at its origin in the epicondyle, also with a screw of the same characteristics. Arthroscopic techniques create fewer complications. This procedure allows the surgeon to address intra-articular elbow joint pathology with less chance of wound complications and the ability to use bone anchors if desired.

Distal Tibiofibular Syndesmosis Injuries in the National Football League (NFL): A Spectrum of Pathology That Correlates With Time to Return to Full Participation.

Studies routinely evaluate high ankle sprains in isolation, but recent data suggest that these injuries are often associated with concomitant pathology, potentially influencing return to full participation. In National Football League (NFL) players, isolated high ankle sprains are rare and syndesmosis injuries with concomitant pathology will result in increased time to return to full participation. Cross-sectional study. Level 3. Distal tibiofibular syndesmosis injuries sustained by NFL players between 2017 and 2019 were identified through NFL Injury Surveillance Database queries and verified with video analysis. Each injury underwent a comprehensive magnetic resonance imaging (MRI) review. Regression modeling was utilized to explore the influence of numerous imaging findings on time to return to full participation. There were 83 external rotation ankle injuries involving the syndesmosis. Isolated distal tibiofibular syndesmosis injuries were rare (n = 11; 13%) and more often associated with other ligamentous injury (deltoid ligament and lateral ligamentous complex) and/or fractures. Regression modeling resulted in clustering of 3 injury pattern groups for time to return to full participation across numerous imaging findings: syndesmosis injury-fracture combinations (250 days [interquartile range [IQR,] 142-266 days]), syndesmosis injury with complete deep deltoid tear or acute diastasis (175 days [IQR, 20-248 days]), and all other syndesmosis injuries (27 days [IQR, 18-46 days]). In NFL athletes with external rotation ankle injuries, isolated distal tibiofibular syndesmosis injuries were rare and more often associated with concomitant pathology. Time to return to full participation was affected by an associated fracture and complete deep deltoid ligament tear or diastasis but no other relevant MRI variables such as lateral ligament complex involvement or the presence of osteochondral lesions or bone contusions.

Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments.

Ankle sprains remain the most common soft tissue injury presenting to Emergency Departments. Recently, there has been increased awareness and reporting of deltoid ligament injuries in association with injuries to the lateral ligament complex as well as with fibula fractures. This article reviews the currently available literature on the anatomy of the deltoid ligament, clinical and radiological diagnosis of injuries to the deltoid ligamentand treatment recommendations. A literature review was conducted for keywords associated with deltoid ligament injuries. MEDLINE, PubMed and Embase databases were utilised for this search. Articles were included if involving an adult population, were English-language, were related to deltoid ligament injuries (with or without associated injuries)and reported on patho-anatomy, clinical or radiological diagnosisor treatment methods. A total of 93 articles were assessed for relevance from the database search, and 47 were included after the removal of irrelevant articles and duplicates. Several studies reported on the clinical findings of deltoid ligament injury, as well as the radiographic analysis. Arthroscopy was considered the gold standard of diagnosis, with authors reporting on the potential benefit of performing arthroscopic repair or reconstruction at the same time. There were no studies that provided a system for the classification of deltoid ligament injuryor larger studies of treatment pathways. Long-term studies of the incidence of instability in deltoid ligament injuries were not available. There is limited evidence available regarding deltoid ligament injuries, particularly in terms of treatment options, either in isolation or with concomitant injuries. Long-term follow-up studies are needed to obtain more accurate data on the number of complications. Level IV.

Fascia lata allograft: a suitable alternative in ligamentous reconstruction for chronic elbow instability?

BackgroundUp to now there is no gold standard concerning the optimal graft choice in the surgical therapy of chronic elbow instability. As donor site morbidity represents a rare (1-4%) but severe complication of graft harvest, using an allograft seems favorable. Fascia lata mimics the anatomy through its fan shaped configuration of the ligamentous complex of the elbow joint, making it questionable for use as a graft. The aims of the study are a) to evaluate the biomechanical suitability of fascia lata allograft and b) compare clinical and radiological outcome between ligament reconstruction of the lateral collateral ligament complex (LUCL) using either FibreTape augmented triceps autograft or FibreTape augmented fascia lata allograft. MethodsBiomechanical testing of fascia lata was performed using a 10 kN uniaxial test system with a 1 kN load cell. The retrospective cohort study evaluated all patients who received a ligament reconstruction of the elbow due to chronic instability with allogenic fascia lata or autologous triceps tendon. Exclusion criteria were any type of coexisting fracture or nerval injury. Demographic parameters, patient reported outcome parameters (PROMs) and radiological stability parameters (sonography, fluoroscopy) were evaluated. ResultsTensile testing of 39 fascia lata allografts revealed an ultimate load of 234.8±23.1 N and ultimate strength of 33.4±4.4 MPa. 21 patients were included in the clinical substudy (57.1% men, 42.9% women , age 41.0 ± 12.2 years, BMI 24.9 ± 4.1 kg/m2) with average follow-up of 21.6 ± 17.1 months. No significant differences were found concerning pain level, PROMs or Range of Motion (ROM), between fascia lata and triceps group. There was also no difference concerning sonographic stability of LUCL between the 2 groups (p=0.14). One revision occurred in fascia lata allograft group, 2 in triceps autograft group due to graft elongation. ConclusionCurrently, there is no clinical evidence demonstrating the superiority of either autograft or allograft tissue. Due to its demonstration of sufficient biomechanical properties fascia lata allograft seems an appropriate treatment option for ligamentous reconstruction of chronic elbow instability.

