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

Abstract

Background Minimally invasive reconstruction techniques are used for anatomical ligament construction of the lateral collateral ligament complex of the ankle, but the two key elements, the bone tunnel and the appropriate graft tension, for the identification of the anatomic location during the surgery are not clearly stated. Methods The patients with chronic ankle instability who received arthroscopic anatomic lateral ligament complex reconstruction were retrospectively analyzed. The anatomical location of the bone tunnel was performed under arthroscopy combined with fluoroscopy for accurate location of the bone tunnel entrance. The graft tension and routing were controlled under arthroscopic visualization. The clinical outcomes were assessed using the Karlsson-Peterson score, Sefton articular stability scale, and Visual Analogue Scale (VAS). The complications were recorded during the follow-up. Results A total of 18 patients were enrolled in this study. The mean follow-up was 33.33 ± 3.69 (range from 24 to 36) months. No patient had recurrence of ankle instability after the operation. According to the Sefton articular stability scale, 94.5% of the patients had excellent/good function. The mean value of the anterior drawer tests and the talar tilt angle examination were decreased. The mean of the Karlsson-Peterson score and the Visual Analogue Scale(VAS) score were both improved significantly. Conclusions The anatomic reconstruction of the ankle lateral ligament complex to treat chronic ankle instability using the arthroscopy combined with the fluoroscopic technique could improve the clinical functions, satisfaction, and reduced pain of patients.

Anatomic reconstruction of lateral ankle ligaments: is there an optimal graft option?

“…Nineteen studies reported on autograft procedures [ 1 , 8 , 9 , 12 , 15 , 16 , 22 , 25 , 32 , 38 , 39 , 48 – 50 , 52 , 61 , 63 , 66 , 67 ], nine on allograft procedures [ 10 , 17 , 21 , 29 , 34 , 35 , 42 , 45 , 65 ] and one on both procedures, providing separate outcome description for patients receiving autograft and allograft [ 43 ]. Overall, 616 patients received autograft reconstruction and 314 allograft reconstruction.…”

Arthro-Broström with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques

“…For those patients with grade-4 ATFL lesions or generalized ligamentous laxity, the ligament reconstruction, in my opinion, is the good choice. The reason why we don’t suggest ligament reattachment is because there is a higher risk of rerupture due to the poor quality of the ligament remnant [ 2 , 3 ].…”

“…For those patients with grade-4 ATFL lesions or generalized ligamentous laxity, the ligament reconstruction, in my opinion, is the good choice. The reason why we don't suggest ligament reattachment is because there is a higher risk of rerupture due to the poor quality of the ligament remnant [2,3]. Actually, in most series with percutaneous or arthroscopic Broström-Gould techniques, once passed through the IER, the sutures are then tied into a horizontal mattress configuration [1,[13][14][15].…”

“…Lateral ankle ligament injuries are by far the most common injuries due to people’s active lifestyles, however, around 20% of cases should be treated with operative procedures after conservative methods have not been successful [ 1 , 2 ]. The goal of this surgical treatment is restoration of ankle stability and function while minimizing complications.…”

“…The goal of this surgical treatment is restoration of ankle stability and function while minimizing complications. The modified Broström-Gould procedure has been considered the gold standard for chronic lateral ankle instability (CLAI) over the last five decades [1][2][3]. These procedures were gradually developed from formal open techniques to minimally invasive ones over the years.…”