Application of external torque enhances the detection of subtle syndesmotic ankle instability in a weight-bearing CT.

PURPOSE: Acute syndesmotic ankle injuries continue to impose a diagnostic dilemma and it remains unclear whether weightbearing and/or external rotation should be added during the imaging process. Therefore, the aim of this study was to assess if combined weightbearing and external rotation increases the diagnostic sensitivity of syndesmotic ankle instability using weightbearing CT (WBCT) imaging, compared to isolated weightbearing. METHODS: In this retrospective study, patients with an acute syndesmotic ankle injury were analysed using a WBCT (N = 21; Age = 31.6 ± 14.1 years old). Inclusion criteria were an MRI confirmed syndesmotic ligament injury imaged by a WBCT of the ankle during weightbearing and combined weightbearing-external rotation. Exclusion criteria consisted of fracture associated syndesmotic injuries. Three-dimensional (3D) models were generated from the CT slices. Tibiofibular displacement and talar rotation were quantified using automated 3D measurements (anterior tibiofibular distance (ATFD), Alpha angle, posterior Tibiofibular distance (PTFD) and Talar rotation (TR) angle in comparison to the contralateral non-injured ankle. RESULTS: The difference in neutral-stressed Alpha angle and ATFD showed a significant difference between patients with a syndesmotic ankle lesion and contralateral control (P = 0.046 and P = 0.039, respectively). The difference in neutral-stressed PTFD and TR angle did not show a significant difference between patients with a syndesmotic ankle lesion and healthy ankles (n.s.). CONCLUSION: Application of combined weightbearing-external rotation reveals an increased ATFD in patients with syndesmotic ligament injuries. This study provides the first insights based on 3D measurements to support the potential relevance of applying external rotation during WBCT imaging. In clinical practice, this could enhance the current diagnostic accuracy of subtle syndesmotic instability in a non-invasive manner. However, to what extent certain displacement patterns require operative treatment strategies has yet to be determined in future studies. LEVEL OF EVIDENCE: Level III.

French translation and validation of the Cumberland Ankle Instability Tool, an instrument for measuring functional ankle instability.

BACKGROUND: Ankle sprains are one of the most common musculoskeletal injuries, and can lead to chronic ankle instability (CAI). The Cumberland Ankle Instability Tool (CAIT) measures a subset of CAI, functional ankle instability (FAI). Because no French version existed, we set out to translate and validate the CAIT in French. METHODS: The CAIT was translated using a forward-backward methodology. We examined its psychometric properties and calculated a cut-off score for FAI in a sample of 102 subjects (median age 22 years). RESULTS: The CAIT was translated without significant problems. The CAIT-F can discriminate between those with and without FAI (p < 0.001), with a cut-off score of ≤ 23 points. The test-retest reliability is excellent (ICC = 0.960), as is the internal consistency (α = 0.885). Construct validity was confirmed. No floor or ceiling effects were detected among subjects with FAI. CONCLUSIONS: The CAIT is now available in French, and is a valid and reliable instrument.

French translation and validation of the Achilles Tendon Total Rupture Score "ATRS".

BACKGROUND: To provide a cross-cultural French adaptation of the Achille's Tendon Total Rupture Score (ATRS) and to assess its psychometric performances. METHOD: The ATRS questionnaire was first translated and inter-culturally adapted into French according to international guidelines. Then, 95 subjects were recruited to complete the French version of the ATRS twice (2 weeks of interval). The SF-36 and VISA-A were used as comparative questionnaires. The psychometric properties of the questionnaire were evaluated (test-retest reliability, internal consistency, construct validity, floor/ceiling effects). RESULTS: Thetest-retest reliability was excellent (ICC of 0,966 (95% CI:0.644-0.879)) and the internal consistency very high (Cronbach's alpha of 0,98). The convergent and divergent construct validity were also confirmed. Finally, none of the subjects obtained the lowest score (0) or the maximal score (100) to the questionnaire. CONCLUSION: A valid and reliable French version of the ATRS is now available.

Chronic lateral ankle instability increases the likelihood for surgery in athletes with os trigonum syndrome.

PURPOSE: The etiology and incidence of os trigonum syndrome in professional athletes is highly variable. There is a paucity of data to ascertain why some athletes evolve towards surgery whilst others remain asymptomatic. We hypothesized that a lateral ligament ankle injury would increase the likelihood for surgery in those athletes with os trigonum syndrome. METHODS: Eighty professional athletes with clinical and radiological signs of os trigonum syndrome were identified to ascertain the incidence of injury to the lateral ligamentous ankle complex (acute and chronic) by magnetic resonance imaging (MRI). This cohort was subdivided into 2 groups; a surgical (n = 40) and a non-surgical (n = 40) cohort. Surgical division was decided if (1) the clinical hyper-plantar flexion test was positive, (2) a positive diagnostic ultrasound-guided injection and (3) no improvement was observed after 6 weeks of conservative rehabilitation. RESULTS: From the surgical cohort, 37 players (94.1%) had a chronic lateral ankle ligament injury on MRI, whilst 3 players (5.9%) had an acute lateral ankle ligament injury. Binary logistic linear modelling revealed that having a chronic lateral ligament injury increases the likelihood of os trigonum syndrome surgery by ten times compared to those with an acute lateral ligament injury. CONCLUSION: Professional athletes with chronic lateral ligament ankle injury have an approximate ten times greater risk for os trigonum syndrome surgery compared to athletes with acute lateral ligament ankle injury. LEVEL OF EVIDENCE: IV.

