Safe angles of ATFL and CFL anchor insertion into anatomical attachment of fibula in a lateral ankle ligament repair

Nakasa, Tomoyuki; Ikuta, Yasunari; Ota, Yuki; Kanemitsu, Munekazu; Sumii, Junichi; Nekomoto, Akinori; Adachi, Nobuo

doi:10.1016/j.jos.2020.02.011

Cited by 11 publications

(11 citation statements)

References 28 publications

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“…Furthermore, recent cadaveric studies have suggested that the FOT is located 3.7 mm distal to the ATFL origin. 18,21 As the mean length between the FAI and FOT on the CT scans of the patients in the present study was 19.2 mm, we believe that the lower quarter area between the FAI and FOT was appropriate for the anatomic area for the ATFL insertion site of the distal fibula. Although the location of the anchor position was not evaluated by the distance between the position of the distal anteroinferior tibiofibular ligament and that of the repaired ATFL, the bony protrusions known as the anatomic landmarks for ligaments in the distal fibula were used as reference points; as such, we believe that this method of grouping in the present study is reasonable.…”

Section: Limitationsmentioning

confidence: 59%

“…The FOT and fibular anterior tubercle (FAT) are known as anatomic landmarks for identifying the ligament footprints for minimally invasive surgery for CAI. 18,21 The position of the fibular tunnel for a knotless anchor was measured in the true lateral view of the 3D CT reconstruction using a software program (InSpace 4D or syngo.via; Siemens Healthcare) that could identify the FOT and FAT. We analyzed the location of the tunnel for the anchor between the FAT and FOT by reconstructing the 3D image after marking the location of the tunnel through the sagittal section (Figure 3).…”

Section: Ct Measurement Methodsmentioning

confidence: 99%

“…18 According to previous cadaveric studies investigating the anatomic origin of the ATFL on the distal fibula, the center of origin was located 3.7 mm (range, 0-6.7 mm) proximal to the FOT, with an average width ranging from 6 to 10 mm. 5,14,18,21 The distal fascicle of the ATFL was attached around the FAT, with an average width ranging from 4 to 7 mm. 1,22 Given the anatomic position of these ligaments, the lower quarter between the FAT and the FOT was identified as an anatomic location for ATFL repair.…”

Section: Ct Measurement Methodsmentioning

confidence: 99%

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Nonanatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair With a High-Position Anchor versus Anatomic Repair: An Analysis Based on 3D CT

2022

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Background: In patients with chronic ankle instability, it is important to repair the anterior talofibular ligament (ATFL) at the anatomic origin site. However, there are limited reports on the clinical outcomes according to anatomic ATFL repair. Purpose: To compare the clinical outcomes after arthroscopic ATFL repair according to whether the anchor is fixed at an anatomic position. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair for chronic ankle instability and were available for a minimum 2-year follow-up. The patients were divided into 3 groups according to the anchor position at the distal fibula on 3-dimensional computed tomography: anatomic arthroscopic ATFL repair (anatomic group), subanatomic arthroscopic ATFL repair (subanatomic group), and nonanatomic arthroscopic ATFL repair (nonanatomic group). The visual analog scale for pain, Foot and Ankle Outcome Score (FAOS), and Karlsson ankle functional score were measured as subjective outcomes. Posturographic analysis and radiologic evaluation using stress radiographs and axial view magnetic resonance imaging were performed as objective outcomes. Results: Of 96 patients, 16 were excluded per the exclusion criteria, and 80 were evaluated (anatomic group, n = 24; subanatomic group, n = 42; nonanatomic group, n = 14). The mean age of the patients was 34.5 years, and the mean follow-up period was 27.4 months. A between-group comparison revealed significant differences in FAOS, Karlsson score, and fall risk evaluated by posturography at the final follow-up. Post hoc analysis revealed that the anatomic group had better clinical scores on the FAOS than did the nonanatomic group in all 5 domains (all P < .017). Patients in the anatomic and subanatomic groups had better Karlsson scores and fall risk than those in the nonanatomic group ( P = .004 and P = .013, respectively). In terms of objective outcomes, patients in the anatomic and subanatomic groups had better outcomes in fall risk than did those in the nonanatomic group (both P = .001). There were no differences in clinical scores and objective outcomes between the anatomic and subanatomic groups. Conclusion: Nonanatomic ATFL repair showed inferior outcomes when compared with anatomic ATFL repair. When arthroscopic ATFL repair is performed, the anchor should be fixed in the anatomic position to improve prognosis.

