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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(1): 70-75, 2021 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-33448202

RESUMO

Objective: To investigate the effectiveness of anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws. Methods: A clinical data of 46 patients with the anterior talofibular ligament rupture admitted between September 2015 and October 2019 and met the selection criteria were retrospectively analyzed. All anterior talofibular ligaments were reconstructed with partial peroneal brevis tendon and fixed with double intra-fix screws. There were 22 males and 24 females, with an average age of 28.1 years (range, 16-52 years). Forty cases had a history of ankle sprain, 1 case was injured by a heavy object, and 5 cases were suffered from falls. There were 17 cases on the left side and 29 cases on the right side. The disease duration ranged from 3 months to 10 years (median, 20.3 months). The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, varus angle of ankle, and the difference of the anterior talar translation between healthy and affected sides (looseness, similarity, tightness) were recorded before and after operation; 23 patients were evaluated by Patient-Reported Outcomes Measurement Information System (PROMIS) score, including pain interference (PI) and physical function (PF) scores. Results: The operation time was 39-179 minutes, with an average of 65.8 minutes. All incisions healed by first intention. All patients were followed up 12-30 months (mean, 23 months). The VAS score, AOFAS ankle-hindfoot score, varus angle of ankle, difference of the anterior talar translation between healthy and affected sides, and PI and PF scores of PROMIS at 6 months and last follow-up significantly improved when compared with those before operation ( P<0.05). There was no significant difference in VAS score, PI score of PROMIS, and AOFAS ankle-hindfoot score between at 6 months and at last follow-up ( P>0.05). However, the PF score of PROMIS, the difference of the anterior talar translation between healthy and affected sides, and the varus angle of ankle were significant ( P<0.05). Conclusion: Anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon and double intra-fix screws has the advantages of small incision, convenient tendon removal, and firm graft fixation. The postoperative patients recover quickly and the effectiveness is satisfactory.


Assuntos
Ligamentos Laterais do Tornozelo , Adolescente , Adulto , Articulação do Tornozelo/cirurgia , Parafusos Ósseos , Feminino , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tendões , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 99(46): e22912, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181657

RESUMO

Peroneus longus and peroneus brevis tendon grafts have been frequently used to reconstruct the lateral ankle ligaments. However, there is no literature comparing the effect of the 2 methods. The purpose of this study was to compare the effects of 2 autologous tendon transplants on ankle joint activity.This retrospective study included 100 adult patients with chronic lateral ankle instability (CLAI) who underwent surgery from January 2014 to December 2017. Group A (50 patients): Reconstruction of the lateral ankle ligaments using the anterior half of peroneus longus tendon graft; Group B (50 patients): Using the anterior half of peroneus brevis tendon graft. Outcomes were assessed by comparing pre- and postoperative AOFAS scores, VAS pain scores, and Karlsson scores, and the radiographic assessment included talar tilt and anterior talar translation. A sensitive dynamometer was used before and after surgery to assess inversion, valgus, plantarflexion, and dorsiflexion strength to evaluate changes in muscle strength in the patients feet.Postoperatively, 88 patients were followed up for 12 to 24 months, including 46 cases in group A and 42 in group B. No severe complications were recorded in the 2 groups. There were significant pre- to post-operative differences between the groups. No significant differences were observed in the postoperative scores and muscle strength changes between the groups. However, the number of patients with decreased valgus strength in group B was statistically significant compared with group A.Both methods can improve the stability of the ankle joint, but the peroneus longus tendon has little effect on the postoperative muscle strength of the foot and should be used as the preferred surgical treatment for the treatment of CLAI.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Tendões/transplante , Adulto , Pesquisa Comparativa da Efetividade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
3.
Acta Orthop Belg ; 86(1): 95-101, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32490779

