Treatment Of Chronic Lateral Instability Research Articles

Open Brostrom for Lateral Ligament Stabilization.

Lateral ankle ligament sprains are one of the most commonly reported injuries in high-level athletes and the general population. Unfortunately, up to 40% of these can go on to develop chronic lateral ankle instability which in the right circumstances requires surgical intervention. The purpose of this review is to present the gold standard surgical treatment for chronic lateral instability with anatomic ligament repair and to highlight the techniques, outcomes, and importance of anatomy when considering surgical treatment. Recent and remote literature agrees that the initial treatment for chronic ankle instability is non-operative rehabilitation. In the cases where this fails, the gold standard of surgical treatment is open anatomic repair using the Brostrom-Gould technique which stands out as having very good results over the course of time. Recent studies have shown equally good outcomes with arthroscopy as well as with internal brace devices, and both techniques show potential for earlier rehabilitation. In those with contraindications for anatomic repair including innate soft tissue laxity, high BMI, and in the revision setting, anatomic ligament reconstruction is an appropriate surgical option. Open modified Brostrom lateral ligament repair continues to be the preferred method of surgical treatment for chronic lateral ligament instability. In the setting of new modifications and techniques, long-term outcome studies are necessary to identify both their usefulness in long term and to compare them to the open surgery outcomes. It would be useful to standardize rehabilitation protocols as well as return to sport metrics in order to better evaluate outcomes moving forward.

Use of Modified Arthroscopic Ankle Joint Stabilization for the Treatment of Chronic Lateral Instability

Comparative analysis of the results of anatomic restoration of capsuloligamentous system in chronic lateral ankle instability using low invasive arthroscopic techniques was performed.Patients and methods.Forty seven patients (17 - 60 years old) with chronic lateral ankle instability were operated on. In 20 patients a standard “ArthroBrostrum” technique with a use of 2-3 biocomposite fixatives and in 27 patients - the modified arthroscopic intervention with use of 1 titanium anchor was performed. Treatment efficacy was evaluated by AOFAS score.Results. One year after surgery treatment results were followed up in 39 patients: excellent results were achieved in 7 (36.84%), good - in 7 (36.84%), satisfactory - in 3 (15.79%) and poor - in 2 patients after standard technique and in 8 (40.00%), 7 (35.00%), 4 (20.00%) and 1 (5.00%) after modified method, respectively.Conclusion.Thus modified arthroscopic technique is in no way inferior to a standard “ArthroBrostrum” intervention having certain advantages (use of 1 versus 3 fixatives, possibility of intraoperative X-ray control, and shortening of the operation duration). So it could be recommended for the treatment of patients with lateral ankle instability.

Use of Modified Arthroscopic Ankle Joint Stabilization for the Treatment of Chronic Lateral Instability

Comparative analysis of the results of anatomic restoration of capsuloligamentous system in chronic lateral ankle instability using low invasive arthroscopic techniques was performed. Patients and methods. Forty seven patients (17 - 60 years old) with chronic lateral ankle instability were operated on. In 20 patients a standard “ArthroBrostrum” technique with a use of 2-3 biocomposite fixatives and in 27 patients - the modified arthroscopic intervention with use of 1 titanium anchor was performed. Treatment efficacy was evaluated by AOFAS score. Results. One year after surgery treatment results were followed up in 39 patients: excellent results were achieved in 7 (36.84%), good - in 7 (36.84%), satisfactory - in 3 (15.79%) and poor - in 2 patients after standard technique and in 8 (40.00%), 7 (35.00%), 4 (20.00%) and 1 (5.00%) after modified method, respectively. Conclusion. Thus modified arthroscopic technique is in no way inferior to a standard “ArthroBrostrum” intervention having certain advantages (use of 1 versus 3 fixatives, possibility of intraoperative X-ray control, and shortening of the operation duration). So it could be recommended for the treatment of patients with lateral ankle instability.

The Effect of Ossicle Resection in the Lateral Ligament Repair for Treatment of Chronic Lateral Ankle Instability

The management of an ossicle or avulsion fragment of the fibular tip in chronic lateral ankle instability is an open question. Some authors maintain the necessity of osteosynthesis for reconstruction of the lateral ligamentous structure if the fragment is large. We hypothesized that the modified Broström procedure with resection of the ossicle would result in good outcomes compared to that of the same procedure for chronic lateral instability patients without ossicle. Between December 2004 and December 2010, 102 patients underwent the modified Broström procedure for chronic lateral instability. Of these, 82 patients (86 ankles) were available for this study. Forty ankles had ossicles at the fibular tip (group O), 46 had no ossicle (group N). The average follow-up period was 33 months in group O and 37 months in group N. Irrespective of size, if there were ossicles we resected all fragments and performed the modified Broström procedure. To analyze the surgical outcome, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot pain and function scales and Karlsson scores were compared between the 2 groups preoperatively and postoperatively. Preoperative scores in the 2 groups showed no significant difference, except for AOFAS pain score. There was no significant difference in postoperative AOFAS pain and function score between the groups. Postoperative Karlsson score was significantly higher in group O than in group N (P = .001). Group O was divided into 2 subgroups by the largest diameter of the ossicle (< 10 mm and ≥ 10 mm); there was no significant difference in surgical outcomes. In the treatment of chronic lateral instability of ankle, if there are ossicles on the fibular tip, osteosynthesis of the ossicles may not be necessary, even if the size is considerable. Modified Broström procedure after resection of the ossicle was successful. Level III, retrospective case series.

