Lateral Ligament Reconstruction Research Articles

Evaluation of Return to Military Activities after Combining Anterior Cruciate Ligament Reconstruction with Modified Lateral Extra-articular Tenodesis Versus Anterior Cruciate Ligament Reconstruction Alone in Primary Anterior Cruciate Ligament Tear in Soldiers. A Randomized Comparative Study

Abstract Background: This study aimed to assess the clinical result, complications, failure rate, and return to resuming military duty of a single-stage anterior cruciate ligament reconstruction (ACLR) procedure utilizing quadrupled semitendinosus tendon graft joint with modified lateral extra-articular tenodesis (LET). This study evaluates the potential impact of combined modified LET with ACLR versus ACLR alone on the rate of return to high-impact military activities, which we call return to sports (RTSs), and the subsequent rate of the anterior cruciate ligament (ACL) graft failure. Materials and Methods: A total of 198 soldiers with primary ACL tears with a high-grade pivot test (grade 3) were included and randomized using the simple randomized method and divided into two groups. A consecutive cohort of military personnel with an isolated ACL tear undergoing ACLR with modified LET (group A, n = 116) and ACLR alone (group B, n = 82) were analyzed between 2016 and 2021. Both groups were followed up for a minimum of 2 years. Soldiers underwent a survey evaluating knee function (knee injury and osteoarthritis outcome score [KOOS]), RTS criteria (RTS type), symptoms (International Knee Documentation Committee [IKDC] subjective), activity level (Tegner score), and fear of movement (Tampa Scale of Kinesiophobia-11) to assess psychological readiness for sport participation. Results: Among these, a mean age of 32 ± 2.93 years underwent primary ACLR with modified LET (n = 116) or without LET (n = 82) procedure. A total of 31 soldiers (15.6%) experienced ACL graft failure, including 26 (31.7%) reconstructions without LET and 5 (4.3%) with LET. Combined with LET during primary ACLR, it lowered the risk of graft failure by 2.8 times. Multivariable analysis revealed a significant reduction in graft rupture risk (relative risk = 0.325, P = 0.029) associated with LET compared to ACLR alone after adjusting for age, anthropometric factors, and tibial slopes. 105 out of 113 (90.5%) soldiers were able to return to military duty in group A (combined ACLR with modified LET), whereas 51 of 81 (62.9%) of the soldiers who underwent ACLR alone (group B) returned to military duty (P = 0.05). Conclusion: At 24 months postoperatively, combined ACLR plus LET showed a significantly higher RTS rate than ACLR alone. The combined ACLR with the modified LET group also showed a lower failure rate than the ACLR alone group. No marked differences were observed in KOOS sub-scores, IKDCsubjective, and Tegner activity scores.

Favorable change in patient-reported outcomes following peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction

BackgroundA peroneus longus to brevis tendon transfer is recommended for a severely torn peroneus tendon, but there is little research on the outcome. We conducted a prospective cohort study to examine patient-reported outcomes after this procedure. MethodsThirty-two patients underwent a peroneus longus to brevis tendon transfer and lateral ankle ligament reconstruction, 11 had an additional calcaneal osteotomy. The Foot and Ankle Outcome Score (FAOS) and Short Form-36 (SF-36) were assessed preoperatively, six and 12 months after surgery. ResultsPreoperative mean FAOS was 51.7 (SD 17.8) compared with 72.7 (SD 21.2) at 12 months, an improvement of 21 (95 % CI 12.7–28.0) (p < 0.0001). SF-36 improved significantly in the three domains involving physical function and bodily pain (p < 0.007). ConclusionPatient-reported outcomes improved significantly through peroneus longus to brevis tendon transfer. This procedure is worth considering for patients with a severely damaged peroneus tendon. Level of evidenceLevel II: Prospective cohort study

Arthroscopic lateral collateral ligament imbrication for the treatment of posterolateral rotatory elbow instability