RESUMO

In cases of chronic instability of the lateral ligament complex following an ankle sprain, operative stabilization should be considered when conservative treatment fails. The purpose of this study is to determine the outcome of a percutaneous stabilization of the lateral ligament complex with a gracilis tendon auto-graft, after an adjuvant arthroscopy of the ankle joint. We retrospectively reviewed the medical files of patients who underwent this surgery performed by the senior author. Between 2012 and 2015, 18 ankles were stabilized. Clinical results were assessed at final follow-up at a mean post-operative period of 25 months (range, 10-42 months). The mean post-operative AOFAS ankle-hindfoot score was 90 points (range, 48-100 points). The mean Karlsson Ankle Functional Score was 85 points (range, 37-100 points). The mean VAS score was 1.2 (range, 0-7). Concomitant procedures were performed on 14 out of 18 ankles. In conclusion, we state that this arthroscopically assisted percutaneous technique is a viable treatment option for chronic lateral ankle instability. It offers an alternative for the modified Broström procedure when tissue quality is poor and carries all the advantages of a minimally invasive procedure.


Assuntos
Artroscopia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Tendões/transplante , Autoenxertos , Avaliação da Deficiência , Humanos , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento
4.
Acta Orthop Belg ; 86(1): 115-121, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32490782

RESUMO

Anterior inferior tibiofibular ligament (AITFL) lesion have been shown to result in proliferation of cicatricial tissue ; concomitant insufficiency of the anterior talofibular ligament (ATFL) and AITFL Lesion may cause anterolateral syndesmotic impingement in the ankle joint of runners. Twenty-two runners with suspected syndesmotic impingement after ankle sprain were included in the study. An MRI of the ankle joint was performed followed by arthroscopy. Arthroscopy revealed an ATFL lesion in 20 patients (87%) and anterolateral syndesmotic impingement in 17 patients (77%). An ATFL lesion was detected in all patients with anterolateral syndesmotic impingement. The sensitivity of MRI was 24% (4 patients) on detecting anterolateral syndesmotic impingement, and 25% (5 patients) on ATFL lesion. A traumatic sprain of the ankle frequently results in a combined ATFL lesion and anterolateral syndesmotic impingement in runners. The abilities of MRI to detect this combined pathology are limited. Arthroscopy of the ankle joint should be performed. Study Design : Case series ; level of evidence 4.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Traumatismos em Atletas/diagnóstico , Ligamentos Laterais do Tornozelo/lesões , Corrida/lesões , Entorses e Distensões/diagnóstico , Adulto , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Traumatismos em Atletas/cirurgia , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Entorses e Distensões/cirurgia
5.
Medicine (Baltimore) ; 99(22): e20344, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481413

RESUMO

BACKGROUND: In this study, we will explore the efficacy and safety of repair and reconstruction therapy (RRT) for patients with lateral ankle ligament injury (LALI). METHODS: Searches will be carried out in the Medline, EMBASE, Web of Science, Cochrane Library, PsycINFO, China National Knowledge Infrastructure, along with a comprehensive search of grey literature. All databases will be searched from inception to the March 1, 2020 with no restrictions to language and publication status. Two investigators will independently conduct selection of study, information collection, and risk of bias assessment, respectively. A third investigator will help to solve any different opinions between 2 investigators. RevMan 5.3 software will be utilized for statistical analysis. RESULTS: This study will assess the efficacy and safety of RRT for patients with LALI through assessing pain intensity, ankle function after ligament injury, time to return to work, time to return to sports, Tegner activity level, quality of life, and adverse events. CONCLUSION: This study summarizes latest evidence of RRT for patients with LALI and may provide guidance for clinical practice.Study registration number: INPLASY202040082.


Assuntos
Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
6.
Clin Podiatr Med Surg ; 37(3): 463-473, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32471612

RESUMO

Although most primary lateral ankle ligament repairs have a high success rate, as with any surgery, failures and the need for revision can occur. Nonanatomic lateral ankle ligament repairs have fallen out of favor because of the increased stiffness and resultant change in mechanics of the functioning tendon that is normally used. Allograft anatomic lateral ankle ligament reconstruction for revision surgery has gained popularity over the last few years. This article discusses the factors that can lead to failure and the revision technique.