Postoperative Stability in Displaced Ankle Fractures With Concomitant Ligamentous Injuries

Ankle instability, which can be attributed to either the deltoid or lateral ligamentous complex, may be both a cause and a consequence of ankle fractures. This study aimed to assess postoperative ankle instability in patients with displaced ankle fractures. A total of 54 patients with displaced ankle fractures were included. Malleolar fractures were surgically reduced and fixated, and if necessary, the syndesmosis was stabilized. Concomitant deltoid injuries were left unrepaired. Ankle stress radiographs were taken approximately 25.4 months after surgery, with a standard deviation of 20.5 months. Radiographic measurements included the tibiotalar tilt angle (TT) on varus stress view, anterior translation of the talus (AT) on the anterior drawer view, and the medial clear space (MC) and tibiotalar tilt angle on the valgus stress view. These measurements were compared between the injured and the noninjured contralateral ankle for all patients as well as in a subgroup of 19 patients with concomitant deltoid and syndesmosis injuries. There were no significant differences in Varus TT (p = .675, p = .394), AT (p = .516, p = .967), Valgus MC (p = .190, p = 0.498), and Valgus TT (p = .173, p = .442) between the injured and noninjured ankles in the whole group of patients as well as in the subgroup of patients with concomitant deltoid and syndesmosis injuries. Patients with displaced ankle fractures exhibited radiographically stable ankles postoperatively. Syndesmosis fixation without deltoid ligament repair is a viable treatment option for achieving ankle stability postoperatively in fractures with both ligament injuries.

Posterior Translation of the Radial Head in Magnetic Resonance Imaging of Lateral Epicondylitis.

Posterolateral rotatory instability is produced by disruption of the lateral collateral ligament complex (LCLC); it is commonly induced by trauma, with few cases reported due to lateral epicondylitis. We examined the amount of posterior transition of the radial head with or without LCLC injury, common extensor tendon (CET) injury, and Baker classification in lateral epicondylitis. We retrospectively studied patients with lateral epicondylitis of the humerus who underwent surgery between April 2016 and July 2021. Fifteen elbows with coronal and sagittal images on preoperative magnetic resonance imaging (MRI) were included. We investigated the amount of posterior transition of the radial head in sagittal MRI images of the elbow, which were compared based on LCLC and CET lesion. The mean age of patients was 49 years. The lesions in four, nine, and two patients were classified as LCLC0, LCLC1, and LCLC2, respectively. The mean radio-humeral distance values among the LCLC lesions were 0.65, 2.46, and 2.22 mm in LCLC0, LCLC1, and LCLC2, respectively, with the RHD between LCLC0 and LCLC1 differing significantly. In five, six, and four patients, the lesions were classified as CET1, CET2, and CET3, respectively. The mean RHD values among the CET lesions were 1.33, 2.68, and 1.48 mm in CET1, CET2, and CET3, respectively. Our results showed that posterior transition of the radial head is greater in patients with lateral epicondylitis with LCLC lesions on MRI than those with normal findings of LCLC.

Internal Joint Stabilization for Recurrent Nontraumatic Elbow Dislocation in a Skeletally Immature Patient.

A 14-year-old adolescent boy with SCN1B mutation experienced frequent seizures and recurrent elbow dislocation, occurring up to 30 times per day. Following failed conservative treatment, the decision was made to surgically repair the lateral collateral ligament complex and stabilize the elbow with the internal joint stabilizer (IJS). At more than 3 years postoperatively, the patient has not had a dislocation event and will retain the device for the foreseeable future to maintain predictable elbow stability. Although there is scant evidence supporting the use of the IJS in pediatric cases, the current case supports its use in pediatric elbow instability.

Development of Physiotherapy Standard Operating Procedures Case of Ankle Sprain in Basketball Players

Physiotherapy is a form of health service aimed at individuals and groups as maintaining and restoring body movement functions throughout life. Ankle Sprain is a stretching or tearing that occurs due to (overstretch) trauma to the lateral ligament complex, due to inversion and plantar flexion movements that occur excessively when the foot is unable to provide perfect support on the floor/ground. A common injury to the ankle is Ankle Sprain, a sports injury that often occurs in volleyball and basketball players. To develop Standard Operating Procedures in performing physiotherapy treatment in chronic Ankle Sprain cases. This study was conducted using the research method of developing physiotherapy operational standards with this ankle sprain injury handling model starting with preliminary studies, history taking, assessment, diagnosis, intervention, and evaluation. The type of research conducted is Quantitative research using quasi experimental methods with pretest-posttest control group design. Experimental and control groups conducted an initial test. Both groups received different treatments, where the experimental group received thrust manipulation intervention and the control group received non thrust intervention in the form of myofascial release. There was a significant reduction in pain after manipulation therapy with the thrust and nonthrust methods on two groups were measured using the Numeric Rating Scale and after being evaluated for two weeks the pain did not increase. The provision of thrust and nonthrust manipulation therapy measures is highly recommended for the treatment of ankle pain. However, between the two methods there has not been. However, there is no significant difference between the two methods given the limited time of the study.

