Generalized Ligamentous Laxity Is an Independent Predictor of Poor Outcomes After the Modified Broström Procedure for Chronic Lateral Ankle Instability

Park, Kwang Hwan; Lee, Jin Woo; Suh, Jung Wook; Shin, Mi Hee; Choi, Woo Jin

doi:10.1177/0363546516656183

Cited by 72 publications

(101 citation statements)

References 38 publications

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“…eReferences 2, 3, 7, 8, 12, 26 –29, 35, 36, 38, 42 –44, 46, 69, 73, 74, 86, 90, 93, 95, 97, 102, 103, 105, 107, 114, 117 –119, 132, 134, 139, 142, 151, 153, 156, 157, 166, 179, 180, 184, 189, 191, 196, 197, 199, 206, 215, 216, 226, 229, 234.…”

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confidence: 99%

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Song

Liu

Sun

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered. Purpose: To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI. Study Design: A consensus statement of the Chinese Society of Sports Medicine. Methods: A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized. Results: A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded. Conclusion: This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.

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confidence: 99%

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Song

Liu

Sun

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Anatomic repair/reconstruction is currently the mainstay for operative treatment of MAI [10, 14, 26, 27]. In the last decade, anchor systems have been introduced to secure transplants [28] or as a knotless fixation for sutures [8].…”

Section: Discussionmentioning

confidence: 99%

“…The stability of anchor systems has been tested in cadaver studies, but the strength of these repairs was inferior to native ATFL [31–34]. Recently, suture tape techniques for augmentation of the ATFL were described [12, 35] and are proposed at least for patients with generalized ligamentous laxity [26], athletes, or patients with poor local tissue quality, e.g., following failed previous repair or reconstruction [13, 14].…”

Section: Discussionmentioning

confidence: 99%

Stabilizing lateral ankle instability by suture tape – a cadaver study

et al. 2019

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Background Suture tape is a recent development to augment a Brostrom repair at least during the healing phase of the native tissues used for stabilization of the lateral ankle ligaments. The purpose of this study was to evaluate whether suture tape is an effective mechanical stabilizer against anterior talar drawer in a cadaver experiment when tested with a validated arthrometer. Methods Different stability conditions were created in 14 cadaveric foot and leg specimens. Following anterior talofibular ligament (ATFL) dissection, isolated suture tape ATFL reconstruction was compared to the unaltered specimens, to the condition with ATFL cut, to the ATFL plus calcaneofibular ligament (CFL) cut conditions, and to the ATFL, CFL, and posterior talofibular ligament transected specimens. Three-dimensional bone-to-bone movement between fibula and calcaneus were simultaneously recorded using bone pin markers. Anterior translation was analysed between 20 and 40 N anterior talar drawer load, applied by an ankle arthrometer. Test conditions were compared using non-parametric statistics. Results Dissection of ATFL increased anterior talar drawer in arthrometer and bone pin marker analyses ( p = 0.003 and 0.004, respectively). When the CFL was additionally cut, no further increase of the anterior instability could statistically be documented ( p = 0.810 and 0.626, respectively). Following suture tape reconstruction of the ATFL, stability was not different from the unaltered ankle ( p = 0.173). Conclusions Suture tape augmentation of the ATFL effectively protects the unstable anterolateral ankle in the sagittal plane. The CFL does not seem to stabilize against the anterior talar drawer load.

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“…Clinical failure was defined as revisional surgery with persistent or recurrent symptoms. 4,6,8,33 According to these criteria, 11 of 46 ankles (23.9%) met our definition of clinical failure. Among these, arthroscopic debridement was performed for 9 patients with persistent or recurrent pain.…”

Section: Analysis Of Risk Factors Associated With Clinical Failurementioning

confidence: 95%

Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus

et al. 2018

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Generalized Ligamentous Laxity Is an Independent Predictor of Poor Outcomes After the Modified Broström Procedure for Chronic Lateral Ankle Instability

Abstract: Generalized ligamentous laxity is an independent predictor of poor outcomes and a risk factor of recurrent instability following the modified Broström procedure for CLAI.

Cited by 72 publications

References 38 publications

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Stabilizing lateral ankle instability by suture tape – a cadaver study

Primary Versus Secondary Osteochondral Autograft Transplantation for the Treatment of Large Osteochondral Lesions of the Talus

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