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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-01-2020 | Ankle

Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability

Authors: Jordi Vega, Jörg Allmendinger, Francesc Malagelada, Matteo Guelfi, Miki Dalmau-Pastor

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 1/2020

Abstract

Purpose

When the anterior fascicle of the deltoid ligament is injured in patients with chronic ankle instability, the diagnosis of rotational ankle instability is supported. The aim of this study was to report the results of an all-arthroscopic technique to concomitantly repair the lateral collateral and deltoid ligaments to treat patients with rotational ankle instability.

Methods

Thirteen patients [12 men and 1 woman, median age 32 (15–54) years] with rotational ankle instability were treated by arthroscopic means after failing non-operative management. Median follow-up was 35 (18–42) months. Using a suture passer and knotless anchors, the ligaments were repaired with an arthroscopic all-inside technique.

Results

During diagnostic arthroscopy, 12 patients showed an isolated anterior talofibular ligament (ATFL) injury, and in one patient, both the ATFL and calcaneofibular ligament were affected. Arthroscopic examination of the deltoid ligament demonstrated a tear affecting the anterior area of the ligament in all cases. The tear was described as an "open book" tear, because the ligament was separated from the medial malleolus when applying passive internal rotation of the tibio-talar joint. This gap was closed when the tibio-talar joint was in neutral rotation or externally rotated. All patients reported subjective improvement in their ankle instability after the arthroscopic all-inside ligaments repair. The median AOFAS score increased from 70 (44–77) preoperatively to 100 (77–100) at final follow-up.

Conclusion

Rotational ankle instability can be successfully treated by an arthroscopic all-inside repair of the lateral and medial ligaments of the ankle.

Level of evidence

Level IV, retrospective case series.

Acevedo JI, Mangone PG (2011) Arthroscopic lateral ankle ligament reconstruction. Tech Foot Ankle Surg 10:111–116CrossRef

Alparslan L, Chiodo CP (2008) Lateral ankle instability: MR imaging of associated injuries and surgical treatment procedures. Semin Musculoskelet Radiol 12(4):346–358CrossRef

Boss AP, Hintermann B (2002) Anatomical study of the medial ankle ligament complex. Foot Ankle Int 23(6):547–553CrossRef

Buchhorn T, Ziai P (2009) Ventral impingement syndrome of the ankle joint. Arthroskopie 22:109–115CrossRef

Buchhorn T, Sabeti-Aschraf M, Dlaska CE, Wenzel F, Graf A, Ziai P (2011) Combined medial and lateral anatomic ligament reconstruction for chronic rotational instability of the ankle. Foot Ankle Int 32(12):1122–1126CrossRef

Caputo AM, Lee JY, Spritzer CE, Easley ME, Deorio JK, Nunley JA 2nd, Defrate LE (2009) In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med 37(11):2241–2248CrossRef

Chhabra A, Subhawong TK, Carrino JA (2010) MR imaging of deltoid ligament pathologic findings and associated impingement syndromes. Radiographics 30(3):751–761CrossRef

Chun KY, Choi YS, Lee SH, Kim JS, Young KW, Jeong MS, Kim DJ (2015) Deltoid ligament and tibiofibular syndesmosis injury in chronic lateral ankle instability: magnetic resonance imaging evaluation at 3T and comparison with arthroscopy. Korean J Radiol 16(5):1096–1103CrossRef

Corte-Real NM, Moreira RM (2009) Arthroscopic repair of lateral ankle instability. Foot Ankle Int 30:213–217CrossRef

10.

Crim JR, Beals TC, Nickisch F, Schannen A, Saltzman CL (2011) Deltoid ligament abnormalities in chronic lateral ankle instability. Foot Ankle Int 32(9):873–878CrossRef

11.

Crim J, Longenecker LG (2015) MRI and surgical findings in deltoid ligament tears. Am J Roentgenol 204(1):63–69CrossRef

12.

DiGiovanni BF, Fraga CJ, Cohen BE, Shereff MJ (2000) Associated injuries found in chronic lateral ankle instability. Foot Ankle Int 21(10):809–815CrossRef

13.

DiGiovanni BF, Partal G, Baumhauer JF (2004) Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med 23:1–19CrossRef

14.

Ferkel RD, Chams RN (2007) Chronic lateral ankle instability: arthroscopic findings and long-term results. Foot Ankle Int 28(1):24–31CrossRef

15.

