The ATFL inferior fascicle, the CFL and the PTFL have a continuous footprint at the medial side of the fibula.

PURPOSE: Knowledge of the complex anatomy of the lateral ankle ligaments is essential to understand its function, pathophysiology and treatment options. This study aimed to assess the lateral ligaments and their relationships through a 3D view achieved by digitally marking their footprints. METHODS: Eleven fresh-frozen ankle specimens were dissected. The calcaneus, talus and fibula were separated, maintaining the lateral ligament footprints. Subsequently, each bone was assessed by a light scanner machine. Finally, all the scans were converted to 3D polygonal models. The footprint areas of the talus, calcaneus and fibula were selected, analysed and the surface area was quantified in cm2. RESULTS: After scanning the bones, the anterior talofibular ligament inferior fascicle (ATFLif), calcaneofibular ligament (CFL) and posterior talofibular ligament (PTFL) footprints were continuous at the medial side of the fibula, corresponding to a continuous footprint with a mean area of 4.8 cm2 (± 0.7). The anterior talofibular ligament (ATFL) footprint on the talus consisted of 2 parts in 9 of the 11 feet, whilst there was a continuous insertion in the other 2 feet. The CFL insertion on the calcaneus was one single footprint in all cases. CONCLUSION: The tridimensional analysis of the lateral ligaments of the ankle demonstrates that the ATFLif, CFL and PTFL have a continuous footprint at the medial side of the fibula in all analysed specimens. These data can assist the surgeon in interpreting the ligament injuries, improving the imaging assessment and guiding the surgeon to repair and reconstruct the ligaments in an anatomical position.

Treatment of lateral ankle sprain with platelet-rich plasma: A randomized clinical study.

BACKGROUND: We aimed to clinically evaluate the effect of platelet-rich plasma (PRP) therapy in patients with acute lateral ankle sprain treated with rigid immobilization. METHODS: Patients with first-time grade II lateral ankle sprain clinically diagnosed were evaluated (n=21). A rigid immobilization was placed in all patients for ten days; previously, an application of PRP over the anterior talofibular ligament was performed in patients from the experimental group. The Visual Analogue Scale, the American Orthopedic Foot and Ankle Score, and the Foot and Ankle Disability Index were applied at 3, 5, 8 and 24 weeks of follow-up period. RESULTS: The experimental group presented the highest reduction in pain and better functional scores than the control group at 8 weeks. At the end of follow-up period the results of both groups were similar. CONCLUSIONS: A similar evolution was observed in patients treated with rigid immobilization with or without PRP after 24 weeks. TRIAL REGISTRATION: Clinical Trials.gov with ID NCT02609308.

Knotless Modified Arthroscopic-Broström Technique for Ankle Instability.

Instability is a common sequela after repeated ankle sprains. When nonoperative treatment fails, open lateral ligament complex repair and reinforcement with the inferior extensor retinaculum has been the gold standard procedure. The recent advancements in arthroscopic techniques have created comparable biomechanical and functional results to open procedures. The authors' modification to the standard arthroscopic technique permits ligament approximation to the distal fibula over a larger surface area, using knotless anchors to avoid the need of an accessory portal and limit potential suture knot-related complications. Level of Evidence: Level V, expert opinion.

Occurrence of Lateral Ankle Ligament Disease With Stage 2 to 3 Adult-Acquired Flatfoot Deformity Confirmed via Magnetic Resonance Imaging: A Retrospective Study.

Lateral hindfoot pain associated with stage 2 to 3 adult-acquired flatfoot is often attributed to subfibular impingement. Preoperative magnetic resonance imaging (MRI) is generally performed to assess the extent of degeneration within the posterior tibial tendon, attenuation of medial soft tissue constraints, and degeneration of hindfoot and/or ankle articulations. The purpose of this study is to determine the incidence of lateral collateral ligament disease/injury associated with stages 2 and 3 adult-acquired flatfoot. The subjects were identified using a searchable computerized hospital database between 2015 and 2017. Stage 2 or 3 adult-acquired flatfoot deformity was confirmed in patients via chart review and MRI analysis. Lateral ankle ligament injury was confirmed using patient MRI results per the hospital radiologist and documented within the patients' chart. Inclusion criteria required that patients be diagnosed with Johnson and Strom stage 2 or 3 flatfoot deformity with documented lateral ankle pain and that preoperative MRI scans be available with the radiologist's report. Patient exclusion criteria included patients <18 years of age, patients with flatfoot deformity caused by previous trauma, tarsal coalition, neuropathic arthritis, patients with previous surgery, or patients with incomplete medical records. In total, 118 patients were identified with these parameters. Of the 118 patients, 74 patients (62.7%) had documented lateral ankle ligament injury on MRI. Of the 77 patients with stage 2 adult-acquired flatfoot, 55 (71.4%) had confirmed lateral ankle ligament injury on MRI. Of the 41 patients with stage 3 adult-acquired flatfoot, 19 (46.3%) had confirmed lateral ankle ligament injury on MRI. This study demonstrates a relatively high incidence of lateral ligament disease associated with adult-acquired flatfoot deformity. These findings might have long-term implications regarding ankle arthritis after surgical management of adult-acquired flatfoot.

