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Alzahrani AA, AlQarni NA, Alghamdi FS, Alghamdi TA. Knowledge and attitude towards ankle sprain management among primary care physicians in the department of family medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. J Family Med Prim Care 2025; 14:211-217. [PMID: 39989570 PMCID: PMC11844991 DOI: 10.4103/jfmpc.jfmpc_1109_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 02/25/2025] Open
Abstract
Introduction Family doctors are the primary care providers for ankle sprains, which are a prevalent condition that they treat with great care. Family physicians' differing management styles and levels of knowledge about established recommendations may have a substantial influence on patient outcomes. Aims The current study aimed to assess the level of awareness among family physicians regarding established guidelines for ankle sprain management. Materials and Methods A cross-sectional study was conducted targeting all available and accessible primary care physicians within the Department of Family Medicine at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia during the period from 2023 to May 2024. Data were collected using an online questionnaire that was initiated by the study researchers after comprehensive review of similar articles in the literature. Results A total of 88 primary care physicians were included. Physicians' ages ranged from 25 to 60 years with a mean age of 33.4 ± 7.4 years old. A total of 47 (53.4%) were males, 29 (33%) were residents, 28 (31.8%) were consultants, 16 (18.2%) were senior Registrar, and 9 (10.2%) were GPs. A total of 41 (46.6%) of the study physicians had an overall good knowledge level about ankle sprain while most of them (53.4%) had poor knowledge level. A total of 55 (62.5%) of the study physicians utilize the Ottawa Ankle Rules to guide the need for X-ray imaging in ankle sprains, and 52 (59.1%) routinely provide information on preventive measures to patients diagnosed with an ankle sprain. Conclusion The study found that primary care physicians have average knowledge about ankle sprains, diagnosis, classification, and treatment, with lower knowledge of follow-up plans. They need training and educational programs.
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Affiliation(s)
- Abdullah A. Alzahrani
- Department of Family Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Norah A. AlQarni
- Department of Family Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Fahad S. Alghamdi
- Department of Family Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Tariq A. Alghamdi
- Department of Family Medicine, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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2
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Motley T. Rearfoot and Ankle Dislocations. Clin Podiatr Med Surg 2024; 41:551-569. [PMID: 38789170 DOI: 10.1016/j.cpm.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Subtalar dislocations, ankle dislocations, and total talar dislocations are high-energy injuries. As such, there may be associated osseous or soft tissue injuries that can be diagnosed with advanced imaging such as computed tomography (CT) or MRI. With closed injuries, closed reduction may require sedation or general anesthesia, flexion of the knee to release the tension of the gastrocnemius-soleus complex, distraction is applied, the deformity is accentuated, then the deformity is corrected. Open injuries are usually associated with a higher level of energy and a higher rate of infection. It is important to thoroughly irrigate and debride open dislocations both before and after reduction.
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Affiliation(s)
- Travis Motley
- Podiatry Surgical Residency, Department of Orthopaedic Surgery, Acclaim Multispecialty Group/John Peter Smith Hospital, 1500 South Main Street, 3rd Floor OPC, Fort Worth, TX, USA.
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Sonobe T, Watanabe K, Endo Y, Nikaido T, Matsumoto Y. A Professional Basketball Player Who Suffered an Open Ankle Dislocation Without an Associated Fracture Achieves His Prior Performance Level Three Months Later. Cureus 2024; 16:e64314. [PMID: 39131020 PMCID: PMC11316856 DOI: 10.7759/cureus.64314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
An ankle dislocation without an accompanying fracture is extremely rare, and an open ankle dislocation is even rarer. Due to its rarity, there is no consensus on the optimal treatment strategy. A professional basketball player (a 28-year-old male) incurred an open ankle dislocation (with no accompanying fracture) during a basketball game due to plantar flexion and inversion of his ankle during the transition from dashing to stop motion. The same day, an emergency reduction under spinal anesthesia was performed with primary closure of the wound. Considering the complications of infection and decreased ankle range of motion (ROM), primary ligament repair was not performed. He was treated conservatively with cast immobilization for four weeks, and early weight-bearing and ROM exercises were initiated. At six weeks postoperatively, stress radiography did not reveal ankle instability. After three months of conservative treatment, the patient was able to play basketball at his previous performance level. Four weeks of cast immobilization without ligament repair plus early rehabilitation with weight-bearing and ROM exercises allowed for an early return without complications. Even in high-level athletes, open ankle dislocation without an accompanying fracture can be treated adequately with conservative therapy.
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Affiliation(s)
- Tatsuru Sonobe
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, JPN
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, JPN
- Department of Research for Spine and Spinal Surgery, Fukushima Medical University, Fukushima, JPN
| | - Yasuhiro Endo
- Department of Physical Therapy, Fukushima Medical University, Fukushima, JPN
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, JPN
| | - Yoshihiro Matsumoto
- Department of Orthopaedic Surgery, Fukushima Medical University, Fukushima, JPN
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Lichte P, Weber C, Otto M, Bläsius F, Gutteck N, Hildebrand F, Arbab D. [Current diagnostics and treatment of ankle sprains in German]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:449-456. [PMID: 38634870 PMCID: PMC11133181 DOI: 10.1007/s00113-024-01428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Ankle sprains are one of the most frequent injuries of the musculoskeletal system. The injury pattern determines the treatment and are crucial for the outcome. Nonoperative treatment is commonly recommended for isolated injuries of the lateral ligaments but no standard strategy exists in combined ankle ligament injuries. The goal of this national survey was to achieve an overview about the current diagnostic strategies and common treatment concepts in Germany. MATERIAL AND METHODS All members of the German Society for Orthopaedics and Trauma Surgery (DGOU) were invited to participate in an anonymous survey about the diagnostic and therapeutic approach in cases of ankle sprains. The online survey consisted of 20 questions. Besides questions about the speciality and scope of activities the participants were ask to depict their diagnostic and therapeutic strategy. RESULTS A total of 806 participants completed the survey. Most of them were orthopedic trauma surgeons and worked in a hospital. During the first presentation the anterior drawer test (89.5%) and the inversion/eversion test (81.6%) were most commonly used, 88.1% always make an X‑ray examination and 26.5% an ultrasonography examination. Isolated injuries of the anterior fibulotalar ligament (LFTA) were treated nonoperatively by 99.7% of the participants, 78.8% recommend full weight bearing in an orthesis, 78.8% treat the complete rupture of the lateral ligaments without operation whereas 30.1% stated that they would treat a combined lateral ligaments rupture with an injury of the syndesmosis nonoperatively. DISCUSSION Due to the heterogeneity of injury patterns after ankle sprain no consistent recommendations for diagnostics and treatment exist. The Ottawa ankle rules and ultrasonography were not often utilized despite of the good evidence. The isolated rupture of the LFTA is diagnosed and treated according to the national guidelines by most of the participants. In cases of combined injuries of the lateral and medial ankle ligaments the majority choose a nonoperative treatment strategy which is justified by the guidelines with a low level of evidence. Combined injuries of the syndesmosis and the lateral ankle ligaments were treated operatively, which also correlates with the recommendations in the literature. The standard care of ankle sprain in Germany is in accordance with the recommendations from the current literature.
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Affiliation(s)
- Philipp Lichte
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Christian Weber
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Michael Otto
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Felix Bläsius
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Natalia Gutteck
- Klinik für Orthopädie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Frank Hildebrand
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Dariusch Arbab
- Klinik für Orthopädie/Unfallchirurgie, St. Elisabeth-Hospital Herten, Mitglied der Medizinischen Fakultät der Universität Witten/Herdecke, Herten, Deutschland
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Saadi Y, Neqrachi A, Boufettal M, Bassir RA, Kharmaz M, Berrada MS. Severe pure open dislocation of the ankle and flexor digitorum longus tendon tear a case report. Trauma Case Rep 2023; 48:100929. [PMID: 37711181 PMCID: PMC10498432 DOI: 10.1016/j.tcr.2023.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 09/16/2023] Open
Abstract
Proximal avulsion rupture of the flexor digitorum longus (FDL) tendon associated with an ankle dislocation is extremely rare. We report a case of a 29 years old patient presenting a severe open ankle dislocation with flexor digitorum longus tendon tear after a motorcycle accident. We performed wound debridement, ankle reduction, tendon repair and stabilization with external fixation. At our last follow-up 17 months after the operation, the patient had good functional outcome and returned to work. This report is noticeable as it is, to the best of our knowledge, the third study reporting a case with simultaneous open ankle dislocation and proximal avulsion rupture of the FDL tendon.
