Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 1/2020

01-01-2020 | Magnetic Resonance Imaging | ANKLE

Absence of ATFL remnant does not affect the clinical outcomes of the modified broström operation for chronic ankle instability

Authors: Sunghoon Park, Taehun Kim, Myungsub Lee, Younguk Park

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

Login to get access

Abstract

Purpose

The modified Broström operation for chronic ankle instability has demonstrated good clinical results. Absence of ligamentous tissue is a risk factor for recurrence of ankle instability after surgery. This study evaluated the effect of quality of ligament tissue (anterior talofibular ligament, ATFL) on prognosis, in a cohort of patients with chronic ankle instability after the modified Broström operation.

Methods

This was a retrospective case series. Overall, 60 patients underwent the modified Broström operation for chronic ankle instability (mean follow-up, 30.1 [range, 24–47] months). Presence of ATFL remnant was assessed on ultrasound, magnetic resonance imaging, and arthroscopy in all patients. Foot and ankle outcome score (FAOS) was used to evaluate functional outcomes. Clinical outcomes were compared by the condition of the ligament remnant. Association with other risk factors was evaluated using multiple linear regression analysis.

Results

ATFL was visible in 51/60 cases on ultrasound. Thirty, 22, and eight patients had thin or absent; normal thickness; and thick ATFL on magnetic resonance imaging, respectively. ATFL was visible in 15 patients on arthroscopy and nonvisible or not clear in 45. No significant differences occurred in FAOS with the presence of ATFL remnant on ultrasound, arthroscopy, and the grade of ATFL thickness on magnetic resonance imaging. No correlation was found between FAOS and the thickness of ATFL.

Conclusion

The results suggest that the modified Broström operation for patients with chronic ankle instability was good, regardless of the presence or absence of ATFL remnant.

