Recent Developments in the Treatment of Ankle and Subtalar Instability.

It was nearly a centenary ago that severe ankle sprain was recognized as an injury of the ankle ligament(s). With the recent technological advances and tools in imaging and surgical procedures, the management of ankle sprains - including subtalar injuries - has drastically improved. The repair or reconstruction of ankle ligaments is getting more anatomical and less invasive than previously. More specifically, ligamentous reconstruction with tendon graft has been the gold standard in the management of severely damaged ligament, however, it does not reproduce the original ultrastructure of the ankle ligaments. The anatomical ligament structure of a ligament comprises a ligament with enthesis at both ends and the structure should also exhibit proprioceptive function. To date, it remains impossible to reconstruct a functionally intact and anatomical ligament. Cooperation of the regenerative medicine and surgical technology in expected to improve reconstructions of the ankle ligament, however, we need more time to develop a technology in reproducing the ideal ligament complex.

Effects of reinforcement with the iliotibial tract flap in ACL reconstruction using bone-patellar tendon-bone.

INTRODUCTION: We attempted to reinforce the transplanted ligament by wrapping it with the iliotibial tract (ITT) flap to get more volume and to protect the graft from impingement in the intercondylar space postoperatively in reconstruction of the anterior cruciate ligament (ACL) using bone-patellar tendon-bone (BTB), and investigated the results in comparison with those of BTB alone. MATERIALS AND METHODS: The study included 88 cases (88 knees). Group A comprised 43 knees with the reinforcement and group B 45 knees with BTB alone. Both groups were evaluated by second-look arthroscopy, magnetic resonance imaging (MRI), manual testing, International Knee Documentation Committee (IKDC) score, and histopathological evaluation more than 2 years after the reconstruction. RESULTS: In the second-look arthroscopic findings, 84% of the reconstructed ACL in group A had good appearance, and no fibrous split was observed. The ratio of fibrous disorder was significantly less in group A in comparison with group B (p=0.0037). Distinct reduction of the tension of the reconstructed ligament was observed in 9% of group A and 36% of group B (p=0.0088). Regarding the results of the Lachman test, the ratio of the negative group was higher in group A (p=0.0067). In the MRI findings fulfilled pictures to the inside of the reconstructed ligament were observed in 77% of the patients photographed in group A. In contrast, the fibrous split was observed in 55% in group B. CONCLUSIONS: Reinforcement by wrapping with the ITT flap for the BTB autograft was effective in ACL reconstruction. The ratio of fibrous disorder and reduction of tension in the reconstructed ligament decreased.