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Affiliation(s)
- Yassine Saadi
- Orthopaedic Surgery & Traumatology, University Mohamed V, Ibn Sina Hospital, Rabat, Morocco
| | - Alae Neqrachi
- Orthopaedic Surgery & Traumatology, University Mohamed V, Ibn Sina Hospital, Rabat, Morocco
| | - Moncif Boufettal
- Orthopaedic Surgery & Traumatology, University Mohamed V, Ibn Sina Hospital, Rabat, Morocco
| | - Rida-Allah Bassir
- Orthopaedic Surgery & Traumatology, University Mohamed V, Ibn Sina Hospital, Rabat, Morocco
| | - Mohamed Kharmaz
- Orthopaedic Surgery & Traumatology, University Mohamed V, Ibn Sina Hospital, Rabat, Morocco
| | - Mohamed Saleh Berrada
- Orthopaedic Surgery & Traumatology, University Mohamed V, Ibn Sina Hospital, Rabat, Morocco
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Guyonnet C, Dutra Vieira T, Lopes R. Arthroscopic Double-Row Repair for Acute Proximal Detachment of the Lateral Collateral Ligament in a Complex Ankle Sprain. Arthrosc Tech 2023; 12:e1409-e1416. [PMID: 37654887 PMCID: PMC10466297 DOI: 10.1016/j.eats.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
Management of ankle sprains is still being discussed. For athletes, recent studies recommend surgical treatment for acute grade III rupture, because of better long-term ankle stability. The purpose of this technical note is to describe the arthroscopic acute double-row repair for proximal disinsertion of collateral lateral ligament ankle. With the patient in dorsal decubitus under spinal anesthesia, the foot and ankle are extended beyond the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon in which the arthroscope is introduced. The anterolateral approach is simulated with a needle under arthroscopic control, in front and under the tip of the lateral malleolus. The anterior talofibular ligament (ATFL) is released from the capsule with a beaver blade. The tip of the lateral malleolus is sharpened, and a soft anchor is impacted there. ATFL is caught with a Mini-Scorpio plier, a Lasso loop is performed to improve tissue grasping. The ligament is pressed against the anchor, with the foot in maximum dorsiflexion and eversion. A knotless anchor is impacted 5 mm above and with the threads of the soft anchor, creating a double-row fixation. The arthroscopic acute double-row repair for proximal desinsertion of collatéral lateral ligament ankle can be done especially for athletes.
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Affiliation(s)
- Clément Guyonnet
- Clinique Brétéché, Nantes, France
- Polyclinique de l’Atlantique, Saint-Herblain, France
| | | | - Ronny Lopes
- Clinique Brétéché, Nantes, France
- Polyclinique de l’Atlantique, Saint-Herblain, France
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Zwipp H. Conservative Functional Treatment of Acute Fibular Ligament Rupture of the Ankle. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:454-460. [PMID: 37198926 PMCID: PMC10481941 DOI: 10.3238/arztebl.m2023.0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/05/2022] [Accepted: 05/02/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Acute rupture of the fibular ligament complex is one of the commonest injuries in sports. Prospective randomized trials in the 1980s led to a paradigm shift from primary surgical repair to conservative functional treatment. METHODS This review is based on publications retrieved by a selective search in PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and meta-analyses on surgical versus conservative treatment from the years 1983 to 2023. RESULTS 10 of 11 prospective randomized trials of surgical versus conservative treatment conducted between 1984 and 2017 did not reveal any significant difference in the overall outcome. These findings were confirmed in two meta-analyses and two systematic reviews that were published between 2007 and 2019. Isolated benefits in the surgical group were outweighed by a variety of postoperative complications. The anterior fibulotalar ligament (AFTL) was ruptured in 58% to 100% of cases, followed by the fibulocalcaneal ligament combined with the LFTA in 58% to 85%, and the posterior fibulotalar ligament (mostly incomplete ruptures) in 1.9% to 3%. CONCLUSION Conservative functional treatment is now the standard treatment in acute fibular ligament rupture of the ankle because it is low-risk, low-cost, and safe. Primary surgery is indicated in only 0.5% to 4% of cases. Physical examination for tenderness to palpation and for stability, as well as stress ultrasonography, can be used to differentiate sprains from ligamentous tears. MRI is superior only for the detection of additional injuries. Stable sprains can be successfully treated with an elastic ankle support for a few days, and unstable ligamentous ruptures with an orthosis for 5 to 6 weeks. Subsequent physiotherapy with proprioceptive exercises is the best way to prevent recurrent injury.
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Affiliation(s)
- Hans Zwipp
- TU Dresden, Dresden University of Technology, Center for Orthopedics and Trauma Surgery,Dresden
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8
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Park EH, de Cesar Netto C, Fritz J. MRI in Acute Ankle Sprains: Should We Be More Aggressive with Indications? Foot Ankle Clin 2023; 28:231-264. [PMID: 37137621 DOI: 10.1016/j.fcl.2023.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Acute ankle sprains are common sports injuries. MRI is the most accurate test for assessing the integrity and severity of ligament injuries in acute ankle sprains. However, MRI may not detect syndesmotic and hindfoot instability, and many ankle sprains are treated conservatively, questioning the value of MRI. In our practice, MRI adds value in confirming the absence or presence of ankle sprain-associated hindfoot and midfoot injuries, especially when clinical examinations are challenging, radiographs are inconclusive, and subtle instability is suspected. This article reviews and illustrates the MRI appearances of the spectrum of ankle sprains and associated hindfoot and midfoot injuries.
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Affiliation(s)
- Eun Hae Park
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA; Department of Radiology, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Jan Fritz
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1St Ave, 3rd Floor, New York, NY 10016, USA.
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9
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Kramer Z, Woo Lee Y, Sherrick R. Acute Ankle Sprains. Clin Podiatr Med Surg 2023; 40:117-138. [PMID: 36368838 DOI: 10.1016/j.cpm.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Understanding the types of ankle sprains is essential in determining the most appropriate treatment and preventing substantial missed time from sports. Commonly known and recognized is an acute lateral ankle sprain, however, a differentiation should also be made to understand high (syndesmotic) ankle sprains as the mechanism of injury and recovery periods differ between these two types.
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Affiliation(s)
- Zachary Kramer
- Scripps Memorial Hospital, 310 Santa Fe Drive #112, Encinitas, CA 92024, USA
| | - Yessika Woo Lee
- Dignity Health, St. Mary's Medical Center, 450 Stanyan Street, San Francisco, CA 94117, USA.
| | - Ryan Sherrick
- Foot & Ankle Surgery, Innovative Medical Solutions Foot & Ankle Institute, 2080 Century Park East, STE 710, Los Angeles, CA 90067, USA
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10
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Mederake M, Hofmann UK, Ipach I. Arthroscopic modified Broström operation versus open reconstruction with local periosteal flap in chronic ankle instability. Arch Orthop Trauma Surg 2022; 142:3581-3588. [PMID: 33993359 PMCID: PMC9596524 DOI: 10.1007/s00402-021-03949-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/03/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The modified Broström operation (MBO) has found widespread use in the therapy of lateral chronic ankle instability (CAI). However, alternative surgical techniques like the open reconstruction using a periosteal flap (RPF) are still an important part of the surgical treatment of lateral CAI. Both procedures differ in terms of the reconstruction material used and the surgical procedure. Comparative studies on the surgical therapy of CAI are limited and generally refer to similar surgical procedures. Aim of this study was to compare the arthroscopic MBO and the RPF. MATERIALS AND METHODS We retrospectively analysed 25 patients with lateral CAI after a tear of the anterior talofibular ligament (ATFL). 14 patients received arthroscopic MBO and 11 patients received RPF. We compared the postoperative outcome between both groups with respect to subjective instability, the number of ankle sprains, pain, complications and follow-up operations as well as the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS Both surgical procedures resulted in a significant improvement in pain, in subjective instability, in the reduction in the frequency of ankle sprains and improvement in the AOFAS ankle-hindfoot score one year postoperatively. Three months postoperatively, the values for pain and instability of the MBO group were significantly better compared to the RPF. One year after the operation, these differences were evened out. Also in terms of complications and follow-up operations, no significant difference was found between the two procedures. CONCLUSIONS Both surgical procedures give very good results one year postoperatively in terms of pain, instability, function and complication rate. With significantly better results regarding pain and instability three months postoperatively, the MBO allows a faster recovery in patients operated with this technique.
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Affiliation(s)
- Moritz Mederake
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Ulf Krister Hofmann
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany
| | - Ingmar Ipach
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany
- Orthopädie Straubing, Stadtgraben 1, 94315, Straubing, Germany
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11
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Wang Y, Zhu JX. Arthroscopic anatomical reconstruction of lateral collateral ligaments with ligament advanced reinforcement system artificial ligament for chronic ankle instability. World J Clin Cases 2022; 10:8893-8905. [PMID: 36157669 PMCID: PMC9477045 DOI: 10.12998/wjcc.v10.i25.8893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/04/2021] [Accepted: 07/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, the use of ligament advanced reinforcement system (LARS) artificial ligament, a new graft which has several unique advantages such as no donor-site morbidity, early recovery and no risk of disease transmission which has been a significant breakthrough for anatomical ligament reconstruction. Growing studies suggested that the special design of the LARS ligament with open fibers in its intra-articular part was believed to be more resistant to torsional fatigue and wearing. However, the safety and efficacy of LARS artificial ligament for ankle joint lateral collateral ankle ligament reconstruction has not been defined to date.
