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

01-01-2020 | Ankle

Repair of only anterior talofibular ligament resulted in similar outcomes to those of repair of both anterior talofibular and calcaneofibular ligaments

Authors: Kyung Rae Ko, Won-Young Lee, Hyobeom Lee, Hee Seol Park, Ki-Sun Sung

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

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Abstract

Purpose

To compare the surgical outcomes of the two different ankle stabilization techniques.

Methods

This randomized controlled trial aimed to compare the outcomes of the modified Broström procedure with [calcaneofibular ligament (CFL) group] or without CFL repair [anterior talofibular ligament (ATFL) only group]. Of the 50 patients randomly assigned to two groups, 43 were followed up prospectively for ≥ 2 years (CFL group: 22 patients, 36.6 ± 13.1 months; ATFL Only group: 21 patients, 35.3 ± 11.9 months). Functional outcomes were assessed using the Karlsson–Peterson and Tegner activity level scoring systems. Anterior talar translation (ATT), talar tilt angle (TTA), and degrees of displacement of the calcaneus against the talus on stress radiographs were measured. All parameters were compared between the two groups. Multiple regression analysis setting the postoperative Karlsson–Peterson score as the dependent variable was performed to determine the significant variable.

Results

There were no significant differences between the two groups in functional (Karlsson–Peterson and Tegner activity level) scores at the last follow-up and their changes. There were no significant differences between the two groups in the ATT, TTA, their differences compared with the contralateral ankles, and degrees of displacement of the calcaneus against the talus at the last follow-up. Osteochondral lesion of the talus rather than CFL repair was the significant variable related to functional outcome.

Conclusion

The modified Broström procedure with additional CFL repair did not result in a significant advantage in any measured outcome at 3 years.

