RESUMEN
Background: Ossicles of avulsed fractures of the lateral malleolus can result in pain or chronic ankle instability. The purpose of this study was to evaluate and compare the arthroscopic double-row fixation procedure with anatomic ankle lateral ligaments reconstruction for the treatment of ankle lateral ligaments injury with os subfibulare. Methods: This retrospective study included 38 patients with ankle lateral ligaments injury with concomitant os subfibulare who were treated between July 2016 and November 2021. The patients were divided into a double-row fixation group (n = 19) and an ankle lateral ligaments reconstruction group (n = 19). The Karlsson and Peterson Scoring System for Ankle Function (KAFS), American Orthopedic Foot and Ankle Society (AOFAS) score, Tegner score, visual analog scale (VAS), and anterior drawer test (ADT) were obtained preoperatively and at the last post-operative follow-up. Magnetic resonance imaging (MRI) was also performed at the last post-operative follow-up. Results: The KAFS, AOFAS, VAS, and Tegner scores increased significantly after the surgery. Furthermore, the pre- and post-operative functional scores were comparable between the two groups. The ADT was negative in all participants post-operatively. There were no significant differences between the double-row fixation and ligaments reconstruction groups regarding the proportions of patients who achieved a minimally clinically important difference (MCID) in KAFS, AOFAS, and Tegner scores. There was no significant difference in T2 mapping values for the tibial and talar side post-operatively between the two groups. Moreover, there were no significant differences in functional scores post-operatively between bony fusion and non-fusion patients in the double fixation group. Conclusion: The double-row fixation procedure provided similar satisfactory clinical outcomes when compared with lateral ligaments reconstruction for the treatment of ankle lateral ligaments injury with os subfibulare over a short follow-up duration.
RESUMEN
Background: Avulsion fractures of fibula occur with ankle sprains. The purpose of this study was to compare the biomechanical characteristics of double-row suture versus compression screw techniques in treatment of lateral malleolar avulsion fracturelarger than 10 mm in size, which is typically not associated with an anterior talofibular ligament injury. Methods: We simulated lateral malleolus avulsion fractures in six matched pairs of 12 human cadaveric ankles. These were then randomly divided into two groups: a double-row fixation group and a compression screw group. Biomechanical testing was performed after surgical fixation. The foot was rotated from the neutral position toward inversion at a rate of 1°/s until 12.5 N-m or structural failure was reached. The final rotation torque, rotation angle, stiffness, and displacement of the ossicles were recorded. Results: No significant difference was found in the final rotation torque (7.60 ± 3.70 vs 7.23 ± 2.06 N-m, p = 0.87), rotation angle (43.61 ± 14.77° vs 40.93 ± 10.94°, p = 0.56), stiffness (0.19 ± 0.08 vs 0.13 ± 0.07, p = 0.33), or displacement (6.11 ± 5.23 vs 7.09 ± 5.93 mm, p = 0.77) between the two groups. Conclusions: The stability of the double-row suture fixation was equivalent to compression screw fixation in treating a lateral malleolar avulsion fracture larger than 10 mm in size with ligament injury, as determined by our biomechanical testing.
RESUMEN
BACKGROUND: No conclusive evidence recommends a prior treatment for insertional Achilles tendinopathy (IAT). It is theorized that both percutaneous radiofrequency coblation and extracorporeal shockwave therapy (ESWT) relieve pain within the insertion. However, no clinical evidence shows that either treatment promotes the regeneration of the tendon or if the combination of these 2 interventions offers better function and less pain than one therapy. METHODS: The study is a randomized, controlled trial with patients allocated in a 1:1 ratio to one of two parallel groups. Patients with insertional Achilles tendinopathy who are not satisfied with the effect of conservative treatment will be screened. A minimum of 38 patients will be enrolled after deciding to participate in the trial on an informed basis. Then the intervention group and the control group perform radial ESWT and sham-ESWT respectively at 6 months after percutaneous radiofrequency coblation. The primary outcome will be the Victorian Institute of Sports Assessment Achilles (VISA-A) Score. Secondary outcome measures will be Foot and Ankle Outcome Score (FAOS) scale, visual analog scale (VAS), Tegner Score, and MRI ultra-short echo time (UTE) T2* value. The assessments will occur in 6 months, 1 year, and 2 years, post-operatively. The differences between the 2 groups will be conducted as intention-to-treat basis. DISCUSSION: We aim to investigate if radiofrequency coblation associated with ESWT can provide more encouraging imaging findings as well as functional and clinical outcomes regarding the treatment of the IAT comparing to the single radiofrequency coblation treatment. TRIAL REGISTRATION: ChiCTR1800017898; pre-results. Registered on 20 August 2018.