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Humanos , Reoperação , Falha de Tratamento
7.
Med Sci Monit ; 26: e922925, 2020 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-32134048

RESUMO

BACKGROUND Anatomical reconstruction using a semitendinosus tendon autograft is one of the most widely-used techniques for chronic lateral ankle instability (CLAI), and it can result in good biomechanical recovery for patients. The purpose of this study was to investigate the outcome of a novel individualized three-dimensional printed guide template for lateral ankle ligament reconstruction compared with the traditional surgical methods. MATERIAL AND METHODS We retrospectively studied 34 patients with CLAI who required lateral ankle ligament reconstruction. Patients were randomly divided into 2 cohorts: the template group (18 patients) and the conventional group (16 patients). The average operation duration and number of radiation exposures were compared between the 2 cohorts. The displacement of anterior talar and talar tilt angle were recorded at the last follow-up, and Karlsson-Peterson score and American Orthopedic Foot and Ankle Society Score (AOFAS) were also compared. RESULTS All patients had satisfactory ankle stability at the last follow-up. The average operation duration was 51.9±3.6 min and the average number of radiation exposures was 1.34±0.6 in the template group, and the average operation duration was 72.4±12.6 min and the average number of radiation exposures was 6.58±1.7 in the conventional group. Difference between the 2 cohorts was statistically significant. However, in AOFAS (95.2±2.5 vs. 94.9±2.2; P>0.01.) and Karlsson Score (94.7±3.6 vs. 93.8±4.1; P>0.01.), no significant differences were found between the 2 cohorts. CONCLUSIONS Both the template technique and the conventional method provided satisfactory outcomes for CLAI patients. However, the shorter operation duration and low number of radiation exposures in the template cohort suggest it is the better alternative for treatment of CLAI.


Assuntos
Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Impressão Tridimensional , Tendões/transplante , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Cirurgia Assistida por Computador , Transplante Autólogo , Adulto Jovem
8.
Arthroscopy ; 36(6): 1714-1721, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32057988

RESUMO

PURPOSE: To evaluate the feasibility of arthroscopic reduction percutaneous fixation (ARPF) in the treatment of isolated medial malleolar fracture and compare the results with those of conventional open reduction internal fixation (ORIF). METHODS: This prospective study enrolled 77 patients with isolated medial malleolar fracture between November 2011 and February 2016. The patients were assigned to the ARPF (n = 34) and ORIF (n = 43) groups. The Olerud-Molander ankle score (OMAS), ankle range of motion (ROM), visual analog scale, and radiographic evaluation were determined at the scheduled follow-up. RESULTS: In the ARPF group, 11 of 34 patients (32.4%) had chondral lesions. Tears of the deltoid ligament and anterior inferior tibiofibular ligament were noted in 3 (8.8%) and 15 (44.1%) patients, respectively. The mean follow-up was 5 years. The mean OMAS was higher in the ARPF group than in the ORIF group. The differences were statistically significant at 6 months (mean ± standard deviation, 80.2 ± 4.0 for ARPF vs 77.2 ± 4.1 for ORIF, P = .005) and 1 year (92.9 ± 4.9 vs 88.1 ± 4.6, P < .001), but not at the latest follow-up (P = .081). Ankle ROM was markedly improved in the ARPF group, unlike in the ORIF group at 6 months (dorsiflexion, P = .025; plantarflexion, P < .001) and 1 year (dorsiflexion and plantarflexion, P < .001). The improvement remained at the latest follow-up in plantarflexion (P = .001) but not in dorsiflexion (P = .354). CONCLUSIONS: Arthroscopy-assisted reduction is a feasible alternative modality with superior short-term outcomes for treating isolated medial malleolar fracture, but its superiority may be attenuated in the intermediate term. LEVEL OF EVIDENCE: Level III, comparative study.


Assuntos
Fraturas do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Artroscopia/métodos , Fixação Interna de Fraturas/métodos , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Fraturas do Tornozelo/diagnóstico , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Feminino , Humanos , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Masculino , Estudos Prospectivos , Amplitude de Movimento Articular
9.
Am J Sports Med ; 48(4): 916-922, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32053397