AIM To evaluate the clinical results of all-arthroscopic anatomical reconstruction of ankle joint lateral collateral ligaments with the LARS artificial ligament for chronic ankle instability.
METHODS Twenty-two patients with chronic lateral instability underwent anatomical reconstruction of the lateral collateral ligaments of ankle with LARS artificial ligament. The visual analogue score (VAS), American Orthopaedic Foot and Ankle Society score (AOFAS score) and Karlsson score were used to evaluate the clinical results before and after surgery.
RESULTS A total of 22 patients (22 ankles) were followed up for a mean of 12 mo. All patients reported significant improvement compared to their preoperative status. The mean AOFAS score improved from 42.3 ± 4.9 preoperatively to 90.4 ± 6.7 postoperatively. The mean Karlsson score improved from 38.5 ± 3.2 preoperatively to 90.1 ± 7.8 postoperatively. The mean VAS score improved from 1.9 ± 2.5 preoperatively to 0.8 ± 1.7 postoperatively.
CONCLUSION All-arthroscopic anatomical reconstruction of the lateral collateral ligaments with LARS artificial ligament achieved a satisfactory surgical outcome for chronic ankle instability.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
| | - Jun-Xu Zhu
- Department of Orthopaedics, The General Hospital of Northern Theater Command, Shenyang 110016, Liaoning Province, China
- Department of Orthopaedics, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang 441000, Hubei Province, China
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12
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Gan TJ, Li YX, Liu X, Zhang H. Pure Ankle Dislocation Without Associated Fracture: A Series of Cases and Our Clinical Experience. Indian J Orthop 2022; 56:1370-1377. [PMID: 35928649 PMCID: PMC9283584 DOI: 10.1007/s43465-022-00682-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Pure ankle dislocation without associated fracture is extremely rare. The current study reports eight cases of this type of injury, aiming to add some new material to the published data and present our clinical experience. METHODS Six open and two closed posteromedial tibiotalar dislocations without associated fractures treated in our department from 2015 to 2019 were retrospectively analyzed. Emergent reduction was performed for all patients followed by an average of 6 weeks of immobilization with external fixators in open cases and a short leg cast in closed cases. No patients underwent ligament or capsule repair except one case. The clinical data were recorded and analyzed. RESULTS At a mean follow-up of 33 months (range 13-61), the average AOFAS score was 91 (range 78-100) with five ankles rated as excellent and three rated as good. All of the eight patients returned to their prior daily life and the two closed patients with sports injuries resumed pre-injury activity level. The average range of motion (ROM) loss of the ankles was 9 degrees for plantarflexion and 3 degrees for dorsiflexion. Complications included superficial infection, moderate ankle stiffness, ankle degenerative change and residual numbness. None of the eight patients showed obvious ankle instability. CONCLUSION Pure ankle dislocation without associated fracture is a rare injury. Emergent reduction, appropriate wound care in open injuries and proper joint stabilisation with a cast or external fixator provide good clinical results and could be the mainstay of treatment.
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Affiliation(s)
- Ting-Jiang Gan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Avenue, Chengdu, 610041 Sichuan Province China
| | - Ya-Xing Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Avenue, Chengdu, 610041 Sichuan Province China
- Disaster Medicine Center, Sichuan University, Chengdu, 610041 Sichuan Province China
| | - Xi Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Avenue, Chengdu, 610041 Sichuan Province China
| | - Hui Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Avenue, Chengdu, 610041 Sichuan Province China
- Disaster Medicine Center, Sichuan University, Chengdu, 610041 Sichuan Province China
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13
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Happonen V, Kröger H, Sund R. Trends in operative ankle ligament surgery in Finland between 1986 and 2018. Foot Ankle Surg 2021; 27:252-255. [PMID: 32616465 DOI: 10.1016/j.fas.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/29/2020] [Accepted: 06/09/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ankle sprains are common musculoskeletal injuries. Until the 1990s, ankle ligament injuries were often treated operatively. The aim of this registry study was to determine how the change in treatment practice has affected the number of acute and elective ankle ligament surgeries in Finland. MATERIAL The data of ankle ligament injury patients operated between 1 January 1986 and 31 December 2018 was collected from the Finnish National Hospital Discharge Register. RESULTS A total of 33,770 ankle ligament injuries were repaired. The incidence of acute ankle ligament injury repair surgery has decreased nearly 80% over the last three decades. No increase in the number of late-stage ankle ligament injury repairs was found. CONCLUSION The number of acute and elective ankle ligament surgeries has remained low in the 2000s. This suggests that the occurrence of clinical instability after ankle sprains has not increased, even though acute-phase treatment has become conservative.
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Affiliation(s)
- Ville Happonen
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland.
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, Finland; Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio University Hospital, Yliopistoranta 1, 70210 Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio University Hospital, Yliopistoranta 1, 70210 Kuopio, Finland
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Feng SM, Sun QQ, Wang AG, Zhang ZY, Hao L. Long-term functional outcomes of all-inside arthroscopic repair of anterior talofibular ligament avulsion fracture. Foot Ankle Surg 2021; 27:156-161. [PMID: 32414701 DOI: 10.1016/j.fas.2020.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/26/2020] [Accepted: 03/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The main purpose of this study was to describe the all-inside arthroscopic technique for repairing anterior talofibular ligament (ATFL) avulsion fractures at the attachment points of the fibula and talus, and to evaluate the functional outcomes during long-term follow-up. METHODS The data of 78 patients with ATFL avulsion fracture treated in our hospital from August 2013 to November 2016 were analyzed retrospectively. All patients underwent surgery. Patients were divided into two groups according to whether they had undergone all-inside arthroscopic treatment or open treatment. The American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Foot and Ankle Outcome Score (FAOS) and a 36-item Short Form Health Survey questionnaire (SF-36) were used to evaluate functional outcomes. RESULTS The postoperative follow-up period was 24-48 months. All patients reported subjective improvements to ankle stability without any nerve, blood vessel or tendon complications. At the final follow-up, there was no significant difference in the AOFAS, SF-36 or sport participation rate between the arthroscopic group and the open group; however, the KAFS and FAOS were significantly higher in the arthroscopic group than in the open group. CONCLUSIONS For ATFL avulsion fractures, the all-inside ankle arthroscopic procedure produced better outcomes than did the open procedure. The all-inside ankle arthroscopic procedure provides a minimally invasive technique with acceptable long-term functional outcomes.
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Affiliation(s)
- Shi-Ming Feng
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China.
| | - Qing-Qing Sun
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Ai-Guo Wang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Zai-Yi Zhang
- Hand and Foot Microsurgery Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China
| | - Lin Hao
- Professor of Medicine, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China; Surgical Department, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, PR China.
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15
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Halabchi F, Hassabi M. Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World J Orthop 2020; 11:534-558. [PMID: 33362991 PMCID: PMC7745493 DOI: 10.5312/wjo.v11.i12.534] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Acute ankle sprain is the most common lower limb injury in athletes and accounts for 16%-40% of all sports-related injuries. It is especially common in basketball, American football, and soccer. The majority of sprains affect the lateral ligaments, particularly the anterior talofibular ligament. Despite its high prevalence, a high proportion of patients experience persistent residual symptoms and injury recurrence. A detailed history and proper physical examination are diagnostic cornerstones. Imaging is not indicated for the majority of ankle sprain cases and should be requested according to the Ottawa ankle rules. Several interventions have been recommended in the management of acute ankle sprains including rest, ice, compression, and elevation, analgesic and anti-inflammatory medications, bracing and immobilization, early weight-bearing and walking aids, foot orthoses, manual therapy, exercise therapy, electrophysical modalities and surgery (only in selected refractory cases). Among these interventions, exercise and bracing have been recommended with a higher level of evidence and should be incorporated in the rehabilitation process. An exercise program should be comprehensive and progressive including the range of motion, stretching, strengthening, neuromuscular, proprioceptive, and sport-specific exercises. Decision-making regarding return to the sport in athletes may be challenging and a sports physician should determine this based on the self-reported variables, manual tests for stability, and functional performance testing. There are some common myths and mistakes in the management of ankle sprains, which all clinicians should be aware of and avoid. These include excessive imaging, unwarranted non-weight-bearing, unjustified immobilization, delay in functional movements, and inadequate rehabilitation. The application of an evidence-based algorithmic approach considering the individual characteristics is helpful and should be recommended.