Management of chronic lateral instability due to lateral collateral ligament deficiency after total knee arthroplasty: a case report

IntroductionLateral instability following total knee arthroplasty (TKA) is a rare condition with limited report of treatment options. The objective of this case presentation is to demonstrate the outcomes of different surgical procedures performed in a single patient with lateral collateral ligament (LCL) deficiency.Case presentationWe present a case of chronic lateral instability due to LCL deficiency after primary TKA in a 47-year-old Caucasian woman with an obesity problem. Multiple treatment options have been performed in order to manage this problem, including the following: ligament reconstruction; combined ligament reconstruction and constrained implant; and rotating-hinge knee prosthesis that was the most recent surgery. All ligament reconstruction procedures failed within one year. The varus-valgus constrained prosthesis provided stability for six years.ConclusionsLigament reconstruction alone cannot provide enough stability for the treatment of chronic lateral instability in patients with obesity problems and LCL deficiency. When the reconstruction fails, a salvage procedure with rotating-hinge knee is still available.

Clinical outcome after anatomical reconstruction of the lateral ankle ligaments using the Duquennoy technique in chronic lateral instability of the ankle

We performed a retrospective study to assess the long-term outcome of non-augmented anatomical direct repair of the lateral ankle ligaments, as originally described by Duquennoy et al, for the treatment of chronic lateral instability of the ankle. This procedure aims to restore stability by the re-insertion and tightening of the original talofibular and calcaneofibular ligaments without division of the ligament. We examined the outcome in terms of the post-operative quality of life, the function of the joint and the development of osteoarthritis. Between 1985 and 2002, 23 patients (11 males, 12 females) with a mean age of 32 years (15 to 58) who had undergone this procedure completed the Short-Form 36 assessment of quality of life and the Olerud and Molander Ankle score for the subjective evaluation of symptoms. Clinical re-evaluation, including examination of the ankle and the completion of the American Orthopaedic Foot and Ankle Society questionnaire was performed on 21 patients after a mean follow-up of 13 years (3 to 22.2). At the final follow-up radiographs of both ankles were taken to assess the development of osteoarthritis. The mean total Short-Form 36 and Olerud and Molander Ankle scores in 23 patients at final follow-up were 79.6 points (37 to 100) and 81.6 points (40 to 100), respectively. The mean total post-operative American Orthopaedic Foot and Ankle Society score in 21 patients was 89.7 points (72 to 100). We found a significant post-operative reduction in talar tilt and anterior drawer sign (chi-squared test, p <0.001). The functional outcome of the procedure was excellent in ten patients (48%), good in seven (33%) and fair in four (19%). The results in terms of ankle function and stability did not deteriorate with time and there was little restriction in movement. This procedure is simple and effective with a very low rate of complications.

Long-Term Patient-Oriented Outcome Study of a Modified Evans Procedure

More than 50 surgical procedures have been described for treatment of chronic lateral ankle instability. Anatomic repairs have come into favor in the recent literature based on short-term studies, which have used objective measures for outcome. A long-term (range, 7-20 years; average, 12.6) patient-oriented outcome analysis was performed on 20 patients that underwent a modified Evans procedure for chronic lateral ankle instability by the senior author over a 13-year period. There was a 91% follow-up on all located patients (20 of 22). All patients had mechanical and functional instability, and all had failed conservative therapy. A questionnaire, based on the outcomes questionnaire developed by the American Academy of Orthopaedic Surgeons was used to determine functional stability. The patient's ability to perform recreational or competitive sporting activities at specific time intervals were also assessed (preinjury, 1 year postoperatively, present time). Overall result was considered satisfactory if five criteria were met: patents (a) were happy with the outcome of surgery, (b) were able to perform desired level of activities, (c) had functional stability, (d) were pain free performing desired level activities, (e) would undergo procedure again. The entire cohort demonstrated satisfactory results in 19 (95%) of 20 respondents at 1 year and 17 (85%) at present time. Grouping patients into competitive (12 cases) and recreational (eight cases) athletes demonstrated six of 12, and seven of eight reached their preinjury level (p = 0.074). In this study, we showed that surgical reconstruction using a modified Evans procedure is a reliable and effective treatment for chronic lateral instability. This procedure has proved to stand the test of time, as demonstrated by a patient-oriented outcome analysis. The elite athlete may be better served by a procedure using the principles of anatomic rather than augmented repair; however, the long-term data to our knowledge has yet to be published.

Surgical treatment of chronic lateral instability of the ankle joint. A new procedure.

Sixty patients with chronic lateral functional and mechanical instability of the ankle joint were treated with shortening and reinsertion of the lateral ankle ligaments. All patients were followed prospectively for 2 to 5 years (mean, 3 years 6 months). We found the functional results to be excellent or good in 53 patients (88%). Patients with unsatisfactory results had either generalized joint hypermobility or long-standing ligament insufficiency. Anterior talar translation (ATT) and talar tilt (TT) were measured radiologically on standardized radiographs. Patients with excellent and good functional results had better mechanical stability, both ATT and TT, than those with fair and poor functional results. A good correlation was found between clinical, functional, and radiological results. In conclusion we found that reconstruction of the ankle stability by shortening and reinsertion of the lateral ankle ligaments is a safe and simple method and is a good alternative to other more complex methods of ligament reconstruction. The method should, however, be used with great care in patients with generalized joint hypermobility or in patients with long-standing ligament insufficiency.