Radiographic Instability of the Ankle Joint After Evans' Repair

Orava, Sakari; Jaroma, H; Weitz, Howard H.; Loikkanen, T; Suvela, M

doi:10.3109/17453678308996620

Cited by 43 publications

(13 citation statements)

References 11 publications

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“…18 values for anterior talar translation and talar tilt on stress radiological examination two to ten years after tenodesis in comparison with anatomical reconstruction. Orava et al 39 reported an incidence of almost 50% of a radiologically evident increase in anterior talar translation two to seven years after the Evans tenodesis. In our study, we found higher mean values for anterior talar translation and talar tilt on stress radiological examination after the Evans tenodesis than after anatomical reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle: Clinical and radiological findings after follow-up for 15 to 30 years

Krips

Brandsson

Swensson

et al. 2002

The Journal of Bone and Joint Surgery

109

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In this retrospective study, we assessed the outcome in 99 patients who underwent reconstruction of the lateral ligaments of the ankle for chronic anterolateral instability with a minimum follow-up of 15 years. Two techniques were compared: 54 patients had an anatomical reconstruction (AR group) and 45 had an Evans tenodesis (ET group). They were followed up for 19.9+/-3.6 years and 21.8+/-4.6 years, respectively. During follow-up, seven patients in the AR group and 17 in the ET group required a further operation (p = 0.004). At follow-up, significantly more patients (n = 15) in the ET group had limited dorsiflexion than in the AR group (n = 6, p = 0.007) and 18 in the ET group had a positive anterior drawer test compared with seven in the AR group (p = 0002). In the ET group 27 had tenderness on palpation of the ankle compared with 15 in the AR group (p = 0.001). Stress radiographs showed ligamentous laxity significantly more often in the ET group (n = 30) than in the AR group (n = 13, p < 0.001). The mean values for talar tilt and anterior talar translation were significantly higher in the ET group than in the AR group (p < 0.001, p = 0.007, respectively). There were degenerative changes on standard radiographs in 32 patients in the AR group and 35 in the ET group (p = 0.05). Four patients in the ET group had developed severe osteoarthritis compared with none in the AR group (p = 0.025). Assessment of functional stability revealed a mean Karlsson score of 83.7+/-10.4 points in the AR group and 67.0+/-15.8 points in the ET group (p < 0.001). According to the Good rating system, 43 patients in the AR group had good or excellent results compared with 15 in the ET group (p < 0.001). Compared with anatomical reconstruction, the Evans tenodesis does not prevent laxity in a large number of patients. Long-standing ligamentous laxity leads to degenerative change in the ankle, resulting in chronic pain, limited dorsiflexion and further operations. The functional result deteriorates more rapidly after the Evans tenodesis than after anatomical reconstruction.

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Section: Discussionmentioning

confidence: 99%

Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle: Clinical and radiological findings after follow-up for 15 to 30 years

Krips

Brandsson

Swensson

et al. 2002

The Journal of Bone and Joint Surgery

109

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“…The stabilising effect is achieved by pulling the tip of the fibula downwards and anteriorly to the base of the fifth metatarsal which may help to explain the reports of relatively high rates of residual instability. 7,8,[36][37][38][39] This procedure should not be used before alternatives have been considered. The Watson-Jones procedure was the best of the procedures with respect to fixation of the talus and also prevented impairment of subtalar movement.…”

Section: 34-36mentioning

confidence: 99%

“…Clinical long-term follow-up studies have shown an impaired range of movement after certain types of tenodesis, which may partly explain the high rate of residual problems and the occurrence of advanced arthritis. [6][7][8][9] Various techniques have been described to determine the three-dimensional range of movement of the ankle joint complex in vivo, 10,11 but they do not differentiate between movement in the separate joints. Recently, invasive in vivo measurements in the talocrural and subtalar joints have been reported.…”

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Tenodeses destroy the kinematic coupling of the ankle joint complex

Rosenbaum

Becker

Wilke

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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T o study the effect of ligament injuries and surgical repair we investigated the three-dimensional kinematics of the ankle joint complex and the talocrural and the subtalar joints in seven fresh-frozen lower legs before and after sectioning and reconstruction of the ligaments. A foot movement simulator produced controlled torque in one plane of movement while allowing unconstrained movement in the remainder.After testing the intact joint the measurements were repeated after simulation of ligament injuries by cutting the anterior talofibular and calcaneofibular ligaments. The tests were repeated after the Evans, Watson-Jones and Chrisman-Snook tenodeses. The range of movement (ROM) was measured using two goniometer systems which determined the relative movement between the tibia and talus (talocrural ROM) and between the talus and calcaneus (subtalar ROM).Ligament lesions led to increased inversion and internal rotation, predominantly in the talocrural joint. The reconstruction procedures reduced the movement in the ankle joint complex by reducing subtalar movement to a non-physiological level but did not correct the instability of the talocrural joint.

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“…The use of the patient's medical history, physical examination, fluoroscopic stress radiographs, plain films, and MRI can help in determining a clear diagnosis. [38][39][40][41] …”

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confidence: 99%