Level of evidence

Randomized controlled trial, Level I.
Appendix
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Literature
1.
go back to reference Ahn JH, Lee Y-G, Jung S-H, Choy W-S (2007) Treatment of chronic ankle lateral instability using modified Brostrom procedure. J Korean Orthop Assoc 42:91–97CrossRef Ahn JH, Lee Y-G, Jung S-H, Choy W-S (2007) Treatment of chronic ankle lateral instability using modified Brostrom procedure. J Korean Orthop Assoc 42:91–97CrossRef
2.
go back to reference Beighton P, Solomon L, Soskolne CL (1973) Articular mobility in an African population. Ann Rheum Dis 32:413–418CrossRef Beighton P, Solomon L, Soskolne CL (1973) Articular mobility in an African population. Ann Rheum Dis 32:413–418CrossRef
3.
go back to reference 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 34:975–978CrossRef 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 34:975–978CrossRef
4.
go back to reference Breitenseher MJ, Trattnig S, Kukla C, Gaebler C, Kaider A, Baldt MM, Haller J, Imhof H (1997) MRI versus lateral stress radiography in acute lateral ankle ligament injuries. J Comput Assist Tomogr 21:280–285CrossRef Breitenseher MJ, Trattnig S, Kukla C, Gaebler C, Kaider A, Baldt MM, Haller J, Imhof H (1997) MRI versus lateral stress radiography in acute lateral ankle ligament injuries. J Comput Assist Tomogr 21:280–285CrossRef
5.
go back to reference Broström L (1966) Sprained ankles. V. Treatment and prognosis in recent ligament ruptures. Acta Chir Scand 132:537–550PubMed Broström L (1966) Sprained ankles. V. Treatment and prognosis in recent ligament ruptures. Acta Chir Scand 132:537–550PubMed
6.
go back to reference 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 36:2167–2172CrossRef 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 36:2167–2172CrossRef
7.
go back to reference 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 24:957–962CrossRef 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 24:957–962CrossRef
8.
go back to reference De Vries J, Struijs PA, Raaymakers EL, Marti RK (2005) Long-term results of the Weber operation for chronic ankle instability: 37 patients followed for 20–30 years. Acta Orthop 76:891–898CrossRef De Vries J, Struijs PA, Raaymakers EL, Marti RK (2005) Long-term results of the Weber operation for chronic ankle instability: 37 patients followed for 20–30 years. Acta Orthop 76:891–898CrossRef
9.
go back to reference Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C (2014) The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 44:123–140CrossRef Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C (2014) The incidence and prevalence of ankle sprain injury: a systematic review and meta-analysis of prospective epidemiological studies. Sports Med 44:123–140CrossRef
10.
go back to reference Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC (1998) Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 19:653–660CrossRef Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC (1998) Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 19:653–660CrossRef
11.
go back to reference Gould N, Seligson D, Gassman J (1980) Early and late repair of lateral ligament of the ankle. Foot Ankle 1:84–89CrossRef Gould N, Seligson D, Gassman J (1980) Early and late repair of lateral ligament of the ankle. Foot Ankle 1:84–89CrossRef
12.
go back to reference Grace DL (1984) Lateral ankle ligament injuries. Inversion and anterior stress radiography. Clin Orthop Relat Res 183:153–159 Grace DL (1984) Lateral ankle ligament injuries. Inversion and anterior stress radiography. Clin Orthop Relat Res 183:153–159
13.
go back to reference Jung HG, Park JT, Shin MH, Lee SH, Eom JS, Lee DO (2015) Outcome of subtalar instability reconstruction using the semitendinosus allograft tendon and biotenodesis screws. Knee Surg Sports Traumatol Arthrosc 23:2376–2383CrossRef Jung HG, Park JT, Shin MH, Lee SH, Eom JS, Lee DO (2015) Outcome of subtalar instability reconstruction using the semitendinosus allograft tendon and biotenodesis screws. Knee Surg Sports Traumatol Arthrosc 23:2376–2383CrossRef
14.
go back to reference Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Jt Surg Am 70:581–588CrossRef Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Jt Surg Am 70:581–588CrossRef
15.
go back to reference Karlsson J, Eriksson BI, Swärd L (1996) Early functional treatment for acute ligament injuries of the ankle joint. Scand J Med Sci Sports 6:341–345CrossRef Karlsson J, Eriksson BI, Swärd L (1996) Early functional treatment for acute ligament injuries of the ankle joint. Scand J Med Sci Sports 6:341–345CrossRef
16.
go back to reference Karlsson J, Petersen L (1991) Evaluation of ankle function: the use of a scoring scale. Foot 1:15–19CrossRef Karlsson J, Petersen L (1991) Evaluation of ankle function: the use of a scoring scale. Foot 1:15–19CrossRef
17.
go back to reference Kato T (1995) The diagnosis and treatment of instability of the subtalar joint. J Bone Jt Surg Br 77:400–406CrossRef Kato T (1995) The diagnosis and treatment of instability of the subtalar joint. J Bone Jt Surg Br 77:400–406CrossRef
18.
go back to reference Kobayashi T, Yamakawa S, Watanabe K, Kimura K, Suzuki D, Otsubo H, Teramoto A, Fujimiya M, Fujie H, Yamashita T (2016) The in situ force in the calcaneofibular ligament and the contribution of this ligament to ankle joint stability. Clin Biomech (Bristol Avon) 40:8–13CrossRef Kobayashi T, Yamakawa S, Watanabe K, Kimura K, Suzuki D, Otsubo H, Teramoto A, Fujimiya M, Fujie H, Yamashita T (2016) The in situ force in the calcaneofibular ligament and the contribution of this ligament to ankle joint stability. Clin Biomech (Bristol Avon) 40:8–13CrossRef
19.
go back to reference Lee KT, Lee JI, Sung KS, Kim JY, Kim ES, Lee SH, Wang JH (2008) Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 16:781–786CrossRef Lee KT, Lee JI, Sung KS, Kim JY, Kim ES, Lee SH, Wang JH (2008) Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 16:781–786CrossRef
20.
go back to reference 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 32:153–157CrossRef 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 32:153–157CrossRef