RESUMO

BACKGROUND: Although a variety of surgical procedures for anterior talofibular ligament (ATFL) reconstruction have been reported, the effect of initial graft tension during ATFL reconstruction remains unclear. PURPOSE/HYPOTHESIS: This study investigated the effects of initial graft tension on ATFL reconstruction. We hypothesized that a high degree of initial graft tension would cause abnormal kinematics and laxity. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve cadaveric ankles were tested with a robotic system with 6 degrees of freedom to apply passive plantarflexion and dorsiflexion motions and a multidirectional load. A repeated measures experiment was designed with the intact ATFL, transected ATFL, and reconstructed ATFL at initial tension conditions of 10, 30, 50, and 70 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ forces of the ATFL and reconstructed graft were calculated with the principle of superposition. RESULTS: Initial tension of 10 N was sufficient to imitate normal ankle kinematics and laxity, which were not significantly different when compared with those of the intact ankles. The in situ force on the reconstructed graft tended to increase as the initial tension increased. In situ force on the reconstructed graft >30 N was significantly greater than that of intact ankles. The in situ force on the ATFL was 19 N at 30° of plantarflexion. In situ forces of 21.9, 30.4, 38.2, and 46.8 N were observed at initial tensions of 10, 30, 50, and 70 N, respectively, at 30° of plantarflexion. CONCLUSION: Approximate ankle kinematic patterns and sufficient laxity, even with an initial tension of 10 N, could be obtained immediately after ATFL reconstruction. Moreover, excessive initial graft tension during ATFL reconstruction caused excessive in situ force on the reconstructed graft. CLINICAL RELEVANCE: This study revealed the effects of initial graft tension during ATFL reconstruction. These data suggest that excessive tension during ATFL reconstruction should be avoided to ensure restoration of normal ankle motion.


Assuntos
Traumatismos do Tornozelo , Instabilidade Articular , Ligamentos Laterais do Tornozelo , Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Ligamentos Laterais do Tornozelo/transplante
10.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 253-261, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31359101

RESUMO

PURPOSE: To assess the impact on ankle stability after repairing the ATFL alone compared to repairing both the ATFL and CFL in a biomechanical cadaver model. METHODS: Ten matched pairs of intact, fresh frozen human cadaver ankles (normal) were mounted to a test machine in 20.0° plantar flexion and 15.0° of internal rotation. Each ankle was loaded to body weight and then tested from 0.0° to 20.0° of inversion. The data recorded were torque at 20.0° and stiffness, peak pressure and contact area in the ankle joint using a Tekscan sensor, rotation of the talus and calcaneus, and translation of the calcaneus using a three-dimensional motion capture system. Ankles then underwent sectioning of the ATFL and CFL (injured), retested, then randomly assigned to ATFL-only Broström repair or combined ATFL and CFL repair. Testing was repeated after repair then loaded in inversion to failure (LTF). RESULTS: The stiffness of the ankle was not significantly increased compared to the injured condition by repairing the ATFL only (n.s.) or the ATFL/CFL (n.s.). The calcaneus had significantly more rotation than the injured condition in the ATFL-only repair (p = 0.037) but not in the ATFL/CFL repair (n.s.). The ATFL failed at 40.3% higher torque than the CFL, at 17.4 ± 7.0 N m and 12.4 ± 4.1 N m, respectively, and 62.0% more rotation, at 43.9 ± 5.6° and 27.1 ± 6.8°, respectively. CONCLUSIONS: There was a greater increase in stiffness following combined ATFL/CFL repair compared to ATFL-only repair, although this did not reach statistical significance. The CFL fails before the ATFL, potentially indicating its vulnerability immediately following repair. LEVEL OF EVIDENCE: III, case-control therapeutic study.


Assuntos
Traumatismos do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Adulto , Tornozelo , Articulação do Tornozelo , Fenômenos Biomecânicos , Cadáver , Calcâneo , Estudos de Casos e Controles , Feminino , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Rotação , Tálus , Torque
11.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 108-115, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31388694

