Avulsion Fracture of the Lateral Ankle Ligament Complex in Severe Inversion Injury

Haraguchi, Naotsugu; Toga, Hidekazu; Shiba, Nobumasa; Kato, Fumio

doi:10.1177/0363546507299531

Cited by 60 publications

(61 citation statements)

References 21 publications

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“…(iii) The establishment of the anterior channel of the lateral malleolus under arthroscopy should be carried out in the safe area to avoid injury to the superficial peroneal nerve and sural nerve. (iv) The small bone mass of lateral malleolus avulsion can be removed to prevent the formation of corpus liberum and impact. (v) During the operation, the position of the anchor should be located at the middle point of the footprint region of the distal fibula, and the bone freshening of the footprint region should be carried out before inserting the anchor to facilitate better healing of ATFL.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium‐ and Long‐Term Functional Follow‐Up

Feng

Sun

Wang

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium-and long-term follow-up.Methods: From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles, 25 right ankles) aged between 21 and 56 years, with an average age of 32.17 AE 6.35 years, presenting with CLAI, was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07 AE 13.29 months. All patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair of ATFL, with the fixation of one to two anchors. Pre-and post-operative visual analogue scales (VAS), the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation. Results:The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average of 51.25 AE 11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve, blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77 AE 1.36 days. All patients were followed for 24 to 45 months, averaging 33.16 AE 10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow-up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12 AE 0.13, the AOFAS score increased to 92.53 AE 4.87, and the KAFS score increased to 93.36 AE 6.15. All the follow-up indexes were significantly different from those before surgery.Conclusion: Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable medium-and long-term effect.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic Anatomical Repair of Anterior Talofibular Ligament for Chronic Lateral Instability of the Ankle: Medium‐ and Long‐Term Functional Follow‐Up

Feng

Sun

Wang

et al. 2020

Orthopaedic Surgery

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“…Many of these lateral ligament sprains involve additional injuries to other soft tissue structures (Fallet et al, 1998). In severe sprains, avulsion fractures of the lateral malleolus are common in children and in adults over 40 years old (Haraguchi et al,2007).…”

Section: Epidemiology and Fracture Classificationmentioning

confidence: 99%

“…Like many other parts of the body, the ankle is fractured more often in young men and older women (Yde,1980; Daly et al,1987; Jensen et al,1998). Comminuted fractures, multiple fractures, and avulsion fractures occur more often in older patients and as the result of low‐energy trauma (Bauer et al,1987; Court‐Brown and Caesar,2006; Haraguchi et al,2007; Aktas et al,2008). On the basis of the age and sex distribution of injured patients, Court‐Brown and Caesar (2006) concluded that bimalleolar and trimalleolar fractures of the ankle should be regarded as predominantly osteoporotic.…”

Section: Epidemiology and Fracture Classificationmentioning

confidence: 99%

“…Moreover, it is difficult to accept logically that supination‐external rotation is the most common mechanism of ankle injury, since supination is typically caused by loading to the lateral side of the foot and external rotation is typically caused by loading to the medial side of the foot. Although much of the scheme is clearly valid, more recent cadaveric studies have demonstrated that the injury mechanisms described by Lauge‐Hansen are neither complete nor unique (Michelson et al,1997; Haraguchi et al,2007; Kwon et al,2010).…”

Section: Epidemiology and Fracture Classificationmentioning

confidence: 99%

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Ankle injury mechanisms: Lessons learned from cadaveric studies

Funk

2011

Clinical Anatomy

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The biomechanics of ankle injury have been studied extensively, primarily through mechanical testing of human cadavers. Cadaveric testing is an invaluable methodology in biomechanics, because the magnitude and direction of the loading can be measured precisely and correlated with the resulting injury pattern. Clinical and epidemiological studies provide useful descriptions of injury patterns that occur in the real world, but their retrospective nature precludes a definitive analysis of the forces that caused the injury. Understanding the mechanism of ankle injuries is essential for developing countermeasures to prevent injury and for reconstructing injurious events. Knowledge of an injury's mechanism can also suggest potential associated injuries, which is helpful in diagnosis and treatment. The purpose of this review is to summarize the published research on ankle injury mechanisms with an emphasis on biomechanical experiments on human cadavers. Injury patterns are described based on the principal axis of force or torque producing the injury in conjunction with off-axis forces and out-of-plane foot positions. A mechanistic description of ankle injuries is complicated by the fact that the same mechanism can sometimes produce different injuries and the same injury can sometimes be caused by multiple mechanisms. Nonetheless, a framework for relating injury mechanisms and injury patterns is a valuable tool in the understanding, prevention, and treatment of ankle injuries.

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“…However, an isolated injury to the CFL ligament has rarely been reported (3). Theoretically, the latter injury pattern should involve an inversion type of mechanism with the ankle in extreme dorsiflexion to entirely avoid a concomitant injury to the ATFL (2).…”

Section: Discussionmentioning

confidence: 99%