21.
go back to reference Maffulli N, Del Buono A, Maffulli GD, Oliva F, Testa V, Capasso G, Denaro V (2013) Isolated anterior talofibular ligament Brostrom repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med 41:858–864CrossRef Maffulli N, Del Buono A, Maffulli GD, Oliva F, Testa V, Capasso G, Denaro V (2013) Isolated anterior talofibular ligament Brostrom repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med 41:858–864CrossRef
22.
go back to reference Michels F, Pereira H, Calder J, Matricali G, Glazebrook M, Guillo S, Karlsson J, Acevedo J, Batista J, Bauer T, Calder J, Carreira D, Choi W, Corte-Real N, Glazebrook M, Ghorbani A, Giza E, Guillo S, Hunt K, Karlsson J, Kong SW, Lee JW, Michels F, Molloy A, Mangone P, Matsui K, Nery C, Ozeki S, Pearce C, Pereira H, Perera A, Pijnenburg B, Raduan F, Stone J, Takao M, Tourne Y, Vega J (2018) Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26:2095–2102CrossRef Michels F, Pereira H, Calder J, Matricali G, Glazebrook M, Guillo S, Karlsson J, Acevedo J, Batista J, Bauer T, Calder J, Carreira D, Choi W, Corte-Real N, Glazebrook M, Ghorbani A, Giza E, Guillo S, Hunt K, Karlsson J, Kong SW, Lee JW, Michels F, Molloy A, Mangone P, Matsui K, Nery C, Ozeki S, Pearce C, Pereira H, Perera A, Pijnenburg B, Raduan F, Stone J, Takao M, Tourne Y, Vega J (2018) Searching for consensus in the approach to patients with chronic lateral ankle instability: ask the expert. Knee Surg Sports Traumatol Arthrosc 26:2095–2102CrossRef
23.
go back to reference Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Brostrom–Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39:2381–2388CrossRef Nery C, Raduan F, Del Buono A, Asaumi ID, Cohen M, Maffulli N (2011) Arthroscopic-assisted Brostrom–Gould for chronic ankle instability: a long-term follow-up. Am J Sports Med 39:2381–2388CrossRef
24.
go back to reference Okuda R, Kinoshita M, Morikawa J, Jotoku T, Abe M (1999) Reconstruction for chronic lateral ankle instability using the palmaris longus tendon: is reconstruction of the calcaneofibular ligament necessary? Foot Ankle Int 20:714–720CrossRef Okuda R, Kinoshita M, Morikawa J, Jotoku T, Abe M (1999) Reconstruction for chronic lateral ankle instability using the palmaris longus tendon: is reconstruction of the calcaneofibular ligament necessary? Foot Ankle Int 20:714–720CrossRef
25.
go back to reference Park HJ, Cha SD, Kim SS, Rho MH, Kwag HJ, Park NH, Lee SY (2012) Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings. Clin Radiol 67:313–318CrossRef Park HJ, Cha SD, Kim SS, Rho MH, Kwag HJ, Park NH, Lee SY (2012) Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings. Clin Radiol 67:313–318CrossRef
26.
go back to reference 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 44:2975–2983CrossRef 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 44:2975–2983CrossRef
27.
go back to reference Pellegrini MJ, Glisson RR, Wurm M, Ousema PH, Romash MM, Nunley JA 2nd, Easley ME (2016) Systematic quantification of stabilizing effects of subtalar joint soft-tissue constraints in a novel cadaveric model. J Bone Jt Surg Am 98:842–848CrossRef Pellegrini MJ, Glisson RR, Wurm M, Ousema PH, Romash MM, Nunley JA 2nd, Easley ME (2016) Systematic quantification of stabilizing effects of subtalar joint soft-tissue constraints in a novel cadaveric model. J Bone Jt Surg Am 98:842–848CrossRef
28.
go back to reference Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Bruggemann GP, Best R (2013) Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg 133:1129–1141CrossRef Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Bruggemann GP, Best R (2013) Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg 133:1129–1141CrossRef
29.
go back to reference Sarrafian SK (1993) Biomechanics of the subtalar joint complex. Clin Orthop Relat Res 290:17–26 Sarrafian SK (1993) Biomechanics of the subtalar joint complex. Clin Orthop Relat Res 290:17–26
30.
go back to reference Schneck CD, Mesgarzadeh M, Bonakdarpour A (1992) MR imaging of the most commonly injured ankle ligaments. Part II. Ligament injuries. Radiology 184:507–512CrossRef Schneck CD, Mesgarzadeh M, Bonakdarpour A (1992) MR imaging of the most commonly injured ankle ligaments. Part II. Ligament injuries. Radiology 184:507–512CrossRef
31.
go back to reference Shon HC, Cho BK, Kim YM, Kim DS, Choi ES, Park KJ, Park JK (2011) A comparison between the modified Brostrom procedure using single and double suture anchor for chronic lateral ankle instability. J Korean Orthop Soc Sports Med 10:69–77 Shon HC, Cho BK, Kim YM, Kim DS, Choi ES, Park KJ, Park JK (2011) A comparison between the modified Brostrom procedure using single and double suture anchor for chronic lateral ankle instability. J Korean Orthop Soc Sports Med 10:69–77
32.
go back to reference Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49 Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49
33.
go back to reference van Dijk CN, Tol JL, Verheyen CC (1997) A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med 25:737–745CrossRef van Dijk CN, Tol JL, Verheyen CC (1997) A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement. Am J Sports Med 25:737–745CrossRef
34.
go back to reference 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 26:2183–2195CrossRef 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 26:2183–2195CrossRef
35.
go back to reference Weindel S, Schmidt R, Rammelt S, Claes L, v Campe A, Rein S (2010) Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg 130:313–319CrossRef Weindel S, Schmidt R, Rammelt S, Claes L, v Campe A, Rein S (2010) Subtalar instability: a biomechanical cadaver study. Arch Orthop Trauma Surg 130:313–319CrossRef
Metadata
Title
Repair of only anterior talofibular ligament resulted in similar outcomes to those of repair of both anterior talofibular and calcaneofibular ligaments
Authors
Kyung Rae Ko
Won-Young Lee
Hyobeom Lee
Hee Seol Park
Ki-Sun Sung
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/s00167-018-5091-3

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