RESUMO

PURPOSE: The open "Broström-Gould" procedure has become the gold standard technique for the treatment of chronic ankle instability. Although arthroscopic techniques treating ankle instability have significantly evolved in the last years, no all arthroscopic Broström-Gould has been described. The aim of the study was to describe the all-arthroscopic Broström-Gould technique [anterior talofibular ligament (ATFL) repair with biological augmentation using the inferior extensor retinaculum (IER)], and to evaluate the clinical results in a group of patients. METHODS: Fifty-five patients with isolated lateral ankle instability were arthroscopically treated. Arthroscopic ATFL repair with biological augmentation was performed through a two-step procedure. First, the ligament is reattached through an arthroscopic procedure. Next, the ligament is augmented with the IER that is endoscopically grasped. Both the ligament repair and its augmentation with IER were performed with the help of an automatic suture passer and two soft anchors. Characteristics of the patients, and pre- and postoperatively AOFAS and Karlsson scores were recorded. RESULTS: The median preoperative AOFAS score increased from 74 (range 48-84) to 90 (range 63-100). According to the Karlsson score, the median preoperative average increased from 65 (range 42-82) to 95 (range 65-100). No major complications were reported. Only one case (1.8%) required a revision surgery at 23 months of follow-up. CONCLUSION: The arthroscopic all-inside ATFL repair with biological augmentation using the IER is a reproducible technique. Excellent clinical results were obtained. The technique has the advantage of its minimally invasive approach and the potential to treat concomitant ankle intra-articular pathology. LEVEL OF EVIDENCE: Retrospective case series, Level IV.


Assuntos
Articulação do Tornozelo/cirurgia , Artroscopia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Adolescente , Adulto , Traumatismos do Tornozelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Entorses e Distensões/cirurgia , Âncoras de Sutura , Técnicas de Sutura , Adulto Jovem
12.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 116-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31432243

RESUMO

PURPOSE: Chronic ankle instability has been described as presenting with complete tears of both the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in 20% of cases. Arthroscopic techniques to treat chronic ankle instability are increasingly being reported and in some instances they can be technically demanding. The aim of this study was to describe an arthroscopic all-inside repair of both the ATFL and CFL, and to report the outcomes of a group of patients with chronic ankle instability that underwent the technique. METHODS: Twenty-four patients [22 male and 2 female, median age 41 (range 22-56) years] with chronic ankle instability and torn ATFL and CFL were treated arthroscopically after failing non-operative management. Median follow-up was 35 (mean 34.7, and range 18-55) months. Through an arthroscopic all-inside technique, and using a suture passer and two knotless anchors, both fascicles of the ATFL and the CFL were repaired. RESULTS: Arthroscopic examination demonstrated ATFL and CFL injuries in all patients. Subjective improvement in their ankle instability was observed postoperatively. The anterior drawer and the talar tilt tests were negative at follow-up. The median AOFAS score increased from 65 (mean 65, range 52-85) preoperatively to 97 (mean 97, range 85-100) at final follow-up. CONCLUSION: Chronic ankle instability with concomitant injury of both the ATFL and CFL, can be successfully treated by an arthroscopic all-inside repair. The clinical relevance of the study is the description of the first arthroscopic all-inside ATFL and CFL anatomic repair technique, which offers excellent clinical results and the inherent benefits from minimally invasive surgery. LEVEL OF EVIDENCE: IV, retrospective case series.


Assuntos
Articulação do Tornozelo/cirurgia , Artroscopia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Adulto , Tornozelo , Traumatismos do Tornozelo/cirurgia , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Entorses e Distensões/cirurgia , Suturas , Adulto Jovem
13.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 298-304, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31535192

RESUMO

PURPOSE: To elucidate surgical outcomes in pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare. METHODS: A retrospective chart review was conducted of pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare following simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active range of motion exercises for the ankle in our department between 2013 and 2017. Clinical outcomes were evaluated by comparing preoperative and final follow-up American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and Karlsson-Peterson ankle function scores. Intervals between surgery and return to physical education in school were determined. RESULTS: 31 feet of 15 male and 16 female patients were examined. Mean postoperative follow-up duration was 40.7 ± 12.7 (range 24-66) months. Mean AOFAS score increased significantly from 66.3 ± 2.5 (range 62-77) preoperatively to 96.5 ± 4.9 (range 87-100) at final follow-up (p < 0.001). Mean Karlsson-Peterson score increased significantly from 51.7 ± 4.0 (range 47-70) preoperatively to 95.3 ± 6.7 (range 80-100) at final follow-up (p < 0.001). Mean interval between surgery and return to physical education in school was 11.4 ± 1.6 (range 10-18) weeks. CONCLUSION: Simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active ankle range of motion exercises may give excellent clinical outcomes with early return to physical activity for chronic lateral ankle instability with os subfibulare in pediatric/adolescent patients desiring an early return to physical activity. Level of evidence III.


