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1.
Einstein (Sao Paulo) ; 18: eAO4739, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553355

RESUMO

OBJECTIVE: To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. METHODS: We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. RESULTS: Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. CONCLUSION: There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Brasil/epidemiologia , Cartilagem Articular/lesões , Criança , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
2.
Medicine (Baltimore) ; 98(41): e17447, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593100

RESUMO

INTRODUCTION: Lateral ligamentous complex injury without fracture or dislocation is rare in the literature. Due to the rare injury, it is not clear yet about the proper treatment. This case report suggests a specific diagnosis of this injury as well as an appropriate surgical method. PATIENT CONCERNS: In one-month period of time, 2 male soldiers participating in recreational basketball game presented with open wound on the lateral aspect of ankle without associated dislocation or fracture when they attempted to rebound the ball which consequently made them land on another player's foot. DIAGNOSIS: Total rupture of the lateral ligament complex with open wound was found without any associated fracture or dislocation. INTERVENTIONS: Open repair of the ruptured ligaments and capsule was performed. OUTCOMES: Patients returned to his own job's duty with none to minimal limitation in sport and activities of daily living at 9 to 10 months after the injury. CONCLUSION: Although open disruption of the lateral ligamentous complex without fracture or dislocation is rare, an adequate assessment and prompt surgical repair led to satisfactory outcome.


Assuntos
Traumatismos do Tornozelo/cirurgia , Basquetebol/lesões , Ligamentos Laterais do Tornozelo/lesões , Ruptura/cirurgia , Traumatismos do Tornozelo/etiologia , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Ruptura/etiologia , Adulto Jovem
3.
Oper Orthop Traumatol ; 31(3): 169-179, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31037330

RESUMO

OBJECTIVE: For chronic lateral ankle instability an anatomical repair procedure of the lateral collateral ligaments (LCL) of the ankle with augmentation by an inferior extensor retinaculum (IER) flap is proposed. INDICATIONS: To treat the mechanical parts of an instable ankle involving both LCL and subtalar joint ligament damage. CONTRAINDICATIONS: This technique is not suitable when the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are in a poor anatomical condition (exhaustive preoperative lesion mapping mandatory). SURGICAL TECHNIQUE: This technique combines the reinsertion of the remnants of the lateral ligaments of the ankle, the ATFL and the CFL using anchors, with augmentation using an inferior extensor retinaculum flap fixed in a tunnel by an interference screw. This flap works as an actual neoligament, providing not only reinforcement and collagen input but also peripheral stabilization of the subtalar joint by its calcaneal insertion and reinforcing the CFL stabilizing effect. POSTOPERATIVE MANAGEMENT: Following immediate immobilization in an ankle-foot orthosis, proprioceptive physiotherapy exercises are initiated with a return to sports depending on the type of sport. RESULTS: The postoperative outcomes and long-term follow-up results of this technique are discussed.


Assuntos
Instabilidade Articular , Ligamentos Laterais do Tornozelo , Tornozelo , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Humanos , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Ligamentos , Resultado do Tratamento
4.
J Orthop Surg Res ; 14(1): 69, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819216

RESUMO

BACKGROUND: The objective of the current study is to compare reliability, accuracy, sensitivity, and specificity in magnetic resonance imaging (MRI) evaluation of anterior talofibular ligament (ATFL) among the routine axial scanning plane, oblique axial-coronal scanning plane, and oblique axial-sagittal scanning plane. METHODS: Twenty cadaveric feet were studied. ATFL was exposed before scanning. Routine axial, oblique axial-coronal, and oblique axial-sagittal MRI scanning of 20 ATFL-intact cadaveric feet were acquired utilizing a 1.5-T MRI unit. The scans were repeated on the 20 cadaveric feet after the ATFL was artificially injured. In total, 120 sets of MR images were obtained and were randomly numbered. Three independent observers who were blinded to the experiment evaluated the images. Interobserver agreement, sensitivity, specificity, and accuracy were calculated and compared between different scanning planes utilizing the McNemar test. RESULTS: The interobserver agreement was fair to good (kappa, 0.55 to 0.65) in the routine axial plane, fair to good (kappa, 0.557 to 0.75) in the oblique axial-sagittal plane, and excellent (kappa, 0.85 to 0.95) in the oblique axial-coronal plane. The accuracy was significantly higher when utilizing oblique axial-coronal MRI scanning than routine axial MRI scanning (reader 1: p = .018; reader 2: p = .005). CONCLUSIONS: The diagnostic accuracy of oblique axial-coronal plane MRI was higher than the routine axial plane concerning ATFL injury, and the interobserver agreement was excellent. The oblique axial-coronal plane could be added to the MRI scanning protocol during clinical practices to improve the diagnostic accuracy of ATFL injury.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/normas , Tornozelo/diagnóstico por imagem , Tornozelo/patologia , Traumatismos do Tornozelo/patologia , Cadáver , Humanos , Ligamentos Laterais do Tornozelo/patologia , Variações Dependentes do Observador , Reprodutibilidade dos Testes
5.
Arch Orthop Trauma Surg ; 139(6): 787-793, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30770996