ObjectivesPosterolateral rotatory elbow instability (PLRI) is commonly treated with open lateral collateral ligament (LCL) reconstruction techniques. This cohort study evaluates the efficacy of a less invasive arthroscopic LCL imbrication technique for reducing grade I or II PLRI. MethodsForty-three patients with stage I or II PLRI, unresponsive to conservative therapy, were included. Diagnoses were based on chronic post-traumatic pain (11 patients), chronic atraumatic lateral elbow pain (20), and previous open tennis elbow surgery (12). Following clinical and arthroscopic diagnosis confirmation, the LCL imbrication technique was performed. The Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were assessed preoperatively and postoperatively using the Shapiro-Wilk test and Wilcoxon signed rank test, respectively, with a minimum 12-month follow-up (range 12-48 months). ResultsMEPS increased significantly from a median of 45 points preoperatively to 90 (range 80–100) at three months and 95 (range 80-100) at 12 months follow-up (p < 0.001). Postoperative median flexion reached 140°, and extension was 0°. At 12 months, two patients experienced a 10° extension deficit; 95.3% (41/43) achieved full ROM. Knot irritation occurred in four patients (out of the first ten of this cohort, 9.3%), three of them requiring knot removal. Switching to a PDS 1 suture eliminated this complication. One patient underwent arthroscopic arthrolysis for adhesions after 14 months. ConclusionArthroscopic LCL imbrication offers favorable outcomes for grade I or II PLRI from the third postoperative month, with minimal complications. A slight restriction in ROM and transient knot discomfort were the main issues, the latter resolved by switching to a thinner PDS suture.

Which tendon graft to choose for anatomical ligament reconstruction in chronic lateral ankle instability? A biomechanical study

BackgroundThe need for anatomic lateral ligament reconstruction of the ankle continues to grow. This procedure usually requires a gracilis autograft or in some cases an allograft. Siegler et al. reported the mechanical characteristics of the collateral lateral ligaments of the human ankle: 231 ± 129 N for the ATFL and 307 ± 142 N for the CFL.The objective of this study was to evaluate the mechanical properties of different tendon grafts available for ATFL and CFL reconstruction. We hypothesized that the properties of the tested grafts are not inferior to the published values of those of the original ligaments on the lateral side of the ankle. MethodsThis was a comparative biomechanical study using 6 cadaver specimens (108 grafts): The biomechanical properties of nine types of grafts were determined using validated tensile testing methods: Gracilis, SemiT, EHL, FHL, Plantaris, Peroneus longus and brevis, TA and TP.The main outcome measure was the comparison of the mechanical properties of each single-stranded tendon with each other and with the known values ​​for the ATFL and CFL, during a uniaxial static rupture test. ResultsThe mean load to failure for the gracilis was 257.5 ± 52.9 N. The groups had similar mean values in terms of the maximum load that they could withstand before failing except for the plantaris (137.9 ± 33.7 N) which was statistically lower than all other tested tendons (p < 0,01).The mean load to failure values of the grafts tested were equal or higher than that of the ATFL and CFL reported by Siegler et al. [14]: 231 ± 129 N for the ATFL and 307 ± 142 N for the CFL, while the grafts tested here had mean failure load between 258 ± 53 N and 464 ± 136 N. ConclusionThe gracilis, peroneus longus/brevis, EHL, FHL, TA, TP and semiT are legitimate grafts for combined ATFL and CFL reconstruction in the ankle. These tendons have mechanical properties (load to failure, maximum strain at failure and stiffness) that are equal to or higher than the native ligaments on the lateral side of the ankle, except the plantaris. Clinical relevanceThis study validates the current use of the gracilis autograft for the anatomical reconstruction of the ATFL and CFL, and even provides proof that other tendons would be suitable for this anatomical reconstruction of the lateral ankle ligament by auto or even allograft under certain conditions. Level of evidenceDescriptive laboratory study.

Lateral ligament reconstruction and additive medial ligament reconstruction in chronic ankle instability: a retrospective study.