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Affiliation(s)
- Farzin Halabchi
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran
| | - Mohammad Hassabi
- Department of Sports and Exercise Medicine, Shahid Beheshti University of Medical Sciences, Tehran 19979-64151, Iran
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16
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Smith CS, Mollon B, Vannabouathong C, Fu JM, Sales B, Bhandari M, Whelan DB. An Assessment of Randomized Controlled Trial Quality in The Journal of Bone & Joint Surgery: Update from 2001 to 2013. J Bone Joint Surg Am 2020; 102:e116. [PMID: 33086352 DOI: 10.2106/jbjs.18.00653] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The quality of reporting of randomized controlled trials (RCTs) published in The Journal of Bone & Joint Surgery (JBJS) from 1988 to 2000 was previously analyzed. The purpose of this current study was to analyze the quality of reporting of RCTs published in JBJS from 2001 to 2013 to identify trends over time and potential areas of improvement for future clinical trials. METHODS A manual search of the JBJS database identified RCTs published between January 2001 and December 2013. Quality assessments, using the Detsky quality-of-reporting index (Detsky score), a modified Cochrane risk-of-bias tool, and abstraction of relevant data identifying predictors of quality, were conducted. RESULTS A total of 5,780 publications were identified in JBJS from 2001 to 2013, with 285 RCTs (4.9%), representing an increase from the prior 13-year period. The overall mean transformed Detsky score (and standard error) increased significantly (p < 0.001) from 68.1% ± 1.67% to 76.24% ± 0.72%. The percentage of multicenter RCTs decreased from 67% to 31%. The percentage of positive trials also decreased from 80% to 50.5%, as did the mean sample size (212 to 166). Regression analysis indicated that trials with an epidemiologist as the first author and nonsurgical trials were significantly associated (p = 0.001) with a higher overall trial quality score. The categories of the lowest mean methodology scores were randomization and concealment, eligibility criteria, and reasons for patient exclusion, as identified with the Detsky score, and patient and assessor blinding, as identified with the risk-of-bias assessment. CONCLUSIONS The quantity and quality of published RCTs in JBJS have increased in the 2001 to 2013 time period compared with the previous time period. Although these improvements are encouraging, trends to smaller, single-center trials were also observed. To efficiently determine the efficacy of orthopaedic treatments and limit bias, high-quality randomized trials of appropriate sample size and rigorous design are needed.
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Affiliation(s)
| | - Brent Mollon
- Soldiers' Memorial Hospital, Orillia, Ontario, Canada
| | | | - Joyce M Fu
- Department of Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | | | - Mohit Bhandari
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Daniel B Whelan
- University of Toronto Orthopaedic Sports Medicine, St. Michael's and Women's College Hospitals, Toronto, Ontario, Canada
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17
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Abstract
PURPOSE OF REVIEW Ankle sprains are a common injury that can lead to chronic lateral ankle instability resulting in pain, poor function, and decreased quality of life. The purpose of this review is to present information regarding injury mechanisms to the lateral ligaments of the ankle and the necessary steps to appropriately diagnose lateral ligament instability. RECENT FINDINGS The literature demonstrates that history and physical examination is often a reliable method for diagnosis of lateral ankle instability. In addition, imaging modalities are often used as adjuncts for diagnosis, especially when physical exam findings are equivocal. In summary, chronic lateral ligament instability of the ankle occurs secondary to failure of the lateral ligamentous complex. A focused physical examination to evaluate the anterior talofibular ligament, calcaneofibular ligament, and posterior talofibular ligament is necessary for diagnosis. Imaging modalities including plain radiographs, stress radiographs, and MRI are helpful for definitive diagnosis and to rule out other pathology.
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Affiliation(s)
- Edward S. Hur
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Daniel D. Bohl
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Simon Lee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL USA
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18
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Evaluation modalities for the anatomical repair of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28:163-176. [PMID: 31646350 DOI: 10.1007/s00167-019-05755-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/07/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE Several evaluation modalities are reported in the literature dealing with the operative treatment of chronic ankle instability (CAI) both to establish the CAI diagnosis leading to the surgical indication and to assess the effectiveness of ankle stabilisation procedure. The purpose of this study is to present an overview of the pre- and postoperative evaluation modalities reported in the literature dealing with CAI operative treatment. The comprehensive analysis of the different modalities chosen by researchers is expected to suggest critical points in current evaluation ability of CAI surgical treatment. METHODS Systematic review of the literature on surgical treatment of CAI through anatomic procedures. Pubmed, Embase and Cochrane electronic databases were analysed, from 2004 to 2018. RESULTS One-hundred-and-four studies met inclusion in this systematic review. 88 out of 104 studies analysed preoperative mechanical laxity of the ankle to depict the ligamentous insufficiency related to the subjective feeling of functional instability. Stress radiographs and manual stress examination of the ankle were the two most common modalities to evaluate joint laxity, reported in 67 and 53 studies, respectively. Clinical Outcome Measurement Scales (COMs) is the most common evaluation modality (102 out of 104 studies) to assess CAI surgical outcome. The American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS) and the Karlsson score are the most frequent COMs, reported in the 66% and 33%, respectively of the included literature. The radiographic analysis of ankle laxity after stabilisation procedures is the second most frequent postoperative evaluation modality, reported in 55 out 104 studies. CONCLUSIONS There is a lack of standardization among researchers related to both the criteria to establish the CAI diagnosis leading to the surgical indication and the modality chosen to evaluate the effectiveness of surgical treatment. Future standardization of evaluation modalities in the CAI population is desirable to increase consistency of reported data. LEVEL OF EVIDENCE Level IV, review of level I, II, III and IV studies.
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19
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Tümer N, Vuurberg G, Blankevoort L, Kerkhoffs GMMJ, Tuijthof GJM, Zadpoor AA. Typical Shape Differences in the Subtalar Joint Bones Between Subjects with Chronic Ankle Instability and Controls. J Orthop Res 2019; 37:1892-1902. [PMID: 31042001 PMCID: PMC6772087 DOI: 10.1002/jor.24336] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/23/2019] [Indexed: 02/04/2023]
Abstract
Bone shapes, particularly those defining the subtalar joint (STJ), have not received much attention yet as a risk factor for developing chronic ankle instability (CAI) after sustaining a lateral ankle sprain (LAS). This study aimed to compare three-dimensional (3D) shape variations in the STJ bones within individuals with CAI and healthy controls. 3D statistical shape models (SSMs) of the STJ bones were built to describe the bone shape variations observed within a population consisting of 26 individuals with unilateral CAI and 26 healthy controls. Using the SSMs and analysis of covariance test, age- and gender-adjusted shape variations in the bones were compared within individuals with CAI and healthy controls. The mean age of the CAI patients (14 males and 12 females) and healthy controls (12 males and 14 females) was 29 (standard deviation [SD] = 11) and 36 years (SD = 11), respectively. Tali and calcanei did not significantly vary between ipsilateral CAI and their contralateral ankle. Two shape modes, one for the talus (p = 0.015, variations in the curvature of the talar lateral process and the inclination angle of the talar neck relative to the body) and one for the calcaneus (p = 0.003, variations in the medial and lateral tuberosities, and the contour of the anterior articular surface), described significant shape differences between the CAI patients and healthy controls. The CAI patients generally had flatter talar joint surfaces and a flattened calcaneal ground-contact surface. These findings suggest that specific bone shapes may increase the risk of developing CAI after sustaining a LAS. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:1892-1902, 2019.
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Affiliation(s)
- Nazlı Tümer
- Department of Biomechanical EngineeringDelft University of Technology (TU Delft)DelftThe Netherlands
| | - Gwendolyn Vuurberg
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Gino M M. J. Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands
| | - Gabrielle J. M. Tuijthof
- Department of Orthopaedic Surgery, Amsterdam UMC, University of AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands,Academic Center for Evidence‐based Sports Medicine (ACES)AmsterdamThe Netherlands,Amsterdam Collaboration on Health & Safety in Sports (ACHSS)AMC/VUmc IOC Research CenterAmsterdamThe Netherlands,Research Centre Smart DevicesZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical EngineeringDelft University of Technology (TU Delft)DelftThe Netherlands
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Matherne T, Cooke J, McMorris M, Gross M. Delayed conservative treatment of an acute lateral ankle sprain in a non-athlete female following walking boot immobilisation. BMJ Case Rep 2019; 12:12/7/e229625. [PMID: 31352385 DOI: 10.1136/bcr-2019-229625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Lateral ankle sprains are a common injury with an estimated occurrence rate of 23 000 per day in the USA. Prolonged immobilisation and delayed referral to physical therapy are associated with poorer outcomes. The patient was a 49-year-old woman working as a surgical technologist. She sustained an inversion injury to her left ankle while descending from a stool. Her primary care physician examined her, issued a Controlled Ankle Movement (CAM) walking boot and immobilised her ankle for 6 weeks. Patients with grade I and II lateral ankle sprains who are treated with early mobilisation and referral to physical therapy have demonstrated earlier return to function compared with patients who are treated with prolonged immobilisation and delayed referral. Nevertheless, it remains common for individuals who have sustained a lateral ankle sprain to be immobilised. This case study highlights the importance of early mobilisation and early physical therapy referral for patients with lateral ankle sprains.