RESUMO

BACKGROUND: There is no consensus about the optimal treatment of anterior inferior ligament avulsion fractures of the ankle. The aim of this study is to provide insights regarding the incidence of anterior inferior ligament avulsion fractures, the association with fracture type, and correlation with treatment. METHODS: This study is a retrospective analysis in a level-1 trauma center of adult patients with an ankle fracture operated between the dates 01-01-2009 and 01-09-2017 who had a pre- and postoperative CT-scan. Within the study population, the incidence of AITFL avulsion fracture was defined. Primary outcome was the type of avulsion fracture and related treatment. Secondary outcome was additional surgery in relation to the initial treatment. RESULTS: In total, 65 of 252 (25.8%) patients were diagnosed with an anterior inferior ligament avulsion fracture. Zero patients had a Wagstaffe type 1 fracture, 28 (43.1%) had a type 2, 32 (49.2%) had a type 3, and 5 (7.7%) had a type 4. There was a correlation between Wagstaffe type 2 and Weber B fractures, p < 0.0001, and Wagstaffe type 3 avulsions were correlated with a Weber C fracture, p < 0.0001. Thirty-five of the avulsed fragments (53.8%) were smaller than 5 mm. In 13 (20%) of patients with anterior inferior ligament avulsion fracture, the avulsed fragments were directly fixated during initial surgery. Size and direct fixation of the fragment were significantly correlated (p < 0.0001). Within the anterior inferior ligament avulsion fracture group, only a total of four patients (6.2%) underwent a revision. CONCLUSION: In the current study, an incidence of 25.8% of anterior inferior ligament avulsion fracture in surgically treated ankle fractures is reported. A correlation between the type of Wagstaffe injury and Weber classification was showed. Most fragments smaller than 5 mm were not fixated; however, not all injuries needed syndesmotic screws due to syndesmotic instability. LEVEL OF EVIDENCE: Level IV.


Assuntos
Fraturas do Tornozelo , Fratura Avulsão , Ligamentos Laterais do Tornozelo , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/epidemiologia , Fraturas do Tornozelo/cirurgia , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/epidemiologia , Fratura Avulsão/cirurgia , Humanos , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Estudos Retrospectivos
6.
Adv Exp Med Biol ; 1059: 85-108, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29736570

RESUMO

Ankle sprain is amongst the most frequent musculoskeletal injuries, particularly during sports activities. Chronic ankle instability (CAI) resulting from an ankle sprain might have severe long-lasting consequences on the ankle joint. Despite the fact that most patients will respond favourably to appropriate conservative treatment, around 20% will develop symptomatic CAI with sense of giving away and recurrent sprains leading to functional impairment. "Classical" surgical repair by Brostrom-like surgery in one of its many modifications has achieved good results over the years. Recently, major advances in surgical techniques have enabled arthroscopic repair of ankle instability with favourable outcome while also enabling the treatment of other concomitant lesions: loose bodies, osteochondral defects (OCDs) or ankle impingement. Moreover, when the tissue remnant does not permit a repair technique, anatomic reconstruction by means of using a free graft has been developed. In many cases, OCDs occur as a consequence of CAI. However, traumatic and non-traumatic aetiologies have been described. There is no evidence favouring any surgical treatment over another concerning OCDs. Considering lower cost and limited aggression, microfracture is still the most frequent surgical approach. Herein, the authors describe their algorithm in the treatment of these conditions. Similarly, anterior or posterior impingement might be linked with CAI. These are clinical syndromes based on clinical diagnosis which are currently managed arthroscopically upon failure of conservative treatment.


Assuntos
Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Artroplastia de Substituição do Tornozelo , Artroplastia Subcondral , Artroscopia/métodos , Fenômenos Biomecânicos , Cartilagem/transplante , Humanos , Instabilidade Articular/etiologia , Corpos Livres Articulares/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Microtraumatismos Físicos/complicações , Osteotomia/métodos , Recuperação de Função Fisiológica , Terapia de Salvação , Tecidos Suporte , Tomografia Computadorizada por Raios X , Transplante Autólogo
7.
J Orthop Surg Res ; 13(1): 122, 2018 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-29788978