Ligamentous lesions of the ankle joint are common. Isolated medial ligament injuries are rare but are often associated with lateral ligament injuries, isolated medial ligament lesions are often overlooked. The present study aimed to evaluate the clinical and functional differences in the outcomes of isolated lateral and combined medial and lateral ligament reconstruction. The study is based on patient-reported outcome measurements and motion sensor technology to assess these outcomes. The purpose of this study was to compare the clinical and functional outcomes of isolated lateral and combined lateral and medial ankle ligament reconstruction. From December 2014 to August 2018, 111 patients underwent either isolated lateral ligament (LG) or medial and lateral ligament (MLG) reconstruction. Of the 104 patients meeting the inclusion criteria, 49 had LG and 55 had MLG reconstruction. Outcome measures included the Short Form-36 Health Survey SF-36, Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAMG), Tegner Activity Scale, the European Foot and Ankle Society (EFAS), American Orthopaedic Foot and Ancle Society (AOFAS) hindfoot score, and the Karlsson Peterson Score. Mobility and stability were assessed using the Ortheligent™ motion sensor for both healthy and treated ankles. While there were no significant differences in outcome scores between the groups, overall scores improved after treatment (p >0.00). Notably LG showed improved movement, with better dorsal extension measured by the Sensor (p ÷ 0.02). The sensor's results correlated significantly with FAOS subscales for pain (p ÷0.05), stiffness (p ÷ 0.01), ADL (p ÷0.02), and sports (p >0.00). Postoperative results, regardless of LG or MLG, showed significant subjective well-being improvement. LG's advantages were highlighted by a significant improvement in dorsal extension, supported by correlated results from a portable motion sensor assessing ankle stability.

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 &lt; .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.

Poster 283: Revision Patellofemoral Surgery: A Retrospective Cohort Analysis

Objectives: To report demographic and radiologic data, and clinical outcomes of patients undergoing revision surgery for patellar instability Methods: This is a retrospective cohort study. We included patients undergoing revision surgery for patellar instability between January 2010 and January 2022 in our institution. Exclusion criteria included patients with missing information regarding their primary surgery, patients with congenital disorders and patients with a history of distal femoral or proximal tibial osteotomy. Statistical analysis was performed using SPSS v. 20. Results: Ninety-six patients underwent revision surgery for patellofemoral instability. Eight patients were excluded based on exclusion criteria (Figure 1). Of the 88 patients included in final analysis, 44 (50%) had their primary surgery in our institution and revision rate in our institution was 3.8%. Primary surgeries included lateral retinacular release (LRR):18, medial patellofemoral ligament (MPFL) reefing: 19, MPFL reconstruction (MPFLR): 33, Tibial tubercle osteotomy (TTO): 24 (Table 1). Revision surgeries included: Lateral patellofemoral ligament reconstruction for iatrogenic medial instability: 6, MPFL release for persistent pain: 3, MPFLR: 36, MPFLR with Patellar tendon shortening: 5, MPFLR with Trochleoplasty: 4, Revision of femoral screw: 1, TTO: 19, TTO+MPFLR: 10, TTO+Trochleoplasty: 1, TTO+MPFLR+Trochleoplasty: 3 (Table 2). Patients having LRR as primary surgery had more female patients and higher patellar tilt, MPFLR patients had higher incidence of trochlear dysplasia, MPFL reefing patients were younger (Table 1). In our cohort of patients undergoing revision surgery for patellar instability, the mean tibial tubercle-trochlear groove (TT-TG) distance was 17.2 mm and the mean Caton-Deschamps Index (CDI) was 1.42. The incidences of trochlear dysplasia and skeletally immature patients were 61% and 68.2%, respectively (Table 1). The Median follow up period after revision surgery was 81 months. The overall complication rate after revision surgery was 12.5% (11/88) and occurred at a median of 31.5 months. Ten patients had recurrent patellar instability and one patient had tibial tubercle fracture (Table 3). Conclusions: The overall incidence of revision surgery was 3.8 after a primary surgery for patellar instability at a median of 31.5 months. Complications occur in 12.5% of patients after the revision surgery with the majority (10/11) being recurrent patellar instability. In our cohort, CDI and the incidences of trochlear dysplasia and skeletally immature patients were increased while the mean TT-TG distance was not.

Improvement in clinical outcomes following arthroscopic all-inside medial lateral ligament reconstruction for rotational ankle instability.