Endoscopic surgery in athletes with a symptomatic calcaneal lipoma.

PURPOSE: This study shows that endoscopy is an effective treatment modality for athletes with a symptomatic calcaneal lipoma. METHODS: Between 2013 and 2016, five professional athletes with symptomatic calcaneal lipoma underwent endoscopic-assisted curettage and bone graft treatment. Lipoma size was measured by magnetic resonance imaging (MRI) and rated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS). All athletes were followed up for 12 months postoperatively and monitored on return to previous activity level. RESULTS: The mean ankle-hindfoot scale score improved from a preoperative 71.3 +/-3.9 points (median 67-81) to a postoperative 97.8 +/-3.4 points (median 89-100). Radiological assessment revealed no recurrence or pathologic fracture, with adequate bone fill-up in all 5 cases. All athletes returned to their previous level of activity within 8 weeks of surgery (mean period 7.2 weeks, median 5-8 weeks). CONCLUSION: Endoscopic surgery can be used as a valid treatment tool for athletes with a calcaneal lipoma. It allows for a safe and early return to sports activities and minimises risk for recurrence and pathological fracture after initial return to play. LEVEL OF EVIDENCE: IV.

Return to Play After a Lateral Ligament Ankle Sprain.

PURPOSE OF REVIEW: The purpose of this review is to describe the current evidence on the most common sports-related ankle injuries. Joint anatomy, epidemiology, clinical findings, diagnostic approach, and treatment are presented with a specific focus on the available evidence towards return to play. RECENT FINDINGS: Recent findings show that ankle sprain is the most common injury in the world of sports. Bony fractures, cartilage defects, and syndesmotic lesions are frequently seen in association with the more severe type of ankle sprains. In summary, the majority of the athletes' ankle sprains are managed conservatively with excellent outcomes and full return to their pre-injury level of play. However, it is essential to differentiate the single ligament sprain from a more complex injury to the ankle joint. The evidence-based treatment and rehabilitation programmes are associated with a better prognosis and a faster time to return to sport participation.

A combined tension-band braided polyester and suture button technique is a valuable treatment alternative for transverse patellar fractures in athletes.

PURPOSE: Transverse patellar fractures (TPFs) are uncommon in athletes, and their treatment can be challenging. Stable fixation is commonly achieved by compression screw fixation and stainless steel cerclage wire, but this technique can be associated with complications like nonunion, infection and the need for early hardware removal. We used a combined tension-band (figure-of-eight) braided polyester and suture button technique to treat four athletes who presented with transverse patellar fractures. This technique has shown to be a valuable alternative to the classic technique and allows for adequate fracture compression, stability and union in TPF. METHODS: Using a tension-band braided polyester and suture button technique (Arthrex FibreTapeR&TightRopeR), we treated four athletes with transverse patellar fractures from September 2015 till January 2017. The polyester was looped over the four suture button fixation points and tensioned in a figure-of-eight fashion. The average age of the athletes was 26 years (range 17-36). Follow-up ranged from 5 to 21 months. All four patients were treated using the same surgical technique (minimally invasive surgery) with the same postoperative recovery and the same physiotherapy protocol. RESULTS: Full recovery using suture button adjustable loop fixation device was obtained in all four cases within 3 months after surgery, with fracture healing confirmed on postoperative radiographs. No patients required hardware removal. Potential problems with this technique can include bony tunnel malpositioning or soft tissue interpositioning underneath the suture buttons. CONCLUSION: The combination of a suture button fixation and a braided polyester tension-band technique has shown to be a valuable alternative to the fracture management of transverse patella fractures in athletes. This results in fracture healing, low risk of complications and no need for hardware removal.

[A simplified technique of skin transplantation (author's transl)]. / Een vereenvoudigde techniek voor huidoverplanting

A simplified technique of skin transplantation is proposed: local anaesthesia of donor site; use of a regular razor-blade for skin harvesting and use of donor site for preservation of residual skin grafts.

Upper lid loading with dermis graft and levator weakening. Management of lagophthalmos due to facial palsy.

A method to protect the cornea in case of lagophthalmos is presented, consisting in weighting the upper eyelid with dermis graft, combined with a weakening of the levator palpebrae. The technique is described, and the method is discussed versus other methods of upper lid loading.