Inestabilidad cronica lateral del tobillo: comparacion entre la reparacion de brostrom-gould y una tecnica artroscopica / Chronic Lateral Ankle Instability: Comparison Between Brostrom-Gould Repair And An Arthroscopic Technique

Introducción La inestabilidad crónica lateral del tobillo es una patología frecuente en las personas que sufren esguinces. El tratamiento inicial es conservador y de no funcionar se recomienda el tratamiento quirúrgico; la técnica descrita por Broström y modificada por Gould es la más utilizada, efectiva y reportada en la actualidad. Con el advenimiento de la cirugía artroscópica, uno de los autores (JBGG) ha desarrollado una técnica mínimamente invasiva que se ha utilizado en la unidad de pie desde hace 8 años. Este trabajo evalúa los resultados funcionales, de dolor y cicatrización de los pacientes tratados con la técnica Artroscópica y la técnica de Broström-Gould abierta. Materiales & Métodos Se evaluaron un total de 111 pacientes, 50 con la técnica abierta y 61 con técnica artroscópica, operados por inestabilidad lateral crónica del tobillo entre enero de 2004 y diciembre de 2011. Se utilizo la escala AOFAS de tobillo y retropié para la medición del dolor, función y alineación, y la escala EVA para la medición del dolor. Resultados El promedio de puntuación final de la escala AOFAS fue de 90 puntos y la inestabilidad se revirtió en el 96% de los casos, para ambos grupo de pacientes. El dolor fue aliviado eficientemente por ambas técnicas. No se observaron diferencias estadísticamente significativas entre los grupos del estudio. Discusión La reparación artroscópica de la inestabilidad crónica lateral del tobillo fue tan efectiva para restablecer la función, estabilidad y eliminar el dolor del tobillo como la técnica abierta y puede tener una menor posibilidad de complicaciones relacionadas con las heridas.

Background Chronic lateral ankle instability is a common condition in people with inversion sprains. Initial treatment is conservative, and if that does not work a surgical approach is recommended, such as that described by Broström and later modified by Gould, and is the most used and effective. With the advent of arthroscopic surgery, one of the authors (JBGG) has recently developed a minimally invasive technique that has been used in the Surgical Foot and Ankle Unit of Imbanaco Medical Centre for 8 years. Therefore, this work aims to determine functional outcomes of patients treated with the arthroscopic technique compared with the open technique of Broström-Gould. Methods A total of 111 patients were evaluated, including 50 with the open method, and 61 with arthroscopic surgery technique for chronic lateral ankle instability between January 2004 and December 2011. The American orthopaedic foot and ankle score (AOFAS) scale for ankle and hindfoot was used for measuring pain, function, and alignment, and a visual analogue scale (VAS) was used to assess the pain. Results The final AOFAS score was 90 points, and instability was reversed in 96% of cases, for both groups of patients. The pain was relieved efficiently by both techniques. There were no statistically significant differences between the study groups. Discussion Arthroscopic repair of chronic lateral ankle instability is an effective tool to restore the function and stability, as well as eliminate ankle pain, and is comparable in effectiveness with the conventional technique. Additionally, there is a lower chance of complications related to wounds.

Clinical evaluation of fibularis tertius muscle prevalence / Evaluación clínica de la prevalencia del músculo fibular tercero

The fibularis tertius muscle (FTM) in man has been developed over time to acquire subsequent bipedal gait. The FTM functions as a crucial contributor in dorsiflexion and eversion, postulated over the years as a stabilizer of the talocrural joint, avoiding forced investment and protecting the anterior talofibular ligament. The literature describes that FTM is absent in 10 percent of cases, with no data on Chilean population. A study of surface anatomy in 168 young subjects, 60 percent female and 40 percent male students at the Universidad de Talca, Chile, with a mean age of 20.6 +/- 1.68 years, was conducted. The presence of FTM was identified following the implementation of a clinical assessment protocol that determines the presence of muscle on the basis of a progression called F1, F2, and F3. The FTM was present in 49.11 percent of cases. On the right side, 20 percent (n = 37) of the subjects presented the FTM in F2 and 30 percent (n = 50) in F3. On the left side, 1 percent (n = 2) showed the muscle in F1, 21 percent (n = 35) in F2, and 26 percent (n = 44) in F3. Our results contrast with the high prevalence of FTM in the literature and suggest studies of association with lesions of the talocrural region.

El músculo fibular tercero (MFT) es un músculo que en el hombre se ha desarrollado paulatinamente, al adquirir la posición bípeda y posteriormente la marcha. Dentro de las funciones del MFT destaca su contribución en la flexión dorsal y eversión, postulándose que actuaría como estabilizador de la articulación talocrural, al evitar la inversión forzada y proteger al ligamento talofibular anterior. La literatura describe que el MFT se encuentra ausente en un 10 por ciento de los casos, no existiendo datos de la población chilena. Se realizó un estudio de anatomía de superficie en 168 sujetos jóvenes, el 60 por ciento de sexo femenino y 40 por ciento de sexo masculino, estudiantes de la Universidad de Talca, Chile, con edad promedio de 20,6 +/- 1,68 años. La presencia del MFT se identificó tras la aplicación de un protocolo de evaluación clínica que determina la presencia del músculo en base a una progresión denominada F1, F2, F3. El MFT estuvo presente en el 49,11 por ciento de los casos. En el lado derecho el 20 por ciento (n=37) de los sujetos presenta el MFT en F2 y un 30 por ciento (n=50) en F3. En el lado izquierdo un 1 por ciento (n=2) exhibe el músculo en F1, 21 por ciento (n=35) en F2 y un 26 por ciento(n=44) en F3. Nuestros resultados contrastan con la alta prevalencia del MFT descrita en la literatura y se sugiere la realización de estudios de asociación con las lesiones de la región talocrural.