Rotational ankle instability can be diagnosed in up to 18% of cases of chronic lateral ankle instability. It is characterised by an abnormal increase of talar rotation within the tibiofibular mortise, due to an injury in the most anterior component of the deltoid ligament secondary to a chronic deficiency of the lateral collateral ligament. The aim of this prospective observational study was to investigate the clinical outcomes following arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability. A prospective observational study of consecutive patients undergoing arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability with minimum 6-month follow-up. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire. Secondary outcomes included the EQ-5D, European Foot and Ankle Society score and complications. Between 2020 and 2023, 12 patients underwent primary arthroscopic all-inside medial and lateral ligament reconstruction for rotational ankle instability with pre- and post-operative PROMs available for all 12 patients. The mean ± standard deviation age was 33.9 ± 7.2 years and the mean follow-up was 1.9 ± 1.2 (range: 0.5-3.8, interquartile range: 0.9-3.0) years. There was a significant improvement in all Manchester-Oxford Foot Questionnaire domain scores (p < 0.05): Index 53.1 ± 19.1 to 26.4 ± 27.6, Pain 46.7 ± 20.3 to 26.2 ± 26.8, Walking/Standing 58.7 ± 26.0 to 27.0 ± 30.0 and Social Interaction 51.2 ± 19.5 to 25.6 ± 30.1. There were improvements in EQ-5D-5L Index, VAS and VAS Pain; however, these were not statistically significant. There was one complication-a superficial peroneal nerve injury which resolved with a corticosteroid injection. The arthroscopic all-inside medial and lateral ligament reconstruction technique is a reliable and safe method for treating rotational ankle instability, demonstrating significant improvement in PROMs at a mean 1.9-year follow-up. Level IV.

A Novel Fixation Method of the Graft to the Fibular Head in Knee Lateral Collateral Ligament Reconstruction: Technical Note.

The lateral collateral ligament (LCL) is the strongest lateral stabilizer of the knee. It provides support against varus stress and posterolateral rotation of the knee. Lateral collateral ligament injuries mostly occur together with anterior and/or posterior cruciate ligament injuries. While grades 1 and 2 injuries are treated conservatively since they are partial injuries, total ruptures, as in grade 3, require surgical treatment. In conventional LCL reconstruction methods, hamstring grafts are used, and bioscrews are used in bone-tendon fixation. Lateral collateral ligament reconstruction is usually performed as a component of multiple ligament surgery. Therefore, there is a need for a contralateral hamstring tendon or allograft. The present article aims to define a technique that does not require tendon grafts and bioscrews in fibular fixation.

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.

Medial Patellofemoral Ligament and Lateral Patellofemoral Ligament Reconstruction after Tibial Tuberosity Transposition in a Young Woman with Patellar Instability

In patients with reccurent lateral and medial patellar instability, isolated medial patellofemoral ligament (MPFL) reconstruction may be insufficient due to poor lateral retinacular tissue quality. In this report, we describe a case of a patient that underwent simultaneous MPFL and lateral patellofemoral ligament (LPFL) reconstruction on the left knee due to chronic bidirectional patellar instability. A 29-year-old female patient presented with first-time lateral patellar dislocation five years ago due to acute strain. She underwent a tibial tuberosity transposition in another hospital. After the surgery, she suffered from recurrent medial and lateral patellar dislocation and presented to our center. MPFL and concomitant LPFL reconstruction on the left knee was simultaneously performed due to bilateral patellar dislocation. The patella was stable postoperatively, and the patient underwent physiotherapy with successful results to date. Single-time patellar dislocation should be treated conservatively. Surgical treatment after the first episode of dislocation can magnitude the risk of postoperative complications. The simultaneous reconstructing of the LPFL yields patellar fixation indistinguishable from the native LPFL. These grafts provide separate tensioning depending on body anatomy, allowing for individualized stability. Anatomical MPFL reconstruction is supported by well-established high-quality research. Reconstructing the LPFL anatomically yields patellar fixation indistinguishable from the native LPFL.

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.

Surgical Technique for Lateral Patellofemoral Ligament Reconstruction Using Bone Tunnels: A New Method.

Medial patellar instability (lateral patellofemoral ligament tear) is a rare condition which is commonly associated with lateral release for lateral patellar instability. LPFL is a lateralstabilizer of the patellofemoral joint. Reconstruction of LPFL is necessary to provide stability to the patella-femoral joint in patients with instability. We describe a novel technique of trans-osseous reconstruction of LPFL to gain stability and have better graft incorporation. A doubled peroneus longus graft is inserted into the patellar tunnel and secured with an endo button on the anteromedial aspect of the patella; the other end is then inserted into the insertional point on the femur and secured with an interference screw. This is an easy, novel, and reproducible technique which can be used to reconstruct LPFL.

