Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle

Takao, Masato; Matsui, Kentaro; Stone, James W.; Glazebrook, Mark; Kennedy, John G.; Guillo, Stéphane; Calder, James; Karlsson, Jón

doi:10.1007/s00167-015-3638-0

Cited by 116 publications

(104 citation statements)

References 18 publications

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“…24 An 18-gauge hollow needle with No. 2-0 nylon thread penetrates the ATFL inferior limb remnant 25,26 through the AAL or ST portal depending on the accessibility to the remnant. A suture passer, such as the Micro SutureLasso (Arthrex, Naples, FL) or SpeedSnare (Zimmer Biomet), is also useful for grasping the ATFL remnant.…”

Section: Step 4: Tunnel Creationmentioning

confidence: 99%

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Higashiyama

Sekiguchi

Takata

et al. 2020

Arthroscopy Techniques

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Arthroscopic techniques for anterior talofibular ligament (ATFL) repair and reconstruction have been developed in recent years. We simultaneously performed anatomical arthroscopic ATFL repair and reconstruction using a free tendon graft. The ATFL remnant is carefully dissected only at the footprint of the superior limb of the ATFL, and a bone tunnel is created on each side of the fibula and talus. A soft suture anchor with 2 sets of threads is inserted into the fibular tunnel. One set of threads is used to grab the ATFL remnant via a lasso-loop technique, whereas the other set of threads is used to introduce the ATFL graft. The graft is first fixed with a screw in the talar tunnel. Subsequently, the ATFL remnant and the graft are tightened simultaneously by pulling the 2 sets of suture anchor threads at the fibular tunnel and are fixed with a screw. This technique provides the possible advantages of remnant preservation and promotion of load sharing by the repaired ATFL remnant and the reconstructed ATFL graft.

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Section: Step 4: Tunnel Creationmentioning

confidence: 99%

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Higashiyama

Sekiguchi

Takata

et al. 2020

Arthroscopy Techniques

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“…The knot suture anchor repair procedure was performed according to a previous report ( Figure 1, A and C). 25 After the ATFL insertion at the distal fibula was identified (a mean 10-11 mm proximal to the distal tip of the fibula), 1 suture anchor (3.0-mm SutureTak) was placed at the fibular ATFL footprint. The ATFL remnant was penetrated by a tissue-penetrating instrument.…”

Section: Surgical Proceduresmentioning

confidence: 99%

“…‡ Generally, the suture anchors for ankle ligament repair can be divided into knot and knotless. Previously, Takao et al 25 described a simplified repair technique of the lateral ligament alone with a knot suture anchor, which avoids additionally tightening the inferior extensor retinaculum. Moreover, Li et al 16 repaired the ATFL with a knot suture anchor technique and reported that arthroscopic repair of the ATFL produced favorable magnetic resonance imaging outcomes with excellent functional outcomes 2 years postoperatively.…”

mentioning

confidence: 99%

Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison

Hua

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: To date, there are few biomechanical studies comparing the strength between knot repair and knotless repair procedures for anterior talofibular ligament (ATFL) injury. Purpose: To perform a biomechanical comparison of the strength of the arthroscopic ATFL repair technique with knot or knotless suture anchors in a cadaveric model with partial or complete ATFL injuries. Study Design: Controlled laboratory study. Methods: A total of 24 fresh-frozen cadaveric ankles were used. Arthroscopy was used to identify, section, and repair the ATFL on the fibular insertion site. The specimens were then randomly placed into 1 of 4 groups: group A received complete ATFL section and 1–suture anchor repair with knot, group B received complete ATFL section and 1-anchor knotless repair, group C received partial ATFL section and 1–suture anchor repair with knot, and group D received partial ATFL section and 1-anchor knotless repair. After repair, the ATFL tension was measured first with a digitalized tensiometer. Specimens were then mounted on a materials testing system to determine the ultimate load to failure and stiffness. Results: The mean ± SD ligament tension measured during the arthroscopic procedure was 8.6 ± 0.6 N for group A, 9.2 ± 0.5 N for group B, 9.4 ± 1.1 N for group C, and 9.6 ± 0.9 N for group D. No significant difference in tension was detected among groups. In load-to-failure testing, the mean ultimate failure load was 27.9 ± 4.1 N for group A, 26.2 ± 9.3 N for group B, 81.9 ± 26.5 N for group C, and 88.1 ± 41.6 N for group D. The mean ultimate failure loads of the partial repair groups were significantly higher than those of the complete repair groups (C vs A, P = .008; D vs B, P = .002), while there was no significant difference between groups A and B ( P > .05) or between groups C and D ( P > .05). Conclusion: The results of the present study showed that there was no significant difference in biomechanical properties between knot repair and knotless repair techniques. Clinical Relevance: Biomechanically, the results showed that knot suture anchor and knotless suture repair provide similar biomechanical strength for ATFL injury. Unfortunately, these methods in the complete ATFL section models provided less than half the strength and stiffness in the partial ATFL section models at time zero after surgery. As a result, 1–suture anchor repair is not suitable for complete ATFL injury regardless of the repair method.

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“…They can be divided into 2 categories: ligament repair or ligament reconstruction using a tendon graft or transfer. [3][4][5][6][7][8][9][10][11][12] The surgical procedure should be selected based on the tissue quality determined during arthroscopic assessment of the ATFL remnant. 11,13 The aim of this article was to present an arthroscopic technique for all-inside ATFL repair that allows for restoration of the ankle joint stability in a minimally invasive way.…”

mentioning

confidence: 99%

Arthroscopic Anatomic Anterior Talofibular Ligament Repair for Anterolateral Ankle Instability

Malinowski¹,

Paszkowski²,

Góralczyk³

et al. 2020

Arthroscopy Techniques

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Ankle instability is due to repetitive inversion injuries and is usually treated conservatively; however, after repeated sprains, chronic instability occurs and usually requires a surgical procedure. Recently, arthroscopic repair of a torn anterior talofibular ligament (ATFL) has become more popular owing to its minimal invasiveness and high efficacy. An all-inside technique allows for anatomic restoration of the injured ATFL, provides stability to the ankle joint, prevents a limitation of ankle range of motion, and may prevent arthritic development. We present an all-inside arthroscopic ATFL repair technique.

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Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle

Cited by 116 publications

References 18 publications

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison

Arthroscopic Anatomic Anterior Talofibular Ligament Repair for Anterolateral Ankle Instability

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