Arthroscopic classification of chronic anterior talo-fibular ligament lesions in chronic ankle instability

Thès, André; Odagiri, Haruki; Elkaïm, Marc; Lopes, Ronny; Andrieu, Michaël; Cordier, Guillaume; Molinier, F.; Benoist, Jonathan; Colin, Fabrice; Boniface, Olivier; Guillo, Stéphane; Bauer, Thomas

doi:10.1016/j.otsr.2018.09.004

Cited by 48 publications

(35 citation statements)

References 34 publications

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“…Age, sex, follow-up period, smoking status, body mass index, generalized hyperlaxity, arthroscopic ATFL grade, 41 and concomitant intra-articular lesions were evaluated as factors. No significant differences were found in characteristics between the groups (Table 1).…”

Section: Patient Characteristicsmentioning

confidence: 99%

Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

2021

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Background: Although several arthroscopic surgical techniques for the treatment of chronic ankle instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Purpose: To compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI between 2016 and 2018. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into 2 groups according to the surgical technique used for CAI: arthroscopic ATFL repair (group A; n = 37) and arthroscopic ATFL repair with additional IER augmentation (group R; n = 45). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). Results: Out of 101 patients, 19 (18.5%) were excluded per the exclusion criteria, and 82 were evaluated. We identified 6 retears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL retear on MRI (8.1% [3/37] in group A and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement >3 mm as compared with the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups ( P < .001). However, there were no significant differences in the clinical results and radiologic findings between the groups. Conclusion: The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.

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Section: Patient Characteristicsmentioning

confidence: 99%

Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

2021

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“…Since at the moment it is difficult to distinguish clearly whether the ATFL is attenuated or not, we recommend using arthroscopy with the hook test to evaluate the quality of the ATFL. 9 The long-term results of this technique need to be further evaluated. The anteromedial portal is made in a position of dorsiflexion, and the arthroscope is placed to see the lateral gutter.…”

Section: Discussionmentioning

confidence: 99%

All-Inside Endoscopic Broström–Gould Technique

Guillo

Odagiri

2020

Arthroscopy Techniques

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Ankle sprain is the most frequent sports trauma. Surgical treatment is needed in case of chronical instability, after failure of conservative treatment. The technique established today worldwide consists in repairing the ligament (Broström technique) and strengthening the repair by adding extensor retinaculum (Gould technique). An arthroscopic technique recently has been developed; nevertheless, no published technique has proposed a total endoscopic Broström technique associated with a Gould augmentation because of difficulty in visualizing the retinaculum by anterior ankle arthroscopy. Lateral ankle endoscopy can provide a view of this area that is superior to open surgery. In this technique, the procedure is able to be performed safely and reproducible under perfect viewing. The purpose of this study is to describe an all-inside endoscopic BroströmeGould technique.

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“…An orthopedic professor (MD) specializing in ankles and feet was responsible for all patient surgeries. Severity level of the ATFL was classified by arthroscopic grade based on a previous study: grade 0, normal and continuous ligament without tearing, normal thickness, and taut between the lateral malleolus and the talar neck; grade 1, distended ligament without tearing, normal in thickness but with decreased tension by hook palpation; grade 2, fibular or talar avulsion (with fibrous tissue) of the ATFL, normal thickness, but decreased tension by hook palpation; grade 3, thin ATFL ligament with no mechanical resistance by hook palpation, with or without scar tissue; and grade 4, scar tissue with absent ATFL [ 17 ]. Arthroscopic grade 2 or 3 CAI patients underwent MBP, and the orthopedic surgeon referred them to the Department of Rehabilitation Medicine in a tertiary hospital to perform rehabilitation therapy on an outpatient basis.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients

Kong

Lee

Park

et al. 2021

BioMed Research International

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We investigated the therapeutic effect of a postoperative hospital-based systemic rehabilitation protocol on ankle function in chronic ankle instability (CAI) patients. Thirty-five patients who underwent a modified Broström procedure for CAI were recruited in this prospective randomized controlled trial. Fifty-minute sessions of hospital-based rehabilitation were performed three times weekly for 12 weeks in the intervention group. Education-based rehabilitation was conducted at home in the control group. The outcomes were evaluated at baseline (T0), 12 weeks (T1), and 16 weeks (T2). The primary outcome was the foot and ankle outcome score (FAOS). Ankle motor strength and spatiotemporal gait metrics were assessed as secondary outcomes. There were significant time and group interaction effects on the pain, symptoms, activities of daily living, sports activities, and quality of life (QOL) domains of the FAOS ( P < 0.05 , all). The patients in the intervention group showed larger improvements in all domains of the FAOS than did the control group at both T1 and T2 ( P < 0.05 , all). The time and group interaction effects on invertor and evertor strength were also significant ( P = 0.047 and P = 0.044 ). Invertor and evertor strength improved significantly more in the intervention group than in the control group at T1 and T2 ( P < 0.05 , all). The preferred walking velocity, cadence, step length on the affected side, and double stance phase duration tended to improve over time. Postoperative hospital-based rehabilitation helped improve CAI pain, symptoms, independence in activities of daily living, sports activity levels, and QOL more effectively than did conventional rehabilitation at home.

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Arthroscopic classification of chronic anterior talo-fibular ligament lesions in chronic ankle instability

Abstract: This arthroscopic classification of chronic ATFL lesions confirms the diagnostic role for arthroscopy in assessing the ligaments in patients with CAI. It is helpful for determining the best surgical technique for stabilising the ankle. These results must be confirmed in a larger study.

Cited by 48 publications

References 34 publications

Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

Additional Inferior Extensor Retinaculum Augmentation After All-Inside Arthroscopic Anterior Talofibular Ligament Repair for Chronic Ankle Instability Is Not Necessary

All-Inside Endoscopic Broström–Gould Technique

Effectiveness of Hospital-Based Systemic Rehabilitation in Improving Ankle Function after Surgery in Chronic Ankle Instability Patients

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