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Affiliation(s)
- Tyler Matherne
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Jennifer Cooke
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Michael McMorris
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
| | - Michael Gross
- Department of Physical Therapy, University of North Carolina System, Chapel Hill, North Carolina, USA
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21
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Boey H, Verfaillie S, Natsakis T, Vander Sloten J, Jonkers I. Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures. Am J Sports Med 2019; 47:1921-1930. [PMID: 31125267 DOI: 10.1177/0363546519848421] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Altered kinematics and persisting ankle instability have been associated with degenerative changes and osteochondral lesions. PURPOSE To study the effect of ligament reconstruction surgery with suture tape augmentation (isolated anterior talofibular ligament [ATFL] vs combined ATFL and calcaneofibular ligament [CFL]) after lateral ligament ruptures (combined ATFL and CFL) on foot-ankle kinematics during simulated gait. STUDY DESIGN Controlled laboratory study. METHODS Five fresh-frozen cadaveric specimens were tested in a custom-built gait simulator in 5 different conditions: intact, ATFL rupture, ATFL-CFL rupture, ATFL-CFL reconstruction, and ATFL reconstruction. For each condition, range of motion (ROM) and the average angle (AA) in the hindfoot and midfoot joints were calculated during the stance phase of normal and inverted gait. RESULTS Ligament ruptures mainly changed ROM in the hindfoot and the AA in the hindfoot and midfoot and influenced the kinematics in all 3 movement directions. Combined ligament reconstruction was able to restore ROM in inversion-eversion in 4 of the 5 joints and ROM in internal-external rotation and dorsiflexion-plantarflexion in 3 of the 5 joints. It was also able to restore the AA in inversion-eversion in 2 of the 5 joints, the AA in internal-external rotation in all joints, and the AA in dorsiflexion-plantarflexion in 1 of the joints. Isolated ATFL reconstruction was able to restore ROM in inversion-eversion and internal-external rotation in 3 of the 5 joints and ROM in dorsiflexion-plantarflexion in 2 of the 5 joints. Isolated reconstruction was also able to restore the AA in inversion-eversion and dorsiflexion-plantarflexion in 2 of the joints and the AA in internal-external rotation in 3 of the joints. Both isolated reconstruction and combined reconstruction were most successful in restoring motion in the tibiocalcaneal and talonavicular joints and least successful in restoring motion in the talocalcaneal joint. However, combined reconstruction was still better at restoring motion in the talocalcaneal joint than isolated reconstruction (1/3 for ROM and 1/3 for the AA with isolated reconstruction compared to 1/3 for ROM and 2/3 for the AA with combined reconstruction). CONCLUSION Combined ATFL-CFL reconstruction showed better restored motion immediately after surgery than isolated ATFL reconstruction after a combined ATFL-CFL rupture. CLINICAL RELEVANCE This study shows that ligament reconstruction with suture tape augmentation is able to partially restore kinematics in the hindfoot and midfoot at the time of surgery. In clinical applications, where the classic Broström-Gould technique is followed by augmentation with suture tape, this procedure may protect the repaired ligament during healing by limiting excessive ROM after a ligament rupture.
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Affiliation(s)
- Hannelore Boey
- Biomechanics Section, KU Leuven, Leuven, Belgium
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | | | - Tassos Natsakis
- Biomechanics Section, KU Leuven, Leuven, Belgium
- Department of Automation, Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | | | - Ilse Jonkers
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
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22
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Liu FQ, Diao NC. Surgical therapy vs conservative therapy for patients with acute injury of lateral ankle ligament: A meta-analysis and systematic review. Int Wound J 2019; 16:925-931. [PMID: 30924305 DOI: 10.1111/iwj.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/26/2022] Open
Abstract
The goal of this meta-analysis was to explore the overall safety and efficacy of surgical therapy vs conservative therapy for acute injury of the lateral ankle ligament based on eligible studies. Eligible studies were identified by searching PubMed, Cochrane, and Embase databases using appropriate updated index words to January 2018. We also searched relevant publication sources. Eligible studies included randomised controlled trials and comparative studies. Mean difference or relative risk (RR), along with 95% confidence interval (CI), was used to analyse the main outcomes. A total of 13 studies were eligible for this meta-analysis, with 834 patients in the surgical therapy group and 930 patients in the conservative therapy group. Compared with patients receiving conservative treatment, patients undergoing surgical treatment had a significant higher American Orthopedic Foot And Ankle Society (AOFAS) score (weighted mean difference(WMD): 10.33, 95% CI: 6.83-13.83) and an effective rate (RR: 1.15, 95% CI: 1.04-1.28). No significant differences were observed in the incidence of recurrent ankle injury (RR: 1.01, 95% CI: 0.62-1.65), limited range of motion (RR: 1.44, 95% CI: 0.83-2.50), deep vein thrombosis (RR: 1.33, 95% CI: 0.73-2.41), and wound infection or necrosis (RR: 3.99, 95% CI: 0.45-35.34). However, compared with patients receiving conservative treatment, patients undergoing surgical therapy had significantly increased rates of complications (RR: 3.31, 95% CI: 2.55-4.28), ankylosis (RR: 3.63, 95% CI: 2.16-6.08), scare tenderness (RR: 10.16, 95% CI: 3.89-26.52) and sensory loss (RR: 5.66, 95% CI: 2.76-11.59). The results demonstrated that surgical treatment increased the AOFAS score and effective rate compared with conservative treatment. Besides, surgical treatment increased the rate of complications. Nevertheless, more high-quality randomised controlled trials with a larger sample size conducted at multiple centres with a long-term follow up are needed to confirm our conclusions.
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Affiliation(s)
- Feng-Qi Liu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nai-Cheng Diao
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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23
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Abstract
Approximately 7-10% of all emergency department patients are diagnosed with distortion of the upper ankle joint. A dislocation of the upper ankle joint without fracture is described in the literature as being very rare. In 33-50% the ankle dislocations are at least first-degree open and associated with a fracture of the tibia, the fibula or the talus. We report the course, treatment and results 12 months after trauma of a posteromedial first-degree open dislocation of the upper ankle joint without fracture. To our knowledge, there is no record of this pathology mentioned in the German language literature.
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24
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Reiner MM, Sharpe JJ. The Role of the Accessory Malleolar Ossicles and Malleolar Avulsion Fractures in Lateral Ankle Ligament Reconstruction. Foot Ankle Spec 2018; 11:308-314. [PMID: 28874066 DOI: 10.1177/1938640017729498] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
UNLABELLED While it is well known that ankle sprains are one of the most common injuries in the United States, predictive factors regarding failure of conservative treatment are not well known. There are many biomechanical and epidemiological factors that play a role in recurrence and failure of conservative treatment, but most cases are able to be treated with immobilization and/or rest, ice, elevation, physical therapy, and bracing. We propose that one important risk factor is often overlooked simply due to the fact that a vast majority of these cases resolve without the need for surgery. Accessory ossicles and avulsion fractures of the malleoli or talus may represent a predisposition or marker for ligamentous damage that may lead to the need for lateral ankle ligament repair or reconstruction in the future. We have identified 61 consecutive patients who underwent lateral ankle ligament repair or reconstruction by the primary surgeon from the years 2007 to 2017. Out of those patients who met our inclusion and exclusion criteria, 66% had the presence of osseous pathology consisting of accessory ossicles or avulsion fractures of the medial or lateral malleolus or talus. The proportion of osseous pathology seen with lateral ankle ligament repair or reconstruction was higher than what has been previously reported in both operative and nonoperative settings. This may help identify a risk factor for failure of conservative treatment in patients presenting with acute ankle sprains or ankle instability especially in the active cohort. LEVELS OF EVIDENCE Level IV: Case series.
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25
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Vuurberg G, Wink LM, Blankevoort L, Haverkamp D, Hemke R, Jens S, Sierevelt IN, Maas M, Kerkhoffs GMMJ. A risk assessment model for chronic ankle instability: indications for early surgical treatment? An observational prospective cohort - study protocol. BMC Musculoskelet Disord 2018; 19:225. [PMID: 30021553 PMCID: PMC6052530 DOI: 10.1186/s12891-018-2124-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/05/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Chronic ankle instability (CAI) is a common result of an ankle sprain. Even though early surgical treatment yields the best results, overall only professional athletes are eligible for acute surgical stabilization. Treating all patients with early surgical stabilization leads to a high amount of unnecessary invasive interventions, as not all patients progress to CAI. If patients at risk of developing CAI can be identified, treatment policies may be applied more effectively and efficiently. The purpose of this study is to develop a risk assessment model to identify patients at risk for CAI that should receive early surgical treatment. METHODS In this observational prospective cohort, all patients aged sixteen years and older, reporting at the emergency department of one of the participating hospitals after sustaining a lateral ankle sprain, and filled out 1 out of 3 follow-up questionnaires and the 1 year follow-up are included. A lateral and anteroposterior radiograph is made. Patients are excluded if a fracture or other pathology is present. The included patients receive four questionnaires, including questions focusing on the sprain, treatment and complaints, the Foot and Ankle Outcome Score and the Cumberland Ankle Instability Tool. A total of eleven radiographic variables are assessed for inter- and intra-observer reliability. Additionally, four factors extracted from the questionnaires, will be evaluated for correlation with CAI. Significantly correlating factors (e.a. risk factors) will be implemented in a risk assessment model. For the final model, based on sixteen variables with a minimum of 20 events per variable and a prevalence of 30-40% after an initial sprain, a sample size of 2370 patients is needed to perform both internal and external model validation. DISCUSSION This study will develop the first large scale model for the risk at CAI after an ankle sprain combining radiographic and patient characteristics. With this risk assessment model, patients at risk for CAI may be identified and properly informed on the treatment options. Patients identified as being at risk, may receive more adequate follow-up and become eligible for early surgical stabilization. This prevents patients from experiencing unnecessary long-lasting complaints, increasing the success rate of conservative and surgical treatment. TRIAL REGISTRATION Retrospectively registered: NCT02955485 [Registration date: 3-11-2016]. NTR6139 [Registration date: 3-1-2017].