Level of evidence

III, Retrospective cohort study.
Literature
1.
Ahn HW, Lee KB (2016) Comparison of the modified Brostrom procedure for chronic lateral ankle instability with and without subfibular ossicle. Am J Sports Med 44:3158–3164CrossRefPubMed
2.
Ahn JH, Choy WS, Kim HY (2011) Reconstruction of the lateral ankle ligament with a long extensor tendon graft of the fourth toe. Am J Sports Med 39:637–644CrossRefPubMed
3.
Bell SJ, Mologne TS, Sitler DF, Cox JS (2006) Twenty-six-year results after Brostrom procedure for chronic lateral ankle instability. Am J Sports Med 34:975–978CrossRefPubMed
4.
Brodsky AR, O’Malley MJ, Bohne WH, Deland JA, Kennedy JG (2005) An analysis of outcome measures following the Brostrom-Gould procedure for chronic lateral ankle instability. Foot Ankle Int 26:816–819CrossRefPubMed
5.
Brostrom L (1966) Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand 132:551–565PubMed
6.
Buerer Y, Winkler M, Burn A, Chopra S, Crevoisier X (2013) Evaluation of a modified Brostrom-Gould procedure for treatment of chronic lateral ankle instability: a retrospective study with critical analysis of outcome scoring. Foot Ankle Surg 19:36–41CrossRefPubMed
7.
Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU (2016) Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc 24:1022–1028CrossRefPubMed
8.
Choi WJ, Lee JW, Han SH, Kim BS, Lee SK (2008) Chronic lateral ankle instability: the effect of intra-articular lesions on clinical outcome. Am J Sports Med 36:2167–2172CrossRefPubMed
9.
Chun TH, Park YS, Sung KS (2013) The effect of ossicle resection in the lateral ligament repair for treatment of chronic lateral ankle instability. Foot Ankle Int 34:1128–1133CrossRefPubMed
10.
Clanton TO, Viens NA, Campbell KJ, Laprade RF, Wijdicks CA (2014) Anterior talofibular ligament ruptures, part 2: biomechanical comparison of anterior talofibular ligament reconstruction using semitendinosus allografts with the intact ligament. Am J Sports Med 42:412–416CrossRefPubMed
11.
Corte-Real NM, Moreira RM (2009) Arthroscopic repair of chronic lateral ankle instability. Foot Ankle Int 30:213–217CrossRefPubMed
12.
Cottrell JA, Turner JC, Arinzeh TL, O’Connor JP (2016) The biology of bone and ligament healing. Foot ankle clinics 21:739–761CrossRefPubMed
13.
Coughlin MJ, Saltzman CL, Mann RA (2013) Mann’s surgery of the foot and ankle: expert consult-online and print, 9th edn. Saunders, Philadelphia, pp 1571
14.
Croy T, Saliba SA, Saliba E, Anderson MW, Hertel J (2012) Differences in lateral ankle laxity measured via stress ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals. J Orthop Sports Phys Ther 42:593–600CrossRefPubMed
15.
Dalmau-Pastor M, Yasui Y, Calder JD, Karlsson J, Kerkhoffs GM, Kennedy JG (2016) Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 24:957–962CrossRefPubMed
16.
Dimmick S, Kennedy D, Daunt N (2008) Evaluation of thickness and appearance of anterior talofibular and calcaneofibular ligaments in normal versus abnormal ankles with MRI. J Med Imaging Radiat Oncol 52:559–563CrossRefPubMed
17.
Fong DT, Hong Y, Chan LK, Yung PS, Chan KM (2007) A systematic review on ankle injury and ankle sprain in sports. Sports Med 37:73–94CrossRefPubMed
18.
Gould N, Seligson D, Gassman J (1980) Early and late repair of lateral ligament of the ankle. Foot Ankle 1:84–89CrossRefPubMed
19.
Hauser RA, Dolan EE (2011) Ligament injury and healing: an overview of current clinical concepts. J Prolother 3:836–846
20.
Hertel J (2002) Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. J Athl Train 37:364–375PubMedPubMedCentral
21.
Hu CY, Lee KB, Song EK, Kim MS, Park KS (2013) Comparison of bone tunnel and suture anchor techniques in the modified Brostrom procedure for chronic lateral ankle instability. Am J Sports Med 41:1877–1884CrossRefPubMed
22.
Huang B, Kim YT, Kim JU, Shin JH, Park YW, Kim HN (2016) Modified Brostrom procedure for chronic ankle instability with generalized joint hypermobility. Am J Sports Med 44:1011–1016CrossRefPubMed
23.
Jeong BO, Kim TY, Song WJ (2016) Effect of preoperative stress radiographic findings on radiographic and clinical outcomes of the modified brostrom procedure for chronic ankle instability. J Foot Ankle Surg 55:125–128CrossRefPubMed
24.
Jung HG, Kim NR, Kim TH, Eom JS, Lee DO (2017) Magnetic resonance imaging and stress radiography in chronic lateral ankle instability. Foot Ankle Int 38:621–626CrossRefPubMed
25.
Jung HG, Kim TH, Park JY, Bae EJ (2012) Anatomic reconstruction of the anterior talofibular and calcaneofibular ligaments using a semitendinosus tendon allograft and interference screws. Knee Surg Sports Traumatol Arthrosc 20:1432–1437CrossRefPubMed
26.
Kanamoto T, Shiozaki Y, Tanaka Y, Yonetani Y, Horibe S (2014) The use of MRI in pre-operative evaluation of anterior talofibular ligament in chronic ankle instability. Bone Jt Res 3:241–245CrossRef
27.
Kim BS, Choi WJ, Kim YS, Lee JW (2010) The effect of an ossicle of the lateral malleolus on ligament reconstruction of chronic lateral ankle instability. Foot Ankle Int 31:191–196CrossRefPubMed
28.
Kim HN, Jeon JY, Dong Q, Noh KC, Chung KJ, Kim HK, Hwang JH, Park YW (2015) Lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon. Knee Surg Sports Traumatol Arthrosc 23:1877–1885CrossRefPubMed
29.
Langner I, Frank M, Kuehn JP, Hinz P, Ekkernkamp A, Hosten N, Langner S (2011) Acute inversion injury of the ankle without radiological abnormalities: assessment with high-field MR imaging and correlation of findings with clinical outcome. Skelet Radiol 40:423–430CrossRef
30.
Lee KT, Park YU, Jegal H, Park JW, Choi JP, Kim JS (2014) New method of diagnosis for chronic ankle instability: comparison of manual anterior drawer test, stress radiography and stress ultrasound. Knee Surg Sports Traumatol Arthrosc 22:1701–1707CrossRefPubMed
31.
Lee KT, Park YU, Kim JS, Kim JB, Kim KC, Kang SK (2011) Long-term results after modified Brostrom procedure without calcaneofibular ligament reconstruction. Foot Ankle Int 32:153–157CrossRefPubMed
32.
Matheny LM, Johnson NS, Liechti DJ, Clanton TO (2016) Activity level and function after lateral ankle ligament repair versus reconstruction. Am J Sports Med 44:1301–1308CrossRefPubMed
33.
Park KH, Lee JW, Suh JW, Shin MH, Choi WJ (2016) Generalized ligamentous laxity is an independent predictor of poor outcomes after the modified brostrom procedure for chronic lateral ankle instability. Am J Sports Med 44:2975–2983CrossRefPubMed
34.
35.
Sammarco VJ (2001) Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res:123–132CrossRef
36.
Tohyama H, Yasuda K, Ohkoshi Y, Beynnon BD, Renstrom PA (2003) Anterior drawer test for acute anterior talofibular ligament injuries of the ankle. How much load should be applied during the test? Am J Sports Med 31:226–232CrossRefPubMed
37.
Vuurberg G, Pereira H, Blankevoort L, van Dijk CN (2018) Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc 26:2183–2195CrossRefPubMed
38.
Yasui Y, Murawski CD, Wollstein A, Takao M, Kennedy JG (2016) Operative treatment of lateral ankle instability. JBJS Rev 4:e6CrossRefPubMed
Metadata
Title
Absence of ATFL remnant does not affect the clinical outcomes of the modified broström operation for chronic ankle instability
Authors
Sunghoon Park
Taehun Kim
Myungsub Lee
Younguk Park
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/s00167-019-05464-9

Other articles of this Issue 1/2020

Knee Surgery, Sports Traumatology, Arthroscopy 1/2020 Go to the issue

Editorial

Thank you for 2019

ANKLE

The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments

Ankle

Ankle strength is not strongly associated with postural stability in patients awaiting surgery for chronic lateral ankle instability

ANKLE

A step-by-step arthroscopic examination of the anterior ankle compartment

Ankle

Anatomic lectures on structures at risk prior to cadaveric courses reduce injury to the superficial peroneal nerve, the commonest complication in ankle arthroscopy

ANKLE

Increased ATFL–PTFL angle could be an indirect MRI sign in diagnosis of chronic ATFL injury