Kentaro Matsui

Functional Treatment After Surgical Repair for Acute Lateral Ligament Disruption of the Ankle in Athletes

Background: There have been several reports showing 20% to 40% failure after nonoperative functional treatment for acute lateral ligament disruption of the ankle. Hypothesis: Functional treatment after primary surgical repair has the advantage of decreasing the failure rate in comparison with functional treatment alone. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 132 feet of 132 patients were included in this study. Of these, 78 patients were treated with functional treatment alone (group F), and the remaining 54 patients were treated with functional treatment after primary surgical repair (group RF). The clinical results were evaluated using the Japanese Society for Surgery of the Foot Ankle-Hindfoot scale (JSSF) score, measuring the talar tilt angle and the anterior displacement of the talus in stress radiography, and noting the elapsed time between the injury and the return to the full athletic activity with no external supports. Results: The mean JSSF scores at 2 years after injury were 95.6 ± 5.0 points in group F and 97.5 ± 2.6 points in group RF (P = .0669). The differences of the talar tilt angles compared with the contralateral side and displacement of the talus on stress radiography at 2 years after injury were 1.1° ± 1.5° and 3.6 ± 1.6 mm in group F, and 0.8° ± 0.9° and 3.2 ± 0.8 mm in group RF, respectively (P = .4093, .1883). In group F, 8 cases showed fair to poor results, with JSSF scores below 80 points and instability at 2 years after injury. In group RF, 9 cases (9.4%) showed dorsum foot pain along the superficial peroneal nerve, which disappeared within a month. The time elapsed between the injury and the patient’s return to full athletic activity without any external supports was 16.0 ± 5.6 weeks in group F and 10.1 ± 1.8 weeks in group RF (P < .0001). Conclusion: Nonoperative functional treatment alone and functional treatment after primary surgical repair showed similar overall results after acute lateral ankle sprain, but functional treatment alone had an approximately 10% failure rate and a slower return to full athletic activity. The authors recommend that treatment be tailored to suit each individual athlete.

Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle

AbstractAlthough several arthroscopic procedures for lateral ligament instability of the ankle have been reported recently, it is difficult to augment the reconstruction by arthroscopically tightening the inferior extensor retinaculum. There is also concern that when using the inferior extensor retinaculum, this is not strictly an anatomical repair since its calcaneal attachment is different to that of the calcaneofibular ligament. If a ligament repair is completed firmly, it is unnecessary to add argumentation with inferior extensor retinaculum. The authors describe a simplified technique, repair of the lateral ligament alone using a lasso-loop stitch, which avoids additionally tighten the inferior extensor retinaculum. In this paper, it is described an arthroscopic anterior talofibular ligament repair using lasso-loop stitch alone for lateral instability of the ankle that is likely safe for patients and minimal invasive. Level of evidence Therapeutic study, Level V.

Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle.

Although several arthroscopic surgical techniques for the treatment of lateral instability of the ankle have been introduced recently, some concern remains over their procedural complexity, complications, and unclear clinical outcomes. We have simplified the arthroscopic technique of Broström repair with Gould augmentation. This technique requires only two small skin incisions for two ports (medial midline and accessory anterolateral ports), without needing a percutaneous procedure or extension of the skin incisions. The anterior talofibular ligament is reattached to its anatomical footprint on the fibula with suture anchor, under arthroscopic view. The inferior extensor retinaculum is directly visualized through the accessory anterolateral port and is attached to the fibula with another suture anchor under arthroscopic view via the anterolateral port. The use of two small ports offers a procedure that is simple to perform and less morbid for patients.

Percutaneous Ankle Reconstruction of Lateral Ligaments (Perc-Anti RoLL).

Summary Chronic ankle instability following ankle sprains causes pain and functional problems such as recurrent giving way. If non-operative treatments fail, then operative ankle stabilization may be required to improve pain and function. Operative options include both anatomic repair and reconstruction techniques. Anatomic repair techniques utilize pre-existing ligament remnants that are either reattached or tightened to improve stability of the ankle. If pre-existing ligament structures have been damaged beyond repair or are insufficient to allow repair, then it is appropriate to choose an anatomic reconstructive technique. These procedures have traditionally been performed using open techniques and have been successful in restoring function and decreasing pain. In 2005, an open anatomic reconstruction technique using a gracilis Y-graft and Inside-out technique was reported with good results. In the current paper we describe a Percutaneous Reconstruction of the Lateral Ligaments (Perc-Anti RoLL), which is a new minimally invasive surgical technique for anatomic reconstruction of the lateral ligaments of the ankle that utilizes the anatomic Y-graft and Inside-out technique. The Perc-Anti RoLL technique can be performed percutaneously using fluoroscopic guidance.

Fixation for avulsion fracture of the calcaneal tuberosity using a side-locking loop suture technique and anti-slip knot.

Avulsion fracture of the calcaneal tuberosity accounts for 1% to 3% of all calcaneal fractures, and its incidence peaks in women in their 70s, whose calcaneal bone strength and mineral content have decreased. Although nonoperative treatment has been recommended for fractures with less than 1 cm of displacement, operative treatment is indicated for fractures with more displacement to restore the function of the gastrocnemius-soleus complex. In the osteosynthesis for this type of fracture, it can be challenging to achieve sufficient fixation of the fracture fragment to resist the pull-out tension of the triceps surae because the fracture fragments are often small. The most widely accepted operative technique is the use of lag screw fixation followed by nonweightbearing in a short leg cast. However, a cadaveric study revealed that fixation by means of lag screws alone could resist around 250 N of tensile strength, which would seem to be too weak to neutralize the force of the Achilles tendon; for example, the tensile strength of the Achilles tendon when riding a bicycle is 489 to 661 N. Recently, the side locking-loop suture (SLLS) technique using braided polyethylene and polyester suture thread (Fiber Wire; Arthrex, Naples, FL) has been reported to provide good clinical outcomes for tendon repair. Also, a highly effective anti–slip knot for braided polyethylene and polyester suture thread that has satisfactory tensile strength has been introduced. In this article, we introduce a novel technique that provides rigid fixation of an avulsion fracture of the calcaneal tuberosity.

Percutaneous Ankle Reconstruction of Lateral Ligaments

Chronic ankle instability following ankle sprains causes pain and functional problems such as recurrent giving way. Within the 3 ligaments of the lateral ligament complex, 80% of patients tear the anterior talofibular ligament (ATFL), whereas the other 20% of patients tear the ATFL and calcaneofibular ligament (CFL). Rarely, the posterior talofibular ligament is involved. An incidence of 10% to 30% of patients will fail conservative treatment and result in chronic ankle instability that may require surgical treatment. To date, numerous open surgical procedures for anatomic repair or reconstruction of ATFL and/or CFL provide good clinical results.