Anconeus-sparing minimally invasive approach for lateral ulnar collateral ligament reconstruction using a triceps tendon autograft is an effective and safe treatment for chronic posterolateral instability of the elbow

Surgical treatment helps to restore stability of the elbow in patients with posterolateral rotatory instability (PLRI). The anconeus muscle is one of the most important active stabilizers against PLRI. A minimally invasive anconeus-sparing approach for lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon autograft has been previously described. The purpose of this study was to evaluate the outcome of this intervention and identify risk factors that influenced the clinical and patient-reported outcomes. Sixty-one patients with chronic PLRI and no previous elbow surgery who underwent surgical reconstruction of the LUCL using a triceps tendon autograft in a minimally invasive anconeus-sparing approach during 2012 and 2018 were evaluated. Outcome measures included a clinical examination and the Oxford Elbow Score (OES) and the Mayo Elbow Performance Score (MEPS) questionnaires. Subjective patient outcomes were evaluated with the visual analog scale (VAS) for pain and the Subjective Elbow Value (SEV). Integrity of the common extensor tendons and centering of the radial head were assessed preoperatively on standardized magnetic resonance images (MRIs). Fifty-two patients were available at final follow-up. The mean age of patients was 51±12 years with a mean follow-up of 53±14 months (range 20-76). Clinical examination after surgery (n=41) showed no clinical signs of instability in 98% of the patients (P<.001) and a nonsignificant improvement in range of motion. OES, MEPS, and VAS scores averaged 40±10 of 48 points, 92±12 of 100 points, and 1±2 points, respectively, all corresponding with good or excellent outcomes. The SEV was 88%, indicating very high satisfaction with the surgery. Only 1 patient had revision surgery due to pain, and there were no reported postoperative complications in this cohort. A radial head subluxation in the MRI correlated significantly with worse postoperative outcomes. The anconeus-sparing minimally invasive technique for posterolateral stabilization of the elbow using a triceps tendon autograft is an effective and safe treatment for chronic posterolateral instability of the elbow with substantial improvements in elbow function and pain relief with a very low rate of persistent clinical instability.

Lateral Collateral Ligament Reconstruction With Tensionable Loops and Suture Tape Reinforcement

Background: The posterolateral corner (PLC) is an important knee stabilizer that resists varus stress, external tibial rotation, and posterior tibial translation. Untreated PLC injuries have been shown to increase failure rates of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions and lead to degenerative changes. Our modified Arciero technique reconstructs the femoral insertion site and functionality of the lateral collateral ligament (LCL) and popliteal fibular ligament, components of the PLC, with an internal brace and tensionable loops. Indications: The primary indication for PLC reconstruction is identified PLC injury. Patients often have a feeling of knee instability and a varus thrust gait. PLC injury should be confirmed with imaging. Technique Description: We employed a modified Arciero technique via LCL reconstruction with tensionable loops and internal brace. We used a semitendinosus allograft truncated at 240-millimeters to avoid the graft bottoming out. A suture augment was incorporated into the graft to reinforce the LCL reconstruction construct during graft tensioning and early rehabilitation. The graft construct was then passed through the transfibular tunnel to femoral sockets at the LCL and popliteus insertions. The graft construct is then affixed to the opposite femoral cortex. The graft was then tensioned with the knee in approximately 30° of flexion, neutral to 10° of internal rotation, and a valgus force applied. This restored excellent valgus stability. Results: Fibular and tibiofibular-based constructs are common procedures for PLC reconstruction. Our LCL reconstruction with tensionable loops technique and the Arciero technique are fibular-based constructs. The fibular-based construct and the tibiofibular-based construct have been found to be biomechanically equivalent at restoring knee stability. However, fibular-based constructs, such as our LCL reconstruction with tensionable loops, were found to be less technically demanding than tibiofibular-based constructs, used fewer grafts, and required a smaller surgical approach. Conclusion: Given similar clinical outcomes, it was concluded that fibular-based constructs, such as our modified Arciero technique, may be more advantageous because of the ability to avoid some of the pitfalls of tibiofibular-based constructs. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

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.

Ankle Lateral Ligament Reconstruction in Skeletally Immature Patients: Technique Tip

Ankle Lateral Ligament Reconstruction in Skeletally Immature Patients: Technique Tip

Patient-Reported Outcomes Following Open Broström-Gould Procedure: Minimum 5-Year Follow-Up.