Traumatic elbow dislocations

Elbow dislocations occur mostly in the young adult population and nearly 50% occur during sporting activities. Diagnosis and assessment of concentric reduction following manipulation are performed using plain radiography and fluoroscopy. Computed Tomography (CT) enable identifying subtle fractures that can otherwise lead to chronic instability. Simple dislocations by definition have no associated fractures and complex dislocations are associated with a variety of fractures, with the terrible triad injury and trans-humeral dislocations leading to surgical challenges. Assessment of the direction and the mechanics of elbow dislocation enable identify the structures that have been injured. Posterior and posterolateral dislocations are the most common patterns, where the lateral ligament complex is often compromised. Most simple dislocations are amenable to reduction, immobilization, and gradual rehabilitation resulting in good functional outcome. Ongoing instability can occur in 10% of the patients. Complex dislocations pose a surgical challenge and lead to joint stiffness, pain and ongoing instability if not managed properly. Identifying the individual component of a complex dislocation such as radial head fractures, coronoid fractures, proximal ulnar fractures, and ligament injures is important for satisfactory outcome.

Lateral Ankle Ligaments: An Insight Into Their Functional Anatomy, Variations, and Surgical Importance.

Ankle sprains are prevalent injuries leading to functional impairment. The lateral ankle ligament complex (LLC), comprising the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL), is weak and prone to injury. The morphometric data of these ligaments are essential for orthopedic practices, including techniques like direct repair or ATFL reconstruction with autograft/allograft, which are limited in the literature. The present study aims to document the anatomy and morphometry of the LLC. Fifteen adult Indian-origin embalmed cadavers were selected for the study. Ankles with antemortem or postmortem injuries or previous surgical interventions were excluded from the study. After precise dissection of the ankle's anterior and lateral aspects as per Cunningham's dissection manual, ligaments were exposed. Length and width were measured using a digital vernier caliper. Morphological attributes such as shape, orientation, and inter-fiber angles were documented. The most common shape in ATFL was a single band (53.33%). Inner ATFL fibers merged with the ankle joint capsule in 73.33%. ATFL mean length and width were 14 ± 2.4 mm and 7.6 ± 2.0 mm. The angle between the fibula's long axis and ATFL fibers was 107 ± 22°, and the angle between tibiotalar joint lines and parallel ATFL fibers was 30 ± 9.5°. A single band of CFL was predominant (73.33%). The mean length and width ofCFL were 18.4 ± 3.9 mm and 5.2 ± 1.3 mm; the angle between the anterior fibula border's long axes and parallel CFL line was 131°. PTFL length was 20.9 ± 3.3 mm and width was 6.2 ± 1.4 mm. The mean length and width of the anterior inferior talofibular ligament (AiTFL) were 11.7 ± 2.6 mm and 9.5 ± 1.6 mm, and of the posterior inferior talofibular ligament (PiTFL) were 12.8 ± 2.1 mm and 10.4 ± 2 mm. Comprehensive knowledge of these ligaments' anatomy and relationships is vital for clinical examination and ultrasonography. Understanding LLCdetails aids radiologists and orthopedic surgeons in graft selection, sizing, and precise anatomical structure placement during surgical reconstruction.

Comparative analyses of arthroscopic and open repairs of lateral ligament complex injuries of the ankle: a systematic review and meta-analysis of the medium-term outcomes.

Little is known regarding the comparative analyses of the medium-term outcomes (with a mean minimum follow-up period of 24months), between arthroscopic and open repairs of lateral ligament complex (LLC) injuries of the ankle. Thus, in this study, we aimed to explore the comparative analyses regarding the medium-term follow-up outcomes of these repairs, by conducting a systematic review and meta-analysis. The systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines; data were extracted from the PubMed and Google Scholar databases. From an initial search, a total of 1182 abstracts (280 and 902 abstracts, from PubMed and Google Scholar, respectively) were found and screened in accordance with the eligibility criteria. Subsequently, six articles were found to be eligible for further review. A total of 419 patients underwent surgical repairs; 205 and 214 patients underwent arthroscopic and open repairs, respectively. The mean minimum follow-up period was 29.2months. The medium-term follow-up for arthroscopic LLC repairs was found to be superior to that of open LLC repairs, with more favorable outcomes; as evidenced by better clinical scores, lower pooled complication rates, earlier return times to pre-injury sport, and higher early sport ratios. The findings of this systematic review and meta-analysis support near-future developments validating arthroscopic repair as the new gold standard for LLC repairs, similarly to arthroscopic ligament and tendon repairs, as well as arthroscopic reconstruction surgeries, of the knee and shoulder.