Assuntos
Articulação do Tornozelo/cirurgia , Artroplastia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Adolescente , Tornozelo/cirurgia , Traumatismos do Tornozelo/cirurgia , Artroplastia/estatística & dados numéricos , Criança , Exercício Físico , Feminino , Humanos , Masculino , Período Pós-Operatório , Amplitude de Movimento Articular , Estudos Retrospectivos , Volta ao Esporte , Âncoras de Sutura , Suporte de Carga
14.
Foot Ankle Int ; 41(1): 44-49, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31535563

RESUMO

BACKGROUND: The comparative studies on open vs arthroscopic anterior talofibular ligament (ATFL) repair are limited. This study aimed to compare the early therapeutic efficacy and cost between the traditional open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL for chronic lateral ankle instability. METHODS: A total of 27 of patients with chronic lateral ankle instability undergoing repair of the ATFL between January 2013 and June 2015 were retrospectively included with a traditional open surgery (n = 10) group and arthroscopy (n = 17) group. The surgery duration, surgical cost, postoperative complications, and the preoperative/postoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Karlsson-Peterson score were compared between groups. RESULTS: Compared to the arthroscopy group, the open surgery group had significantly shorter surgery duration and lower surgical cost. However, there was no significant difference in hospitalization duration between groups. At 3 years after operation, the AOFAS and Karlsson scores were significantly improved in both groups. Nevertheless, there was no significant difference in the AOFAS and Karlsson scores between groups at both preoperative and postoperative assessment. No significant difference was found in the incidence of postoperative complications between the 2 groups. CONCLUSION: These results suggest that open Broström-Gould repair and all-arthroscopic anatomical repair of the ATFL have comparable therapeutic efficacy for chronic lateral ankle instability. The arthroscopic surgery had a smaller incision, while the open Broström-Gould had a shorter surgery duration and lower cost. LEVEL OF EVIDENCE: Level III, comparative study.


Assuntos
Artroscopia/economia , Artroscopia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Adulto , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Inquéritos e Questionários
15.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 270-280, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31422424

RESUMO

PURPOSE: To analyze the current randomized controlled trials (RCTs) of dynamic fixations (DFs) and static fixations (SFs) in treating distal tibiofibular syndesmosis injuries (DTSIs). METHODS: The Cochrane Central Register of Controlled Trials, PubMed, and EMBASE were systematically searched according to the PRISMA guidelines to identify RCTs comparing the DFs and SFs for DTSIs. Included studies were assessed using the Cochrane Risk of Bias Tool. Postoperative functional scores, range of motion (ROM), complication rate, and incidence of reoperation were statistically analyzed using review manager software, and a p value of < 0.05 was considered statistically significant. RESULTS: Five RCTs with a total of 282 patients were included. Analysis revealed statistically significant differences in favor of DFs with regard to American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score at a follow-up less than 6 months (MD 5.29; 95% CI 0.99-9.59; p = 0.02; I2 = 0%) and at a follow-up more than 2 years (MD 7.53; 95% CI 3.30-11.76; p = 0.0005; I2 = 0%), Olerud-Molander ankle (OMA) score at 1 year follow-up (MD 4.62; 95% CI 0.91-8.32; p = 0.01; I2 = 14%), and overall postoperative complication rate (RR 0.22; 95% CI 0.07-0.77; p = 0.02; I2 = 73%). There was no significant difference between the DFs and SFs regarding ROM and incidence of reoperation. CONCLUSIONS: The DF procedure leads to significantly improved functional scores as well as lower rate of overall postoperative complications when compared with SF procedure. On the basis of results of this meta-analysis, the DF should be recommended for managing the DTSI. LEVEL OF EVIDENCE: I.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Ortopédicos/métodos , Complicações Pós-Operatórias/etiologia , Parafusos Ósseos , Humanos , Procedimentos Ortopédicos/efeitos adversos , Ortopedia , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reoperação , Técnicas de Sutura , Resultado do Tratamento
16.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 63-69, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30830298