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Affiliation(s)
- Gwendolyn Vuurberg
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lauren M. Wink
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Movement Sciences, VU Medical Center, Department of Surgery, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Leendert Blankevoort
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
| | - Daniel Haverkamp
- Slotervaart Medical Center, Department of Orthopedic Surgery, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
- Slotervaart Center of Orthopedic Research & Education (SCORE), Amsterdam, The Netherlands
| | - Robert Hemke
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sjoerd Jens
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Inger N. Sierevelt
- Slotervaart Medical Center, Department of Orthopedic Surgery, Louwesweg 6, 1066 EC Amsterdam, The Netherlands
- Slotervaart Center of Orthopedic Research & Education (SCORE), Amsterdam, The Netherlands
| | - Mario Maas
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
- Department of Musculoskeletal Radiology, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Orthopaedic Research Center Amsterdam, Department of Orthopedic Surgery, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Academic Center for Evidence based Sports medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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Diallo J, Wagener J, Schweizer C, Lang TH, Ruiz R, Hintermann B. Intraoperative Findings of Lateral Ligament Avulsion Fractures and Outcome After Refixation to the Fibula. Foot Ankle Int 2018. [PMID: 29528723 DOI: 10.1177/1071100718760273] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND An acute ankle sprain can result in a bony avulsion of the lateral ankle ligaments. The extent of concomitant lesions and subsequent instability patterns are not clearly understood. The high incidence of old avulsion fractures found in symptomatic chronic ankle instability may indicate the need for primary fixation. METHODS Ten patients (5 male, 5 female; mean age, 34 years; range, 15-64 years) with bony avulsion fractures of the fibula after acute ankle sprains were included. All patients were treated after a mean of 7.7 days (range, 2-17 days) with screw fixation of the fragment to the fibula. Clinical and radiographic assessments were performed, and the extent of ligament injury was documented. RESULTS The anterior talofibular ligament and calcaneofibular ligament were found to be attached to the avulsion fragment. The average size was 6.3 mm (range, 4-9 mm) in width from anterior to posterior and 5.2 mm (range, 4-7 mm) in length from superior to inferior. The displacement of the fragment increased under varus stress. Two patients had cartilage lesions in the lateral talus. After a mean follow-up period of 2.4 years (range, 2-4 years), all were clinically and radiographically stable, and patients were satisfied. CONCLUSIONS It was observed arthroscopically that the anterior talofibular ligament and calcaneofibular ligament were attached to the fragment. This is critical because motion between the fragment and the fibula may prevent spontaneous healing. Primary fixation of the fragment prevented rotational instability and was efficient to restore function and stability. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Jasmin Diallo
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Joe Wagener
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Christine Schweizer
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Tamara Horn Lang
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Roxa Ruiz
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Beat Hintermann
- 1 Clinic of Orthopaedic Surgery, Kantonsspital Baselland, Liestal, Switzerland
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Vuurberg G, Hoorntje A, Wink LM, van der Doelen BFW, van den Bekerom MP, Dekker R, van Dijk CN, Krips R, Loogman MCM, Ridderikhof ML, Smithuis FF, Stufkens SAS, Verhagen EALM, de Bie RA, Kerkhoffs GMMJ. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med 2018. [PMID: 29514819 DOI: 10.1136/bjsports-2017-098106] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.
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Affiliation(s)
- Gwendolyn Vuurberg
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Alexander Hoorntje
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Lauren M Wink
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Brent F W van der Doelen
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | | | - Rienk Dekker
- Dutch Society of Rehabilitation, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - C Niek van Dijk
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
| | - Rover Krips
- Department of Orthopaedic Surgery, Flevoziekenhuis, Almere, The Netherlands
| | | | | | - Frank F Smithuis
- Department of Musculoskeletal Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Sjoerd A S Stufkens
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert A L M Verhagen
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands.,VU Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of of Public and Occupational Health VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rob A de Bie
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery, Orthopaedic Research Center Amsterdam, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), VUmc / AMC IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Amsterdam, The Netherlands
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28
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Wight L, Owen D, Goldbloom D, Knupp M. Pure Ankle Dislocation: A systematic review of the literature and estimation of incidence. Injury 2017; 48:2027-2034. [PMID: 28826653 DOI: 10.1016/j.injury.2017.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 08/05/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ankle dislocation without fracture is rare. We used electronic hospital records to determine the incidence of pure ankle dislocation and performed a systematic review of the literature to investigate the occurrence, treatment and outcome of this injury to better inform treating clinicians. METHODS A review of electronic medical records at a tertiary referral centre was conducted to estimate in incidence of pure ankle dislocation. Systematic review of the literature was undertaken according to PRISMA guidelines for the reporting of individual patient data. This identified 64 English language articles that included 18 case series, 45 case reports and 1 biomechanical cadaveric study. Data was extracted by standard form independently by 2 of the authors and descriptive statistics were used to describe results. RESULTS The estimated incidence of pure ankle dislocation is 0.065% (13/20,000) of presentations with an ankle injury or 0.46% (23/5000) of presentations with an ankle dislocation. Systematic review of English literature identified 154 cases and demonstrated that sporting accidents (31%) and motor vehicle accidents (30%) are the most common cause. 73% (112/154) of the cases occurred in males and 50% (77/154) were open. In 46% (71/154) of patients the direction of dislocation was posteromedial. 46% of patients had nonoperative treatment; ligamentous repair was described in 26% (37 patients). The mean period of immobilisation was just over 6 weeks (range 2-16 weeks). In most patients, good functional outcomes were described. The most common long-term complaint was decreased ankle range of motion (18%) (27/154). Ankle instability was rare (2.6%) (4/154) and not influenced by acute ligament repair (P=0.98). CONCLUSION Pure ankle dislocation is a rare injury. The literature reports that most injuries occur in sports and motor vehicle accidents. The majority of injuries treated with early reduction followed by a short period of immobilisation and functional rehabilitation have good clinical outcomes.
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Affiliation(s)
- Lachlan Wight
- Department of Orthopaedics, Monash Health, Victoria, Australia.
| | - David Owen
- Department of Orthopaedics, Monash Health, Victoria, Australia.
| | | | - Markus Knupp
- Foot and Ankle Department, Kantonsspital Baselland, Liestal, Switzerland.
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29
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Kemler E, Thijs KM, Badenbroek I, van de Port IGL, Hoes AW, Backx FJG. Long-term prognosis of acute lateral ankle ligamentous sprains: high incidence of recurrences and residual symptoms. Fam Pract 2016; 33:596-600. [PMID: 27535328 DOI: 10.1093/fampra/cmw076] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Acute lateral ankle ligamentous sprains (ALALS) are common injuries. This injury does not always have a favourable long-term outcome. Studies reporting the prognosis of ALALS after functional treatment are scarce. OBJECTIVE To determine the prognosis of functionally treated ALALS, in terms of recurrent ALALS and residual symptoms. STUDY DESIGN Retrospective cohort study. SETTING Patients were recruited from 20 family practices, nine physical therapy practices, the emergency departments of a regional hospital and a university hospital. PATIENTS Adult patients with an ALALS caused by an inversion trauma were invited to participate in this study 2.5-5 years after their initial injury. INDEPENDENT VARIABLES Functional treatment of the initial ALALS. MAIN OUTCOME MEASURES Acute lateral ankle ligamentous sprain recurrences and residual symptoms. RESULTS A total of 44 patients were included, with an average follow-up period after the initial ankle sprain of 204 weeks (range 150-274 weeks). Eight patients (18.1%) had reinjured their ankle. Explicit pain around the ankle joint at physical examination was experienced by 45.5%. Clinical symptoms of anterior ankle impingement were present in 25% (all athletes), with radiologically confirmed tibiotalar osteophyte bone formation in 82% of them. CONCLUSIONS A large proportion of patients with ALALS experience recurrences and persistent symptoms after their initial ankle injury. The high percentage of patients with anterior ankle impingement syndromes illustrates the need for early assessment of this impairment in patients with persistent complaints.
