Recent Developments in the Treatment of Ankle and Subtalar Instability

Abstract

It was nearly a centenary ago that severe ankle sprain was recognized as an injury of the ankle ligament(s). With the recent technological advances and tools in imaging and surgical procedures, the management of ankle sprains - including subtalar injuries - has drastically improved. The repair or reconstruction of ankle ligaments is getting more anatomical and less invasive than previously. More specifically, ligamentous reconstruction with tendon graft has been the gold standard in the management of severely damaged ligament, however, it does not reproduce the original ultrastructure of the ankle ligaments. The anatomical ligament structure of a ligament comprises a ligament with enthesis at both ends and the structure should also exhibit proprioceptive function. To date, it remains impossible to reconstruct a functionally intact and anatomical ligament. Cooperation of the regenerative medicine and surgical technology in expected to improve reconstructions of the ankle ligament, however, we need more time to develop a technology in reproducing the ideal ligament complex.

Regeneration of grade 3 ankle sprain, using the recombinant human amelogenin protein (rHAM+) in a rat model

“…About one‐third of these individuals suffer significant disability due to pain, functional instability, mechanical instability, or recurrent sprains after recovery 4,6,9 . To date, no registered therapeutics exist that enables regeneration of injured ligaments 10 …”

Feasibility of MRI for the evaluation of interosseous ligament vertical segment via subtalar arthroscopy correlation: comparison of 2D and 3D MR images

“…High-resolution MRI of the ankle and subtalar joint facilitates the identification and differentiation of the ligament injury prior to surgical reconstruction. Intraoperative stress fluoroscopy and subtalar arthroscopy can be performed to visualize subtalar joint laxity and synovitis and diagnose associated ligamentous lesions [ 4 , 25 ]. Recent MRI studies have indicated that IOLV in tarsal sinus and CFL are important stabilizers of the subtalar joint [ 3 , 15 ].…”

Using arthroscopy combined with fluoroscopic technique for accurate location of the bone tunnel entrance in chronic ankle instability treatment

“…Chronic ankle instability resulting in reduced level of physical function or decreased quality of life is a significant health problem for patients [ 2 ] . Besides, it could cause a significantly increased risk of post-traumatic arthritis in the ankle joint [ 1 , 3 – 5 ]. Standard operative procedures for chronically unstable ankles included anatomical repair, non-anatomic, and anatomic reconstruction [ 6 ].…”