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Section: Limitationsmentioning

confidence: 59%

Section: Ct Measurement Methodsmentioning

confidence: 99%

Section: Ct Measurement Methodsmentioning

confidence: 99%

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Nonanatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair With a High-Position Anchor versus Anatomic Repair: An Analysis Based on 3D CT

2022

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“…The AAL portal was extended toward the fibula tip with a total length of 15 mm. loosening of the CFL was confirmed under direct visualization, and the CFL was reattached to its footprint of the fibula using a soft anchor [14].…”

Section: Arthroscopic Evaluationmentioning

confidence: 96%

“…The preoperative activity level was evaluated using the ankle activity score (AAS), which consisted of 53 sports, three working activities, and four general activities [14]. The CLAI patients were divided into two groups according to AAS (≧6 and ≦5), and the HU values were compared.…”

Section: Clinical Evaluationmentioning

confidence: 99%

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

Nakasa

Ikuta

Sumii

et al. 2021

Arch Orthop Trauma Surg

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Purpose Chronic lateral ankle instability (CLAI) is associated with osteoarthritis (OA). However, the characteristics of patients with CLAI who progress to OA are not clear. Measurement of Hounsfield Unit (HU) value on computed tomography (CT) is reported to be useful to evaluate the stress distribution. We aimed to evaluate the stress distribution in the ankle and subtalar joints and factors enhancing it in patients with CLAI. Materials and methods Thirty-three ankles with CLAI (CLAI group) and 26 ankles without CLAI (control group) were included. A mean age of CLAI was 35.2 years and control was 30.3 years. Color map was created in the ankle and subtalar joint according to the HU values using three-dimensional CT to identify the region with high HU values, and HU values in those regions were measured using two-dimensional CT and compared between control and CLAI groups. In CLAI group, the relationships between HU values and ankle activity score (AAS), OA, talar tilting angle (TTA), cartilage injury were assessed. ResultsThe HU values in the anteromedial region of the talus and lateral region in the subtalar joint were higher than those in the control. In CLAI, patients with an AAS of ≧ 6, over 10° of TTA, cartilage injury, and OA changes in the medial gutter had significantly higher HU values in the lateral region of the subtalar joint than those with an AAS of ≦5, less than 10° of TTA without cartilage injury and OA change. Conclusions CLAI patients, especially in the patients with high activity level, large TTA, cartilage injury, and OA changes at the medial gutter, have high HU values in the lateral region of the subtalar joint, which suggests that disruption of the subtalar compensation toward OA will occur. For these patients, instability should be completely eliminated to prevent ankle OA. Level of evidence Level III, comparative series.

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Stepwise decision making for CFL repair in addition to arthroscopic ATFL repair yields good clinical outcomes in chronic lateral ankle instability regardless of the remnant quality

Nakasa

Ikuta

Sumii

et al. 2023

Journal of Orthopaedic Science

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Safe angles of ATFL and CFL anchor insertion into anatomical attachment of fibula in a lateral ankle ligament repair

Cited by 11 publications

References 28 publications

Nonanatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair With a High-Position Anchor versus Anatomic Repair: An Analysis Based on 3D CT

Nonanatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair With a High-Position Anchor versus Anatomic Repair: An Analysis Based on 3D CT

High-stress distribution in the lateral region of the subtalar joint in the patient with chronic lateral ankle instability

Stepwise decision making for CFL repair in addition to arthroscopic ATFL repair yields good clinical outcomes in chronic lateral ankle instability regardless of the remnant quality

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