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Affiliation(s)
- Ellen Kemler
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin M Thijs
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.,Royal Netherlands Football Association, Zeist, The Netherlands
| | - Ilse Badenbroek
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Ingrid G L van de Port
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.,Revant Rehabilitation Center, Breda, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Frank J G Backx
- Department of Rehabilitation, Nursing Science and Sport, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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30
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Harrasser N, Eichelberg K, Pohlig F, Waizy H, Toepfer A, von Eisenhart-Rothe R. [Lateral instability of the upper ankle joint]. DER ORTHOPADE 2016; 45:1001-1014. [PMID: 27738709 DOI: 10.1007/s00132-016-3344-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Because of their frequency, ankle sprains are of major clinical and economic importance. The simple sprain with uneventful healing has to be distinguished from the potentially complicated sprain which is at risk of transition to chronic ankle instability. Conservative treatment is indicated for the acute, simple ankle sprain without accompanying injuries and also in cases of chronic instability. If conservative treatment fails, good results can be achieved by anatomic ligament reconstruction of the lateral ankle ligaments. Arthroscopic techniques offer the advantage of joint inspection and addressing intra-articular pathologies in combination with ligament repair. Accompanying pathologies must be adequately addressed during ligament repair to avoid persistent ankle discomfort. If syndesmotic insufficiency and tibiofibular instability are suspected, the objective should be early diagnosis with MRI and surgical repair.
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Affiliation(s)
- N Harrasser
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland.
| | - K Eichelberg
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
| | - F Pohlig
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
| | - H Waizy
- Klinik für Fuß- und Sprunggelenkchirurgie, Orthopädische Fachkliniken der Hessing-Stiftung, Hessingstr. 17, 86199, Augsburg, Deutschland
| | - A Toepfer
- Zentrum für Fuß- und Sprunggelenkchirurgie, Schön Klinik München Harlaching, Harlachinger Str. 51, 81547, München, Deutschland
| | - R von Eisenhart-Rothe
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, TU München, Ismaningerstr. 22, 81675, München, Deutschland
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31
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Doherty C, Bleakley C, Delahunt E, Holden S. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Br J Sports Med 2016; 51:113-125. [PMID: 28053200 DOI: 10.1136/bjsports-2016-096178] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ankle sprains are highly prevalent with high risk of recurrence. Consequently, there are a significant number of research reports examining strategies for treating and preventing acute and recurrent sprains (otherwise known as chronic ankle instability (CAI)), with a coinciding proliferation of review articles summarising these reports. OBJECTIVE To provide a systematic overview of the systematic reviews evaluating treatment strategies for acute ankle sprain and CAI. DESIGN Overview of intervention systematic reviews. PARTICIPANTS Individuals with acute ankle sprain/CAI. MAIN OUTCOME MEASUREMENTS The primary outcomes were injury/reinjury incidence and function. RESULTS 46 papers were included in this systematic review. The reviews had a mean score of 6.5/11 on the AMSTAR quality assessment tool. There was strong evidence for bracing and moderate evidence for neuromuscular training in preventing recurrence of an ankle sprain. For the combined outcomes of pain, swelling and function after an acute sprain, there was strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques. There was conflicting evidence regarding the efficacy of surgery and acupuncture for the treatment of acute ankle sprains. There was insufficient evidence to support the use of ultrasound in the treatment of acute ankle sprains. CONCLUSIONS For the treatment of acute ankle sprain, there is strong evidence for non-steroidal anti-inflammatory drugs and early mobilisation, with moderate evidence supporting exercise and manual therapy techniques, for pain, swelling and function. Exercise therapy and bracing are supported in the prevention of CAI.
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Affiliation(s)
- Cailbhe Doherty
- Insight Centre for Data Analytics, O'Brien Centre for Science, University College Dublin, Dublin, Ireland
| | - Chris Bleakley
- Sport and Exercise Sciences Research Institute, Ulster Sports Academy, University of Ulster, Newtownabbey, UK
| | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland.,Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Sinead Holden
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
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Abstract
The purpose of this paper is to present a current review of pathoanatomical features, differential diagnosis, objective assessment, intervention, and clinical course associated with managing lateral ankle ligament sprains. Proper diagnosis and identification of affected structures should be obtained through history and objective assessment. From this information, an individualized evidence-based intervention plan can be developed to enable recovery while decreasing the risk of reinjury. An appropriate evaluation is needed not only to determine the correct diagnosis but also to allow for grading and determining the prognosis of the injury in those with an acute lateral ankle sprain. Examination should include an assessment of impairments as well as a measure of activity and participation. Evidence-based interventions for those with an acute lateral ankle sprain should include weight bearing with bracing, manual therapy, progressive therapeutic exercises, and cryotherapy. For those with chronic ankle instability (CAI), interventions should include manual therapy and a comprehensive rehabilitation program. It is essential to understand the normal clinical course for athletes who sustain a lateral ankle sprain as well as risk factors for an acute injury and CAI. Risk factors for both an acute lateral ankle sprain and CAI include not using an external support and not participating in an appropriate exercise program. Incorporating the latest evidence-based rehabilitation techniques provides the best course of treatment for athletes with an acute ankle sprain or CAI.
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Affiliation(s)
- Ryan P McGovern
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - RobRoy L Martin
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA; Centers for Sports Medicine - University of Pittsburgh, Pittsburgh, PA, USA
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33
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Rückkehr zum Sport. ARTHROSKOPIE 2015. [DOI: 10.1007/s00142-015-0009-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Haapasalo H, Kannus P, Laine HJ, Moilanen T, Mattila VM. Scientific evidence and reduced surgical treatment in acute ligament ruptures of the ankle. Scand J Med Sci Sports 2015; 25:299-300. [PMID: 25809185 DOI: 10.1111/sms.12179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- H Haapasalo
- Department of Orthopaedics, Tampere University Hospital, Tampere, Finland; The School of Medicine, Tampere University, Tampere, Finland
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35
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McCriskin BJ, Cameron KL, Orr JD, Waterman BR. Management and prevention of acute and chronic lateral ankle instability in athletic patient populations. World J Orthop 2015; 6:161-171. [PMID: 25793157 PMCID: PMC4363799 DOI: 10.5312/wjo.v6.i2.161] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 11/16/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
Acute and chronic lateral ankle instability are common in high-demand patient populations. If not managed appropriately, patients may experience recurrent instability, chronic pain, osteochondral lesions of the talus, premature osteoarthritis, and other significant long-term disability. Certain populations, including young athletes, military personnel and those involved in frequent running, jumping, and cutting motions, are at increased risk. Proposed risk factors include prior ankle sprain, elevated body weight or body mass index, female gender, neuromuscular deficits, postural imbalance, foot/ankle malalignment, and exposure to at-risk athletic activity. Prompt, accurate diagnosis is crucial, and evidence-based, functional rehabilitation regimens have a proven track record in returning active patients to work and sport. When patients fail to improve with physical therapy and external bracing, multiple surgical techniques have been described with reliable results, including both anatomic and non-anatomic reconstructive methods. Anatomic repair of the lateral ligamentous complex remains the gold standard for recurrent ankle instability, and it effectively restores native ankle anatomy and joint kinematics while preserving physiologic ankle and subtalar motion. Further preventative measures may minimize the risk of ankle instability in athletic cohorts, including prophylactic bracing and combined neuromuscular and proprioceptive training programs. These interventions have demonstrated benefit in patients at heightened risk for lateral ankle sprain and allow active cohorts to return to full activity without adversely affecting athletic performance.
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Abstract
Over the last 50 years, the surgical management of chronic lateral ankle ligament insufficiency has focused on 2 main categories: local soft-tissue reconstruction and tendon grafts/transfer procedures. There is an increasing interest in the arthroscopic solutions for chronic instability of the ankle. Recent biomechanical studies suggest the at least one of the arthroscopic techniques can provide equivalent results to current open local soft-tissue reconstruction (such as the modified Brostrom technique). Arthroscopic lateral ankle ligament reconstruction is becoming an increasingly acceptable method for the surgical management of chronic lateral ankle instability.
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Affiliation(s)
- Jorge I Acevedo
- Southeast Orthopedic Specialists, Jacksonville, 2627 Riverside Avenue, suite 300, FL 32204, USA.
| | - Peter Mangone
- Foot and Ankle Services, Foot and Ankle Center, Blue Ridge Bone and Joint Clinic, Mission Hospital, 60 Livingston Street, Asheville, NC 28801, USA
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37
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Chaudhry H, Simunovic N, Petrisor B. Cochrane in CORR ®: surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults (review). Clin Orthop Relat Res 2015; 473:17-22. [PMID: 25344407 PMCID: PMC4390949 DOI: 10.1007/s11999-014-4018-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/16/2014] [Indexed: 01/31/2023]
Affiliation(s)
- Harman Chaudhry
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7 Canada
| | - Brad Petrisor
- Division of Orthopaedic Surgery, McMaster University, 293 Wellington Street North, Suite 110, Hamilton, ON L8L 8E7 Canada
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38
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39
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Abstract
Chronic lateral ankle instability is a condition frequently encountered by orthopedic surgeons treating highly active patient populations, particularly military service members. Providers treating military service members must have a high index of suspicion for this condition when signs and symptoms of functional or mechanical instability exist. Stress testing and ankle MRI, although not definitive in sensitivity for detecting instability or other concomitant injuries, should be considered during the treatment decision-making process. Appropriate nonoperative treatment should be attempted initially; however, when nonoperative treatment fails, surgical management is warranted to prevent untoward long-term sequelae. Proper surgical treatment and subsequent postoperative management are at the discretion of the individual surgeon but must account for the concomitant diseases frequently associated with chronic lateral ankle instability. Low recurrence of lateral instability can be achieved even in high-demand military patient populations with a focused treatment plan.