Ankle sprains are a common musculoskeletal injury among the general population and often involve the lateral ligament complex. Although the majority of ankle sprains are treated successfully with nonsurgical conservative measures, an estimated 5% to 20% of ankle injuries ultimately develop chronic lateral ankle instability (CAI). Multiple surgical treatment modalities for the lateral ankle complex exist, such as anatomical and nonanatomical reconstruction. The current gold standard for primary surgical repair is the Broström-Gould procedure. This is the first article to provide PROMIS scores following BG and the largest study with 5-year outcomes for an open BG. This was a descriptive study of a retrospective cohort of patients undergoing a BG with a minimum follow-up of 5 years. Patient-reported outcome instruments collected postoperatively were PROMIS Pain, Physical Function, Depression, and FAAM. Further preoperative clinic characteristics were analyzed to correlate with the final outcome. The electronic medical record was queried for Current Procedural Terminology (CPT) code 27698 (Broström-Gould) from January 2010 to June 2017. Surveys were conducted in the clinic and through phone interviews. Patient charts were reviewed to obtain basic patient demographic information including sex, age, race, and body mass index (BMI). The following preoperative variables were recorded: history of prior CAI procedures, history of major trauma, duration of symptoms, number of diagnosed ankle sprains, other collagen pathologies, generalized ligament laxity, participation in sports/activity level, peroneal subluxation, clinically diagnosed peroneus longus or brevis tendinopathy, deltoid ligament injury, anterior ankle impingement, and posterior ankle impingement. The PROMIS and Foot and Ankle Ability Measure (FAAM) scores were obtained with a combination of clinic and phone interviews. Data were aggregated in Microsoft Excel and entered in R (version 4.2.0) for statistical analysis. Our results show that the minimum 5-year patient-reported PROMIS scores for patients following a Broström-Gould procedure are as follows: PROMIS physical function, 50.5; PROMIS pain interference, 48.2; and PROMIS depression, 38.2. This indicates, at a minimum, that patients 5 years removed from the procedure are within 1 SD of the general population in regard to PROMIS physical function and pain. Our patient-reported FAAM, activities of daily living, and FAAM sports scores were 59.6 and 13.0 respectively. Preoperative magnetic resonance imaging (MRI) findings were recorded. Arthroscopic examination was performed before lateral ligaments reconstruction for patients with intra-articular pathologies confirmed on MRI. The findings from our study offer evidence supporting the effectiveness of the Broström-Gould procedure to be associated with normal physical function, even 5 years after surgery. Furthermore, our research identified specific factors such as tobacco use, diabetes, and sports participation that independently correlated with reported outcome measures. These insights enable physicians to better manage patient expectations and tailor treatment strategies accordingly. Our study establishes a foundation for future prospective research endeavors that aim to leverage the PROMIS system for comprehensive outcome assessments. Level III, retrospective cohort study.

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.

Lateral ulnar collateral ligament reconstruction enhancing secondary stabilizers in chronic PLRI of the elbow provides good to excellent clinical results with no recurrent instability

PurposeThe adopted treatment for chronic elbow PLRI is lateral ulnar collateral ligament reconstruction. However, the most frequently reported complication after primary reconstruction is recurrent instability – up to 25%. It was thus hypothesized that enhancing the secondary stabilizers will provide successful results with a lower rate of recurrent instability in comparison to techniques with primary reconstruction only. This study aimed to demonstrate a novel surgical technique involving secondary stabilizers. MethodsIn this retrospective study of 29 cases with chronic PLRI the mean duration of symptoms was 39.6 ±4.9 months. The mean age was 47.9 years with mainly male patients. The surgeries were performed by one senior surgeon at a single institution. The Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) were recorded. ResultsThe mean follow-up was 36.8 ±7.7 months. The MEPS score improved significantly from 59.8 ±13.1 to 84.7 ±7.6 (p<0.001). 23/29 patients (79.2%) had converted to good and excellent results (MEPS >75 points). The DASH score improved from 40.8 ±4.6 to 20.9 ±7.2 (p<0.001). The total complication rate was 10.3% (N=3). No recurrent instability was recorded in comparison to 12.2% for primary reconstruction only, as reported in the literature (p<0.05). ConclusionEnhancing the secondary stabilizers by utilizing an adjacently located autograft provided good and excellent results with no recurrent instability. This novel surgical procedure is easy to reproduce and provides a safe and reliable alternative in cases of chronic PLRI when compared to techniques with primary reconstruction only.