RESUMO

BACKGROUND: Various imaging techniques have been utilized for the diagnosis of chronic lateral ankle ligament injury. This systemic review will explore the effectiveness of different imaging techniques in diagnosing chronic lateral ankle ligament injury. METHODS: Relative studies were retrieved after searching 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trails). Eligible studies were summarized. Data were extracted to calculate pooled sensitivity and specificity of magnetic resonance imaging (MRI), ultrasonography (US), stress radiography, and arthrography. RESULTS: Fifteen studies met our inclusion and exclusion criteria. A total of 695 participants were included. The pooled sensitivities in diagnosing chronic ATFL injury were 0.83 [0.78, 0.87] for MRI, 0.99 [0.96, 1.00] for US, and 0.81 [0.68, 0.90] for stress radiography. The pooled specificities in diagnosing chronic ATFL injury were 0.79 [0.69, 0.87] for MRI, 0.91 [0.82, 0.97] for US, and 0.92 [0.79, 0.98] for stress radiography. The pooled sensitivities in diagnosing chronic CFL injury were 0.56 [0.46, 0.66] for MRI, 0.94 [0.85, 0.98] for US, and 0.90 [0.73, 0.98] for arthrography. The pooled specificities in diagnosing chronic CFL injury were 0.88 [0.82, 0.93] for MRI, 0.91 [0.80, 0.97] for US, and 0.90 [0.77, 0.97] for arthrography. CONCLUSION: This systematic review with meta-analysis investigated the accuracy of imaging for the diagnosis of chronic lateral ankle ligament injury. Ultrasound manifested high diagnostic accuracy in diagnosing chronic lateral ankle ligament injury. Clinicians should be aware of the limitations of MRI in detecting chronic CFL injuries.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/normas , Artrografia/métodos , Artrografia/normas , Estudos de Casos e Controles , Doença Crônica , Humanos , Imagem por Ressonância Magnética/métodos
8.
Medicine (Baltimore) ; 97(16): e0523, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29668642

RESUMO

The aim of the present study was to investigate the efficacy of the surgical treatment of terrible triad injuries of the elbow using a modified standard surgical approach, and treatment determined by the mode and mechanism of injury, and intraoperative findings.The study was a retrospective analysis of a prospective cohort of patients presenting with terrible triad injuries of the elbow, who underwent surgical treatment between July 2009 and January 2014. All patients were treated surgically according to a modified Pugh standard protocol. Elbow functional status and range of movements were evaluated at 3 months, 6 months, 1 year, and 2 years or more after surgery. Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system.Our series included a final cohort of 29 males and 13 females with a mean age of 48.23 ±â€Š10.95 years at the time of injury. The mean follow-up period was 30.47 ±â€Š7.65 months. The mean flexion-extension arc was 107°â€Š±â€Š22°, and the average forearm rotation arc was 145°â€Š±â€Š14°. The mean Mayo Elbow Performance Score was 88 ±â€Š10 points (range 55 to 100 points), with excellent results in 24 elbows, good results in 16, and poor results in 2. Functional results of the elbow improved significantly from 3 months postoperatively (P < .05), but tended to plateau from 1 year after surgery. Thirteen patients had radiographic signs of arthrosis (9 grade 1, 4 grade 2). Postoperative complications were local infection around the incision (n = 1), transient postoperative median nerve paralysis (n = 1), and postoperative posterior interosseous nerve paralysis (n = 1). Four patients required further surgery. Five patients had evidence of heterotopic ossification.Overall, we show that slight modifications to Pugh standard protocol for the surgical treatment of terrible triad injuries can lead to good to excellent results, although there were a good number of complications. The ideal surgical approach and treatment should be based on the mode and mechanism of injury, and intraoperative findings, and modifying the standard surgical treatment approach for terrible triad elbow injuries may be beneficial.


Assuntos
Artroplastia , Cotovelo , Traumatismos do Antebraço , Fixação Interna de Fraturas , Fraturas do Rádio , Ulna , Adulto , Artroplastia/efeitos adversos , Artroplastia/métodos , China , Protocolos Clínicos , Cotovelo/diagnóstico por imagem , Cotovelo/lesões , Cotovelo/cirurgia , Feminino , Traumatismos do Antebraço/diagnóstico , Traumatismos do Antebraço/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Humanos , Luxações Articulares/diagnóstico , Luxações Articulares/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados (Cuidados de Saúde) , Radiografia/métodos , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Ulna/diagnóstico por imagem , Ulna/lesões , Ulna/cirurgia
9.
Br J Sports Med ; 52(15): 956, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29514819