RESUMO

PURPOSE: Neurovascular structures around the ankle are at risk of injury during arthroscopic all-inside lateral collateral ligament repair for the treatment of chronic ankle instability. This study aimed to evaluate the risk of damage to anatomical structures and reproducibility of the technique amongst surgeons with different levels of expertise in the arthroscopic all-inside ligament repair. METHODS: Twelve fresh-frozen ankle specimens were used for the study. Two foot and ankle surgeons with different level of experience in the technique performed the procedure on 6 specimens each. The repair was performed following a standardized procedure as originally described. Then, an experienced anatomist dissected all the specimens to evaluate the outcome of the ligament repair, any injuries to anatomical structures and the distance between arthroscopic portals and the superficial peroneal nerve (SPN) and sural nerve. RESULTS: Dissections revealed no injury to the nerves assessed. Mean distance from the anterolateral portal and the SPN was of 4.8 (range 0.0-10.4) mm. The mean distance from the accessory anterolateral portal to the SPN and sural nerve was of 14.2 (range 7.1-32.9) mm and 28.1 (range 2.8-39.6) mm, respectively. The difference between the 2 surgeons' groups was non-statistically significant for any measurement (mm). In all specimens both fascicles of the anterior talofibular ligament were reattached onto its original fibular footprint. The calcaneofibular ligament was not penetrated in any specimen. CONCLUSIONS: The all-inside arthroscopic lateral collateral ligament repair is a safe and reproducible technique. The clinical relevance of this study is that this technique provides a safe and anatomic reattachment of the anterior talofibular ligament, with minimal risk of injury to surrounding anatomical structures regardless of the level of experience with the technique.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Artroplastia/métodos , Ligamentos Laterais do Tornozelo/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/anatomia & histologia , Artroplastia/efeitos adversos , Artroscopia/efeitos adversos , Artroscopia/métodos , Cadáver , Doença Crônica , Dissecação , Feminino , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Nervo Fibular/anatomia & histologia , Nervo Fibular/lesões , Nervo Fibular/cirurgia , Reprodutibilidade dos Testes , Nervo Sural/anatomia & histologia , Nervo Sural/lesões , Nervo Sural/cirurgia
17.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 70-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30888451

RESUMO

PURPOSE: Tendon grafts are often utilized for reconstruction of the lateral ligaments unamenable to primary repair. However, tendon and ligaments have different biological roles. The anterior tibiofibular ligament's (ATiFL) distal fascicle may be resected without compromising the stability of the ankle joint. The aim of this study is to describe an all-arthroscopic and intra-articular surgical technique of ATiFL's distal fascicle transfer for the treatment of chronic ankle instability. METHODS: Five unpaired cadaver ankles underwent arthroscopic ATiFL's distal fascicle transfer using a non-absorbable suture and a knotless anchor. Injured or absent ATiFL's distal fascicle were excluded from the study. Following arthroscopy, the ankles were dissected and evaluated for entrapment of nearby adjacent anatomical structures. The ligament transfer was also assessed. The distance between the anterolateral (AL) portals and the superficial peroneal nerve (SPN) was measured and the shortest distance was reported. RESULTS: All specimens revealed successful transfer of the tibial origin of the ATiFL's distal fascicle onto the talar insertion of anterior talofibular ligament's (ATFL) superior fascicle. The fibular origin of the ATiFL's distal fascicle remained intact. There were no specimens with SPN or extensor tendon entrapment. The median distance between the proximal AL portal and SPN was 3.8 mm. The median distance between the distal AL portal and SPN was 3.9 mm. CONCLUSION: An all-arthroscopic approach to an ATiFL's distal fascicle transfer is a reliable method to reconstruct the ATFL's superior fascicle. Transfer of ATiFL's distal fascicle avoids the need for tendon harvest or allograft. The lack of injury to nearby adjacent structures suggests that it is a safe procedure. The clinical relevance of the study is that ATiFL's distal fascicle can be arthroscopically transferred to be used as a biological reinforcement of the ATFL repair, or as an ATFL reconstruction.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Artroplastia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/transplante , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/complicações , Artroscopia/métodos , Cadáver , Doença Crônica , Feminino , Humanos , Instabilidade Articular/etiologia , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Técnicas de Sutura , Tálus/cirurgia
18.
Foot Ankle Surg ; 26(1): 61-65, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30563745