Golanó P, Vega J, Pérez-Carro L, Götzens V (2006) Ankle anatomy for the arthroscopist. Part II: role of ankle ligaments in soft tissue impingement. Foot Ankle Clin 11(2):275–296CrossRef

16.

Golanó P, Vega J, de Leeuw PA, Malagelada F, Manzanares MC, Götzens V, van Dijk CN (2010) Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 18(5):557–569CrossRef

17.

Guillo S, Takao M, Calder J, Karlsson J, Michels F, Bauer T, Ankle Instability Group (2016) Arthroscopic anatomical reconstruction of the lateral ankle ligaments. Knee Surg Sports Traumatol Arthrosc 24(4):998–1002CrossRef

18.

Hintermann B, Sommer C, Nigg BM (1995) Influence of ligament transection on tibial and calcaneal rotation with loading and dorsi-plantarflexion. Foot Ankle Int 16(9):567–571CrossRef

19.

Hintermann B, Boss A, Schäfer D (2002) Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 30(3):402–409CrossRef

20.

Hintermann B (2005) What the orthopaedic foot and ankle surgeon wants to know from MR imaging. Semin Musculoskelet Radiol 9(3):260–271CrossRef

21.

Hintermann B, Knupp M, Pagenstert GI (2006) Deltoid ligament injuries: diagnosis and management. Foot Ankle Clin 11(3):625–637CrossRef

22.

Hintermann B, Golanó P (2014) The anatomy and function of the deltoid ligament. Tech Foot Ankle Surg 13:67–72CrossRef

23.

Kim ES, Lee KT, Park JS, Lee YK (2011) Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique. Orthopedics 34(4):1–5

24.

Mengiardi B, Pfirrmann CW, Vienne P, Hodler J, Zanetti M (2007) Medial collateral ligament complex of the ankle: MR appearance in asymptomatic subjects. Radiology 242(3):817–824CrossRef

25.

Milner CE, Soames RW (1998) The medial collateral ligaments of the human ankle joint: anatomical variations. Foot Ankle Int 19(5):289–292CrossRef

26.

Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Broström-Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39(11):2381–2388CrossRef

27.

O’Neill PJ, Van Aman SE, Guyton GP (2010) Is MRI adequate to detect lesions in patients with ankle instability? Clin Orthop Relat Res 468(4):1115–1119CrossRef

28.

Pankovich AM, Shivaram MS (1979) Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. I. Anatomical studies. Acta Orthop Scand 50(2):217–223CrossRef

29.

Rasmussen O, Kromann-Andersen C, Boe S (1983) Deltoid ligament. Functional analysis of the medial collateral ligamentous apparatus of the ankle joint. Acta Orthop Scand 54(1):36–44CrossRef

30.

Schäfer D, Hintermann B (1996) Arthroscopic assessment of the chronic unstable ankle joint. Knee Surg Sports Traumatol Arthrosc 4(1):48–52CrossRef

31.

Stufkens SA, van den Bekerom MP, Knupp M, Hintermann B, van Dijk CN (2012) The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review. Strateg Trauma Limb Reconstr 7(2):73–85CrossRef

32.

Takao M, Matsui K, Stone J, Glazebrook M, Kennedy JG, Guillo S, Calder JD, Karlsson J, Ankle Instability Group (2016) Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle. Knee Surg Sports Traumatol Arthrosc 24(4):1003–1006CrossRef

33.

Takao M, Glazebrook M, Stone J, Guillo S (2015) Ankle arthroscopic reconstruction of lateral ligaments (ankle anti-ROLL). Arthrosc Tech 4(5):e595–e600CrossRef

34.

Van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM (2008) What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med 121:324–331.e6CrossRef

35.

Vega J, Golanó P, Pellegrino A, Rabat E, Peña F (2013) All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique. Foot Ankle Int 34(12):1701–1709CrossRef

Title: Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability
Authors: Jordi Vega
Jörg Allmendinger
Francesc Malagelada
Matteo Guelfi
Miki Dalmau-Pastor
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 1/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-017-4736-y

ACC 2024 Congress

Springer Medicine

Combined arthroscopic all-inside repair of lateral and medial ankle ligaments is an effective treatment for rotational ankle instability

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

ACC 2024 Congress

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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