RESUMO

This guideline aimed to advance current understandings regarding the diagnosis, prevention and therapeutic interventions for ankle sprains by updating the existing guideline and incorporate new research. A secondary objective was to provide an update related to the cost-effectiveness of diagnostic procedures, therapeutic interventions and prevention strategies. It was posited that subsequent interaction of clinicians with this guideline could help reduce health impairments and patient burden associated with this prevalent musculoskeletal injury. The previous guideline provided evidence that the severity of ligament damage can be assessed most reliably by delayed physical examination (4-5 days post trauma). After correct diagnosis, it can be stated that even though a short time of immobilisation may be helpful in relieving pain and swelling, the patient with an acute lateral ankle ligament rupture benefits most from use of tape or a brace in combination with an exercise programme.New in this update: Participation in certain sports is associated with a heightened risk of sustaining a lateral ankle sprain. Care should be taken with non-steroidal anti-inflammatory drugs (NSAIDs) usage after an ankle sprain. They may be used to reduce pain and swelling, but usage is not without complications and NSAIDs may suppress the natural healing process. Concerning treatment, supervised exercise-based programmes preferred over passive modalities as it stimulates the recovery of functional joint stability. Surgery should be reserved for cases that do not respond to thorough and comprehensive exercise-based treatment. For the prevention of recurrent lateral ankle sprains, ankle braces should be considered as an efficacious option.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/prevenção & controle , Traumatismos do Tornozelo/terapia , Entorses e Distensões/diagnóstico , Entorses e Distensões/prevenção & controle , Entorses e Distensões/terapia , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/uso terapêutico , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/prevenção & controle , Traumatismos em Atletas/terapia , Braquetes , Humanos , Ligamentos Laterais do Tornozelo/lesões , Exame Físico , Fatores de Risco , Medicina Esportiva
10.
J Athl Train ; 53(3): 249-254, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29412694

RESUMO

CONTEXT: Ankle sprains are the most common orthopaedic injury that occurs during sport and physical activity. Many individuals who sprain their ankles develop chronic ankle instability (CAI), a condition characterized by recurrent injury, decreased physical activity, and decreased quality of life. These residual impairments are believed to persist for the remainder of the patient's life, in part due to the link between CAI and posttraumatic ankle osteoarthritis. However, this belief remains speculative due to the lack of long-term prospective investigations. OBJECTIVE: To use a mouse model of mild (MILD) and severe (SEVERE) ankle sprains to quantify balance and locomotor adaptations across the lifespan. DESIGN: Cohort study. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Fifty male mice (CBA/J) were randomly placed into a control (SHAM), MILD, or SEVERE group and housed individually. INTERVENTION(S): The MILD group underwent surgical transection of a single right hind-limb lateral ankle ligament, and the SEVERE group had 2 of the lateral ligaments transected. The SHAM group underwent a sham surgery during which no lateral ligaments were transected. MAIN OUTCOME MEASURE(S): After surgically inducing the ankle sprain, we measured balance and gait using a balance beam and footprint test before and every 6 weeks for 78 weeks. RESULTS: Age-related declines in balance but not stride length were exacerbated by an ankle sprain ( P < .001). Balance and stride lengths changed with age ( P < .001). Foot slips were worse in the SEVERE (4.32 ± 0.98) and MILD (3.53 ± 0.98) groups than in the SHAM group (2.16 ± 0.99; P < .001). Right-limb stride length was shorter in the SEVERE group (6.45 cm ± 0.41 cm) than in the SHAM group (6.87 cm ± 0.40 cm; P = .04). CONCLUSIONS: Transecting the lateral ligaments of a mouse hind foot resulted in lifelong sensorimotor dysfunction. Declines starting at 42 weeks postinjury may have represented the onset of posttraumatic osteoarthritis.


Assuntos
Traumatismos do Tornozelo , Transtornos Neurológicos da Marcha , Marcha/fisiologia , Instabilidade Articular , Entorses e Distensões , Animais , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/fisiopatologia , Modelos Animais de Doenças , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Ligamentos Laterais do Tornozelo/lesões , Ligamentos Laterais do Tornozelo/fisiopatologia , Efeitos Adversos de Longa Duração/diagnóstico , Camundongos , Camundongos Endogâmicos CBA , Equilíbrio Postural/fisiologia , Estudos Prospectivos , Entorses e Distensões/complicações , Entorses e Distensões/fisiopatologia
11.
Foot Ankle Surg ; 24(1): 65-70, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29413777

RESUMO

BACKGROUND: The aim of this study was to investigate the result of the specific conservative treatment of acute lateral ankle ligaments rupture and verify the effect of this therapy by stabilometry. METHODS: 17 young athletes were examined after acute lateral ankle sprain (grade III). Diagnosis was based on musculoskeletal ultrasound examinations. Pressure plate evaluated postural stability after conservative treatment at regular intervals during 1year. RESULTS: There were no significant differences in postural stability in double-leg stance between limbs. In single-leg stance, COP confidence ellipse (p=0,011) and COP excursion in sagittal plane (p=0,000) were significantly higher for the injured leg when compared with the uninjured leg only one week after removing the cast. CONCLUSIONS: After conservative treatment of grade III injuries with STABHA, immobilization with full weight bearing on the injured leg for 6 weeks and rehabilitation, stabilometry results showed that none of the patients had impaired postural stability or were at risk of functional ankle instability in the monitored period.