RESUMO

BACKGROUND: The purpose of this study is to describe the relative location of superficial anatomic landmarks and likely location of structures at risk in order to predict the proximity of the later and avoid their injury during the arthroscopic treatment of lateral ankle instability. METHODS: Fifteen cadaver ankles were dissected. Based on superficial anatomic landmarks, the location and distances to the structures at risk (extensor tendons, peroneus tertius, peroneal tendons, main branch or intermediate branch of the superficial peroneal nerve, and the sural nerve) were measured. RESULTS: The distance from the lateral malleolus along the peroneus brevis to its intersection by the sural nerve was 38.5±10.5mm and from it to the superficial peroneal nerve was 32.0±7.4mm. Based on the minimum distances, a rectangular area of 25mm×22mm was obtained. The anterior talofibular ligament and the proximal border of the inferior extensor retinaculum were within this area. CONCLUSIONS: Our study suggests that based on superficial anatomic landmarks, it is possible to define an anatomic area in order to avoid structures at risk. In addition to the usual precautions, these anatomical references may contribute to lower the complication rate associated to the arthroscopic treatment of lateral ankle instability.


Assuntos
Articulação do Tornozelo/cirurgia , Artroscopia/métodos , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Ossos do Tarso/cirurgia , Idoso , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Articulação do Tornozelo/inervação , Cadáver , Feminino , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Nervo Fibular/diagnóstico por imagem , Ossos do Tarso/diagnóstico por imagem
19.
Foot Ankle Surg ; 26(1): 85-93, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30578157

RESUMO

BACKGROUND: To investigate if there is any evidence in favour of autograft or allograft use for anatomic reconstruction of lateral ankle ligaments in patients with symptomatic chronic ankle instability. METHODS: A literature search was performed in PubMed MEDLINE, Cochrane Library, EMBASE and Google Scholar databases, over the years 1994-2017, to identify the studies presenting clinical results of anatomic lateral ankle ligaments reconstruction using various combinations of the keywords "lateral ankle ligaments reconstruction", "anatomic reconstruction", "chronic ankle instability", "allograft", "autograft". The surgical procedure was considered anatomic if consistent with the description of lateral ankle ligaments made by Burks and Morgan in 1994. RESULTS: Among the 89 papers matching the search terms, only 12 could be included in which 357 anatomic lateral ankle ligaments reconstructions were performed. One was a comparative case series (level of evidence III - LOE III) while other papers were retrospective case series (LOE IV), the mean Modified Coleman Methodology Score (MCMS) was fair: 56.7 (SD±5.2). Due to the low level of evidence of the available literature only a qualitative analysis was performed. The limited evidence from the studies analysed suggests that there is no difference in graft survivorship, graft-dependent variables, patient's satisfaction, clinical outcome measures and radiographic results between allograft and autograft. CONCLUSIONS: Given the low number of studies, their poor methodology score and their low level of evidence it is not possible to determine if allograft is better or safer than autograft. LEVEL OF EVIDENCE: Level IV, review paper of level III and level IV studies.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Aloenxertos , Traumatismos do Tornozelo/diagnóstico , Articulação do Tornozelo/diagnóstico por imagem , Autoenxertos , Doença Crônica , Humanos , Instabilidade Articular/diagnóstico , Ligamentos Laterais do Tornozelo/cirurgia , Satisfação do Paciente
20.
Knee Surg Sports Traumatol Arthrosc ; 28(1): 124-131, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31240379

RESUMO

PURPOSE: A bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm-diameter tunnel and surrounding bone. METHODS: Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30°, 45°, 60° and 90° in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface. RESULTS: A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30° offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm-diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region. CONCLUSION: An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend drilling an oblique fibular tunnel when reconstructing the ATFL and CFL.


Assuntos
Articulação do Tornozelo/cirurgia , Fíbula/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Ortopédicos/métodos , Adulto , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Feminino , Fíbula/diagnóstico por imagem , Humanos , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Masculino , Pessoa de Meia-Idade , Entorses e Distensões/cirurgia , Tomografia Computadorizada Espiral , Adulto Jovem
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