Ultrasound-Guided Ankle Lateral Ligament Stabilization

Abstract

Purpose of Review Ultrasound (US) is an increasingly popular imaging modality currently used both in clinics and operating rooms. The purpose of this review is to appraise literature describing traditional lateral ankle stabilization techniques and discuss potential advantages of US-guided ankle lateral ligament stabilization. In addition, albeit limited, we will describe our experiences in perfecting this technique. Recent Findings To date, the modified open Broström-Gould technique remains as the gold standard surgical treatment for chronic ankle instability (CAI). In the past decade, modifications of this technique have been done, from a combination of arthroscopic and open procedure to an all-inside arthroscopic technique with a goal of minimizing wound complications, better outcomes, and earlier return to activity. Recently, the use of US as an adjunct to surgical procedures has gained popularity and several novel techniques have been described. The use of US in lateral ankle stabilization could allow accurate placement of the suture anchor at the anatomical attachment of the anterior talofibular ligament (ATFL) without iatrogenic damage to the neurovascular structures such as anterolateral malleolar artery, superficial peroneal nerve, and sural nerve. Summary In summary, the use of US in ankle lateral ligament stabilization is a promising new micro-invasive technique. The theoretical advantages of US-guided ankle lateral ligament stabilization include direct visualization of desired anatomical landmarks and structures which could increase accuracy, decrease iatrogenic neurovascular damage, minimize wound complications, and improve outcomes.

Sonographically Guided Anchor Placement in Anterior Talofibular Ligament Repair Is Anatomic and Accurate

“…Finally, knot tying was performed for tensioning the ATFL with the ankle at a neutral plantarflexion-dorsiflexion position. 17 Additional arthroscopic procedures and/or open procedures were performed in cases where intra-articular lesions, such as symptomatic os trigonum, osteochondral lesions, loose bodies, or impinging osteophytes, and peroneal tendon lesions were clinically suspected in addition to CAI ( Table 1 ).…”

“…The potential advantages suggested were the microinvasive nature of the procedure, the safety to nearby neurovascular structures, and the procedural accuracy ( Figure 1 ). 17 However, to our knowledge, no previous reports have examined the anatomic accuracy of the anchor position in sonographically guided ATFL repair.…”

Ultrasound-Guided Anterior Talofibular Ligament Repair With Augmentation Can Restore Ankle Kinematics: A Cadaveric Biomechanical Study

“…Under US guidance, the curved tip of the MicroSutureLasso Minor Bend was introduced into the ATFL stump. 12 After the ATFL, subcutaneous tissue, and skin were penetrated, a nitinol loop wire was deployed. Next, upon visualization of the long axis of the ATFL, the MicroSutureLasso Minor Bend was inserted into the talar stump of the ATFL.…”

“…A suture anchor (DEX Fibertak; Arthrex) was placed at the anatomic fibular footprint after insertion of the drill guide followed by drilling under US guidance. 12 The 4 limbs of the nitinol wires were retrieved subcutaneously through the anchor incision below the superior peroneal nerve and above the ATFL. Each nitinol loop was relayed to each limb of the suture anchor, and 2 limbs of the suture anchor were clamped.…”

Bibliometric evaluation of ultrasound in orthopaedics global publications: 10-year trends and hotspots

“…In the eld of orthopaedics, accurate positioning and navigation during surgery are particularly important; otherwise, nerve and blood vessel damage and other postoperative complications will be caused, leading to poor prognosis of patients. For example, in lateral ankle stabilization techniques, ultrasound-guided arthroscopy can make the direct visualization of ankle anatomical landmarks and structures possible and can also effectively reduce surgical time and decrease the incidence of iatrogenic damage to neurovascular and other soft tissue structures (39). Similarly, Yang et al conducted a randomized controlled study in which ultrasound-mediated anaesthesia was used in 38 patients who needed surgery on the ankle joint and not in another 38; they found that the use of ultrasound results in fewer complications, which points out the direction of the development of ultrasound in treatment.…”