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40
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41
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Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brüggemann GP, Best R. Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg 2013; 133:1129-41. [PMID: 23712708 PMCID: PMC3718986 DOI: 10.1007/s00402-013-1742-5] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Indexed: 01/17/2023]
Abstract
BACKGROUND Lateral ankle sprains are common musculoskeletal injuries. OBJECTIVES The objective of this study was to perform a systematic literature review of the last 10 years regarding evidence for the treatment and prevention of lateral ankle sprains. DATA SOURCE Pubmed central, Google scholar. STUDY ELIGIBILITY CRITERIA Meta-analysis, prospective randomized trials, English language articles. INTERVENTIONS Surgical and non-surgical treatment, immobilization versus functional treatment, different external supports, balance training for rehabilitation, balance training for prevention, braces for prevention. METHODS A systematic search for articles about the treatment of lateral ankle sprains that were published between January 2002 and December 2012. RESULTS Three meta-analysis and 19 articles reporting 16 prospective randomized trials could be identified. The main advantage of surgical ankle ligament repair is that objective instability and recurrence rate is less common when compared with non-operative treatment. Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. For non-surgical treatment, long-term immobilization should be avoided. For grade III injuries, however, a short period of immobilization (max. 10 days) in a below knee cast was shown to be advantageous. After this phase, the ankle is most effectively protected against inversion by a semi-rigid ankle brace. Even grades I and II injuries are most effectively treated with a semi-rigid ankle brace. There is evidence that treatment of acute ankle sprains should be supported by a neuromuscular training. Balance training is also effective for the prevention of ankle sprains in athletes with the previous sprains. There is good evidence from high level randomized trials in the literature that the use of a brace is effective for the prevention of ankle sprains. CONCLUSION Balancing the advantages and disadvantages of surgical and non-surgical treatment, we conclude that the majority of grades I, II and III lateral ankle ligament ruptures can be managed without surgery. The indication for surgical repair should be always made on an individual basis. This systematic review supports a phase adapted non-surgical treatment of acute ankle sprains with a short-term immobilization for grade III injuries followed by a semi-rigid brace. More prospective randomized studies with a longer follow-up are needed to find out what type of non-surgical treatment has the lowest re-sprain rate.
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Affiliation(s)
- Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Caspar Theyß Strasse 27-31, Grunewald, 14193 Berlin, Germany
| | | | | | | | - Christian Liebau
- Asklepios Harzkliniken GmbH, Fritz-König-Stift, Bad Harzburg, Germany
| | | | - Raymond Best
- Sportorthopädische Klinik Tübingen, Tübingen, Germany
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42
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Abstract
The purpose of this foot and ankle update is to educate the reader on important foot and ankle topics including current controversies, physical examination, diagnostics, and management. Quick-view lists are used to give easy access to the most significant knowledge points for providing patient care for these entities. These topics were chosen either because they are very common or because of the high morbidity involved should there be a misdiagnosis or mismanagement.
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Affiliation(s)
- Ahmed Saleh
- PGY-3, Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA
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Pan WR, Li G, Guan JH. Polymorphisms in DNA repair genes and susceptibility to glioma in a chinese population. Int J Mol Sci 2013; 14:3314-24. [PMID: 23385236 PMCID: PMC3588045 DOI: 10.3390/ijms14023314] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 11/16/2022] Open
Abstract
The excision repair cross-complementing rodent repair deficiency complementation group 1 (ERCC1), and X-ray repair cross-complementing group 1 (XRCC1) genes appear to protect mammalian cells from the harmful effects of ionizing radiation. We conducted a large case-control study to investigate the association of polymorphisms in ERCC1 C118T, ERCC1 C8092A, XRCC1 A194T, XRCC1 A194T, and XRCC3 C241T, with glioma risk in a Chinese population. Five single nucleotide polymorphisms (SNPs) were genotyped, using the MassARRAY IPLEX platform, in 443 glioma cases and 443 controls. Association analyses based on an χ2 test and binary logistic regression were performed to determine the odds ratio (OR) and a 95% confidence interval (95% CI) for each SNP. For XRCC1 Arg194Trp, the variant genotype T/T was strongly associated with a lower risk of glioma cancer when compared with the wild type C/C (OR = 2.45, 95% CI = 1.43–4.45). Individuals carrying the XRCC1 399A allele had an increased risk of glioma (OR = 1.33, 95% CI = 1.02–1.64). The XRCC3 241T/T genotype was associated with a strong increased glioma risk (OR = 3.78, 95% CI = 1.86–9.06). Further analysis of the interactions of two susceptibility-associated SNPs, XRCC1 Arg194Trp and XRCC3 Thr241Met, showed that the combination of the XRCC1 194T and XRCC3 241T alleles brought a large increase in glioma risk (OR = 2.75, 95% CI = 1.54–4.04). XRCC1 Arg194Trp, XRCC1 Arg399Gln, and XRCC3 C241T, appear to be associated with susceptibility to glioma in a Chinese population.
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Affiliation(s)
- Wei-Ran Pan
- Department of Neurosurgery, Shengjing Affiliated Hospital of China Medical University, Shenyang 110004, China.
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Abstract
Controversy exists about whether or not similar standards apply to the clinical evaluation of orthopaedic implants and pharmaceuticals. The long-lasting dispute is likely to be abandoned shortly, given that certain regulatory bodies in Europe now mandate proof of effectiveness by randomized controlled trials (RCTs) prior to market approval of innovative devices. This is a timely signal--it will help to strengthen both the credibility of orthopaedic researchers among all health-care disciplines and the role of manufacturers as creative minds and scientific partners. Yet, it must be accompanied by substantial changes in the current trial landscape. Given the level of perfection of available orthopaedic technology, superiority of a new product over an established standard will become a rare finding. Noninferiority or equivalence must be accepted as important trial results by investigators, sponsors, clinicians, and health authorities to enhance the spectrum of therapeutic options and help to individualize patient care. Specific problems are slow recruitment rates and long intervals from the protocol stage to publication of results. This may counteract the innovative potential of a novel product. Pragmatic trial designs, lean but complete documentation, limited but precise end points, the avoidance of competing trials, and the fostering of international collaboration are possible ways to streamline clinical trials of orthopaedic devices. Finally, RCTs should be conducted, conditional to the presumed level of innovation of a new implant, and supplemented by data from registries to fully determine the utility, value, and safety of the intervention.
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Affiliation(s)
- Dirk Stengel
- Center for Clinical Research, Department of Trauma and Orthopaedic Surgery, Unfallkrankenhaus Berlin Trauma Center, Warener Strasse7, 12683 Berlin, Germany.
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Affiliation(s)
- Randall C Marx
- The San Antonio Orthopedic Group, 2829 Babcock Road, Suite #700, San Antonio, TX 78229, USA
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Hao ZT, Ma YX, Hao T, Feng W, Wang JH, Fan DS, Wen SZ. Comparison of surgical intervention with functional treatment for acute ruptures of lateral ankle ligmant: a meta-analysis. ASIAN PAC J TROP MED 2012; 5:396-401. [PMID: 22546658 DOI: 10.1016/s1995-7645(12)60066-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 03/15/2012] [Accepted: 04/15/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To compare the effect of surgical intervention on functional treatment. METHODS By searching the MEDLINE (1966 to October 2011), EMBASE (1980 to October 2011), the Chinese Biomedical Database Databases (1980 to October 2011), a total of 9 related RCT studies comparing surgical intervention with functional treatment were included in our study. RevMan software was taken to analyze the data. RESULTS These 9 studies involved a total of 1 268 mostly young adults, including 580 patients with surgical treatment and 688 patients with functional treatment. The results showed the stability of ankle activity in surgical treatment group was better than that in functional treatment group, with the OR and 95% CI of 0.72 (0.52-0.99). No significant difference was found in the recurrence of the surgical and functional group. However, the movement disorder in the surgical treatment suggested increased risk than that in functional group, with the OR and 95% CI of 2.39 (0.98-5.85). Surgical group found more complication than the function group, such as deep vein thrombosis, deep venous thrombosis, tenderness of scar and sensory loss. CONCLUSIONS In conclusion, our finding showed that surgical treatment could gain better efficacy than functional treatment, but may bring more complication. Therefore, further large sample size RCT is warranted.
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Affiliation(s)
- Zeng-Tao Hao
- The Second Affiliated Hospital, Inner Mongolia Medical College, Hohhot, Inner Mongolia, China
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Pihlajamäki HK, Mattila VM, Visuri TI. Surgical Technique for Treating Acute Ruptures of the Lateral Ligament Complex of the Ankle. JBJS Essent Surg Tech 2011; 1:e17. [DOI: 10.2106/jbjs.st.k.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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