Assuntos
Traumatismos do Tornozelo/terapia , Tratamento Conservador/métodos , Instabilidade Articular/terapia , Ligamentos Laterais do Tornozelo/lesões , Doença Aguda , Adolescente , Adulto , Traumatismos do Tornozelo/diagnóstico , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/reabilitação , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/diagnóstico por imagem , Traumatismos em Atletas/reabilitação , Traumatismos em Atletas/terapia , Moldes Cirúrgicos , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Imobilização , Instabilidade Articular/diagnóstico , Instabilidade Articular/prevenção & controle , Instabilidade Articular/reabilitação , Masculino , Ruptura , Ultrassonografia , Viscossuplementos/administração & dosagem , Suporte de Carga , Cicatrização , Adulto Jovem
12.
Knee Surg Sports Traumatol Arthrosc ; 26(7): 2183-2195, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29138918

RESUMO

PURPOSE: To determine the best surgical treatment for chronic ankle instability (CAI) a systematic review was performed to compare the functional outcomes between various surgical stabilization methods. METHODS: A systematic search was performed from 1950 up to April 2016 using PubMed, EMBASE, Medline and the Cochrane Library. Inclusion criteria were a minimum age of 18 years, persistent lateral ankle instability, treatment by some form of surgical stabilization, described functional outcome measures. Exclusion criteria were case reports, (systematic) reviews, articles not published in English, description of only acute instability or only conservative treatment, medial ankle instability and concomitant injuries, deformities or previous surgical treatment for ankle instability. After inclusion, studies were critically appraised using the Modified Coleman Methodology Score. RESULTS: The search resulted in a total of 19 articles, including 882 patients, which were included in this review. The Modified Coleman Methodology Score ranged from 30 to 73 points on a scale from 0 to 90 points. The AOFAS and Karlsson Score were the most commonly used patient-reported outcome measures to assess functional outcome after surgery. Anatomic repair showed the highest post-operative scores [AOFAS 93.8 (SD ± 2.7; n = 119); Karlsson 95.1 (SD ± 3.6, n = 121)], compared to anatomic reconstruction [AOFAS 90.2 (SD ± 10.9, n = 128); Karlsson 90.1 (SD ± 7.8, n = 35)] and tenodesis [AOFAS 86.5 (SD ± 12.0, n = 10); Karlsson 85.3 (SD ± 2.5, n = 39)]. Anatomic reconstruction showed the highest score increase after surgery (AOFAS 37.0 (SD ± 6.8, n = 128); Karlsson 51.6 (SD ± 5.5, n = 35) compared to anatomic repair [AOFAS 31.8 (SD ± 5.3, n = 119); Karlsson 40.9 (SD ± 2.9, n = 121)] and tenodesis [AOFAS 19.5 (SD ± 13.7, n = 10); Karlsson 29.4 (SD ± 6.3, n = 39)] (p < 0.005). CONCLUSION: Anatomic reconstruction and anatomic repair provide better functional outcome after surgical treatment of patients with CAI compared to tenodesis reconstruction. These results further discourage the use of tenodesis reconstruction and other non-anatomic surgical techniques. Future studies may be required to indicate potential value of tenodesis reconstruction when used as a salvage procedure. Not optimal, but the latter still provides an increase in functional outcome post-operatively. Anatomic reconstruction seems to give the best results, but may be more invasive than anatomic repair. This has to be kept in mind when choosing between reconstruction and repair in the treatment of CAI. LEVEL OF EVIDENCE: IV.


Assuntos
Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Humanos , Ligamentos Laterais do Tornozelo/lesões , Recuperação de Função Fisiológica
13.
J Magn Reson Imaging ; 47(1): 69-77, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28449249

RESUMO

PURPOSE: To quantitatively evaluate the cartilage alteration of talus for chronic lateral ankle instability (LAI) with isolated anterior talofibular ligament (ATFL) tear and combined ATFL and calcaneofibular ligament (CFL) tear using T2 -mapping at 3.0T. MATERIALS AND METHODS: In all, 27 patients including 17 with isolated ATFL tear and 10 with ATFL+CFL tear, and 21 healthy subjects were recruited. All participants underwent T2 -mapping scan at 3T and patients completed American Orthopaedic Foot and Ankle Society (AOFAS) scoring. The total talar cartilage (TTC) was segmented into six compartments: medial anterior (MA), medial center (MC), medial posterior (MP), lateral anterior (LA), lateral center (LC), and lateral posterior (LP). The T2 value of each compartment was measured from T2 -mapping images. Data were analyzed with one-way analysis of variance (ANOVA), Student's t-test, and Pearson's correlation coefficient. RESULTS: The T2 values of MA, MC, MP, TTC in the ATFL group and MA, MC, MP, LC, LP, TTC in the ATFL+CFL group were higher than those in the control group (P < 0.05). Moreover, the T2 values of MC, MP, LC, and TTC in the ATFL+CFL group were higher than those in the ATFL group (P < 0.05). The T2 values of MA in both patient groups were negatively correlated with AOFAS scores (r = -0.596, r = -0.690, P < 0.05). CONCLUSION: Chronic LAI with ATFL tear had a trend of increasing cartilage T2 values in talar trochlea, mainly involving medial cartilage compartments. Chronic LAI with ATFL+CFL tear might result in higher T2 values in a much larger cartilage region than with ATFL tear. MA could be the main cartilage compartment that may affect the patient's clinical symptoms. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:69-77.


Assuntos
Articulação do Tornozelo/diagnóstico por imagem , Tornozelo/diagnóstico por imagem , Instabilidade Articular/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Imagem por Ressonância Magnética , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Cartilagem/diagnóstico por imagem , Cartilagem/lesões , Progressão da Doença , Feminino , Voluntários Saudáveis , Humanos , Ligamentos Laterais do Tornozelo/lesões , Masculino , Variações Dependentes do Observador , Tálus , Adulto Jovem
14.
Skeletal Radiol ; 47(3): 413-417, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29038920

RESUMO

Displaced ulnar collateral ligament injuries of the metacarpophalangeal joint of the thumb, also known as Stener lesions, are a well-recognized clinical entity, requiring surgical intervention because of the trapped location of the torn lateral collateral ligament superficial to the adductor aponeurosis of the thumb. We report a similar lesion located at the first metatarsophalangeal joint, to our knowledge the first ever described in the literature. In our patient, magnetic resonance imaging showed a full-thickness tear of the lateral collateral ligament of the first metatarsophalangeal joint, as well as a full-thickness tear of the extensor hood, with dislocation of the proximal part of the ruptured lateral collateral ligament to a position superficial to the extensor hood. Analogous to true Stener lesions, we are convinced these patients also need early surgical repair. Therefore, we would like to raise awareness about their existence to ensure adequate management of these lesions, in order to prevent possible long-term complications like chronic pain, instability, and joint degeneration.


Assuntos
Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Artes Marciais/lesões , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/lesões , Adolescente , Terapia Combinada , Feminino , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Articulação Metatarsofalângica/cirurgia , Modalidades de Fisioterapia , Ruptura
15.
Knee Surg Sports Traumatol Arthrosc ; 26(7): 2095-2102, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28439639

RESUMO

PURPOSE: The purpose of this study is to propose recommendations for the treatment of patients with chronic lateral ankle instability (CAI) based on expert opinions. METHODS: A questionnaire was sent to 32 orthopaedic surgeons with clinical and scientific experience in the treatment of CAI. The questions were related to preoperative imaging, indications and timing of surgery, technical choices, and the influence of patient-related aspects. RESULTS: Thirty of the 32 invited surgeons (94%) responded. Consensus was found on several aspects of treatment. Preoperative MRI was routinely recommended. Surgery was considered in patients with functional ankle instability after 3-6 months of non-surgical treatment. Ligament repair is still the treatment of choice in patients with mechanical instability; however, in patients with generalized laxity or poor ligament quality, lateral ligament reconstruction (with grafting) of both the ATFL and CFL should be considered. CONCLUSIONS: Most surgeons request an MRI during the preoperative planning. There is a trend towards earlier surgical treatment (after failure of non-surgical treatment) in patients with mechanical ligament laxity (compared with functional instability) and in high-level athletes. This study proposes an assessment and a treatment algorithm that may be used as a recommendation in the treatment of patients with CAI. LEVEL OF EVIDENCE: V.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Prova Pericial/normas , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Doença Crônica , Comorbidade , Consenso , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Instabilidade Articular/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Imagem por Ressonância Magnética , Masculino , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto Jovem
16.
BMC Musculoskelet Disord ; 18(1): 475, 2017 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-29162077

RESUMO

BACKGROUND: MRI analysis of subtalar ligaments in the tarsal sinus has not been well performed. We retrospectively investigated the appearance of subtalar ligaments using 3D isotropic MRI and compared imaging findings of subtalar ligaments between patients with subtalar instability (STI) and controls. METHODS: Preoperative MRIs of 23 STI patients treated with arthroscopic subtalar reconstruction were compared to MRIs of 23 age- and sex-matched control subjects without STI. Thickness and width of anterior capsular ligament (ACL) and interosseous talocalcaneal ligament (ITCL) as well as thickness of calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) were measured. Abnormalities in ACL, ITCL, CFL, ATFL, cervical ligament, and inferior extensor retinaculum were analyzed. RESULTS: STI patients had significantly smaller ACL thickness and ACL width than controls (ACL thickness: 1.73 mm vs. 2.22 mm, p = 0.007; ACL width: 7.21 mm vs. 8.80 mm, p = 0.004). ACL thickness of ≤2.1 mm had a sensitivity of 66.7% and a specificity of 66.7% for diagnosis of STI. ACL width of ≤7.9 mm had a sensitivity of 80.0% and a specificity of 76.2% for the diagnosis of STI. However, thickness and width of ITCL, thickness of CFL, or thickness of ATFL was not significantly different between the two groups. Absence or complete tear of ACL was significantly more frequent in STI patients than that in controls (34.8% vs. 8.7%, p = 0.035). Complete tear of CFL and ATFL was more common in STI patients than that in controls, although the difference between the two groups was not statistically significant. Abnormalities of ITCL, cervical ligament, or inferior extensor retinaculum were not significantly different between the two groups. CONCLUSIONS: MRI features of thin or narrow ACLs may suggest STI. Absence or complete tear of ACL was significantly more common in STI patients than that in controls.


Assuntos
Instabilidade Articular/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Articulação Talocalcânea/diagnóstico por imagem , Adolescente , Adulto , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/fisiopatologia , Artroplastia/métodos , Artroscopia/métodos , Fáscia , Feminino , Humanos , Imagem Tridimensional/métodos , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Estudos Retrospectivos , Sensibilidade e Especificidade , Articulação Talocalcânea/fisiopatologia , Articulação Talocalcânea/cirurgia , Adulto Jovem
17.
BMC Musculoskelet Disord ; 18(1): 421, 2017 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-29061135

RESUMO

BACKGROUND: One-third of individuals who sustain an acute lateral ankle ligament sprain suffer significant disability due to pain, functional instability, mechanical instability or recurrent sprain after recovery plateaus at 1 to 5 years post injury. The identification of early prognostic factors associated with poor recovery may provide an opportunity for early-targeted intervention and improve outcome. METHODS: We performed a comprehensive search of AMED, EMBASE, Psych Info, CINAHL, SportDiscus, PubMed, CENTRAL, PEDro, OpenGrey, abstracts and conference proceedings from inception to September 2016. Prospective studies investigating the association between baseline prognostic factors and recovery over time were included. Two independent assessors performed the study selection, data extraction and quality assessment of the studies. A narrative synthesis is presented due to inability to meta-analyse results due to clinical and statistical heterogeneity. RESULTS: The search strategy yielded 3396 titles/abstracts after duplicates were removed. Thirty-six full text articles were then assessed, nine of which met the study inclusion criteria. Six were prospective cohorts, and three were secondary analyses of randomised controlled trials. Results are presented for nine studies that presented baseline prognostic factors for recovery after an acute ankle sprain. Age, female gender, swelling, restricted range of motion, limited weight bearing ability, pain (at the medial joint line and on weight-bearing dorsi-flexion at 4 weeks, and pain at rest at 3 months), higher injury severity rating, palpation/stress score, non-inversion mechanism injury, lower self-reported recovery, re-sprain within 3 months, MRI determined number of sprained ligaments, severity and bone bruise were found to be independent predictors of poor recovery. Age was one prognostic factor that demonstrated a consistent association with outcome in three studies, however cautious interpretation is advised. CONCLUSIONS: The associations between prognostic factors and poor recovery after an acute lateral ankle sprain are largely inconclusive. At present, there is insufficient evidence to recommend any factor as an independent predictor of outcome. There is a need for well-conducted prospective cohort studies with adequate sample size and long-term follow-up to provide robust evidence on prognostic factors of recovery following an acute lateral ankle sprain. TRIAL REGISTRATION: Prospero registration: CRD42014014471.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Ligamentos Laterais do Tornozelo/lesões , Humanos , Prognóstico , Recuperação de Função Fisiológica
18.
Clin Biomech (Bristol, Avon) ; 50: 16-20, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28985486

RESUMO

BACKGROUND: To assist with visualization, orthopaedic surgeons often apply ankle distraction during arthroscopic procedures. The study aimed to investigate whether ankle distraction suppresses fibular motion in cadaveric specimens with an unstable syndesmotic injury. METHODS: Fourteen fresh-frozen above knee specimens underwent arthroscopic assessment with 1) intact ligaments, 2) after sectioning of the anterior inferior tibiofibular ligament, the interosseous ligament, and the posterior inferior tibiofibular ligament, and 3) after sectioning of the deep and superficial deltoid ligament. In all scenarios, the lateral hook test, anterior-posterior hook test, and posterior-anterior hook test were applied. Each test was performed with and without ankle distraction. Coronal plane anterior and posterior tibiofibular diastasis as well as sagittal plane tibiofibular translation due to the applied load were arthroscopically measured. FINDINGS: Tibiofibular diastasis in the coronal plane, as measured at both the anterior and posterior third of the incisura, was found to be significantly less when ankle distraction was applied, as compared to arthroscopic evaluation in the absence of distraction. In contrast, measurement of sagittal plane tibiofibular translation was not affected by ankle distraction. INTERPRETATION: Since arthroscopic findings of syndesmotic instability are subtle the differential values of the syndesmotic measurements taken on and off distraction are clinically relevant. To optimally assess syndesmotic instability one should evaluate the syndesmosis without distraction or focus on fibular motion in the sagittal plane when distraction is required.


Assuntos
Traumatismos do Tornozelo/diagnóstico , Articulação do Tornozelo/patologia , Artroscopia , Instabilidade Articular/diagnóstico , Ligamentos Articulares/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Humanos , Ligamentos Laterais do Tornozelo/lesões , Masculino , Pessoa de Meia-Idade , Estresse Mecânico , Adulto Jovem
19.
Foot Ankle Int ; 38(12): 1387-1393, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28884593

RESUMO

BACKGROUND: Arthroscopic evaluation of the syndesmosis allows direct visualization of syndesmotic instability. The purpose of this study was to determine the minimum degree of ligamentous injury necessary to destabilize the syndesmosis in the coronal plane when assessed arthroscopically and pinpoint where such instability should be measured within the incisura. METHODS: Fourteen cadaveric specimens were divided into 2 groups and arthroscopically assessed first with the syndesmosis intact and then following serial differential ligamentous transection. Group 1 (n = 7): anterior-inferior tibiofibular (AITFL), interosseous (IOL), posterior-inferior tibiofibular (PITFL), and deltoid (DL) ligament. Group 2 (n = 7): PITFL-IOL-AITFL-DL. At each step, a standard 100-N lateral hook test was applied and tibiofibular coronal plane diastasis measured arthroscopically at both the anterior and posterior third of the incisura. These measurements were in turn compared with those of the stressed intact ligamentous state. RESULTS: There was no significant syndesmotic instability measured at either the anterior or posterior margin of the incisura after transection of a singular ligament (AITFL or PITFL) or after the IOL was additionally transected. Diastasis at the posterior margin was significantly increased when all syndesmotic ligaments were sectioned (group 1: P = .018; group 2: P = .008), but this was not noted along the anterior margin. Diastasis at the anterior margin reached significance only with complete transection of syndesmosis and DL (group 1: P < .001; group 2: P = .044). CONCLUSION: Under arthroscopic evaluation, the syndesmosis becomes unstable in the coronal plane only when all syndesmotic ligaments are transected, which should preferentially be measured at the posterior margin of the incisura. Anteriorly, diastasis becomes apparent only with addition of DL disruption, although this added finding may aid in diagnosis of occult deltoid injury. CLINICAL RELEVANCE: AITFL, IOL, and PITFL need to be injured to produce coronal plane syndesmotic instability. Arthroscopic assessment of such instability should occur along the posterior margin of the incisura. When they exist, similar findings anteriorly suggest concomitant deltoid injury.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Instabilidade Articular , Ligamentos Laterais do Tornozelo/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia , Cadáver , Feminino , Humanos , Ligamentos Laterais do Tornozelo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Orthop Traumatol Surg Res ; 103(8S): S249-S252, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28893616

RESUMO

Antero-lateral ankle impingement syndrome (ALAIS) is a well-established clinical entity that is a common consequence of ankle sprains. Injury to the anterior talo-fibular ligament plays a key role in the genesis of ALAIS. Arthroscopic antero-lateral synovectomy is the standard of care. However, this treatment approach may deserve to be challenged, as it does not include any procedure on the ligaments, despite the presence in some patients of lateral rotational micro-instability of the ankle, without objective laxity. Consequently, we reviewed current data on ALAIS and its links to ankle instability, from the dual perspective of diagnosis and treatment.


Assuntos
Articulação do Tornozelo/cirurgia , Artropatias/cirurgia , Ligamentos Laterais do Tornozelo/lesões , Traumatismos do Tornozelo/complicações , Artroscopia , Humanos , Artropatias/etiologia , Artropatias/fisiopatologia , Instabilidade Articular/etiologia , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Rotação , Sinovectomia
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