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Abstract Background The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients. Methods This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups. Conclusion In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome. Level of Evidence Level III, a retrospective comparative study.

Background: Anatomic repair of anterior talofibular ligament (ATFL) is used to manage chronic lateral ankle instability (CLAI). However, the optimal suture configuration used to repair the ATFL is not yet determined. It remains unclear whether suture configuration affects clinical outcomes in such patients. Purpose: To compare the functional outcomes of all-inside arthroscopic ATFL repair using either a loop suture and or a free-edge suture configuration in CLAI patients. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study included 71 patients with CLAI who had undergone an all-inside arthroscopic ATFL repair procedure with either loop suture (n = 36) or free-edge suture (n = 35) from February 2016 to July 2018. Comparable pre-operatively, the Visual analogy score (VAS), American Orthopedic Foot and Ankle Society scoring system (AOFAS), Karlsson Ankle Functional Score (KAFS) scoring system, Anterior Talar Translation (ATT) and Active Joint Position Sense (AJPS) were used to evaluate postoperative ankle function. Results: There were no postoperative wound complications, implant reactions, or neurological or vascular injuries. Postoperative hospitalization, VAS, AOFAS, KAFS, AJPS and the time of return to sport were similar between the loop suture group and free-edge suture group. Requiring a longer procedure time, patients with loop suture configuration achieved better ATT. Conclusion: All-inside arthroscopic ATFL repair procedure for CLAI treatment provides better ATT and comparable functional outcomes when a loop suture configuration is used instead of a free-edge suture configuration. A statistical difference in ATT was observed. Given the relatively short follow-up, it is questionable whether this will have any clinical relevance. [ABSTRACT FROM AUTHOR]

Background: This study performed a randomized trial data meta-analysis to assess The Modified Brostrom-Gould (MBG) for proven chronic lateral ankle instability (CLAI).Methods: All published randomized clinical trials comparing MBG and other operations were found by searching the Cochrane Library, EMBASE, and PubMed databases. The Review Manager 5.4 software was used to compare the two groups regarding postoperative functional score, ankle stability, and complications. Risk Ratio (RR) and Mean Differences (MD) were used in meta-analyses.Results: 8 experiments are suitable for it, 426 patients were enrolled, and 222 patients underwent other operations surgery. Among the six outcome indicators, in terms of FAOS scores, the other operations group has an advantage, 6.53 points higher than MBG; others show no significant differences.Conclusions: Based on this meta-analysis, the authors believe that other surgical groups can achieve better outcomes than MBG in some aspects of CLAI treatment. [ABSTRACT FROM AUTHOR]

Background: The anterior talofibular ligament (ATFL) comprises the superior and inferior fascicles. The inferior fascicle is connected to the calcaneofibular ligament, and forms "lateral fibulotalocalcaneal ligament (LFTCL) complex". This study aimed to evaluate the feasibility of diagnosing LFTCL complex injuries in patients with chronic lateral ankle instability (CLAI).Methods: Forty-eight ankles (35 with CLAI and 13 without CLAI) underwent arthroscopic surgery, and preoperative magnetic resonance imaging (MRI) was conducted with 0.8 mm- thick axial and oblique slices. The diagnostic accuracy of injuries to the superior fascicle and LFTCL complex was evaluated by two observers.Results: The sensitivity and specificity of the LFTCL complex injury were 94.7% and 92.3% for observer 1 and 84.2% and 84.6% for observer 2, respectively.Conclusions: MRI with 0.8 mm slices could detect LFTCL complex injury in patients with CLAI. Diagnosing the LFTCL complex injury on MRI will improve outcomes of an arthroscopic isolated ATFL repair. [ABSTRACT FROM AUTHOR]

Purpose: To compare the clinical outcomes, rate of return to sports, postural control, and muscle strength between the arthroscopic and open modified Broström procedure for chronic lateral ankle instability (CLAI) patients.Methods: From September 2018 to April 2019, 70 patients diagnosed with CLAI were prospectively included with arthroscopic modified Broström procedure (n = 36) and open modified Broström procedure (n = 34). They were evaluated at five time points (preoperation and 3 months, 6 months, 1 year and 2 years postoperatively). The main results examined the rate of return to sports, American Orthopaedic Foot and Ankle Society Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS), centre of pressure (COP) excursion velocity, time to boundary (TTB), plantar pressure, isokinetic muscle strength and complications.Results: Compared with the open group, the arthroscopic group demonstrated a significantly shorter period of return to the preinjury sport (13.2 ± 2.4 weeks vs. 18.7 ± 3.1 weeks, P = 0.023) and a higher early sport ratio (80.6 vs. 61.8%, P = 0.011) combined with better FAAM sports and AOFAS at 3 months and 6 months postoperatively and VAS at 3 months postoperatively. In addition, better anterior-posterior postural control stability, less time to peak force under lateral hindfoot and better dorsiflexion strength were shown in the arthroscopic group at 6 months postoperatively. No significant difference was found in clinical scores, posture control or muscle strength at the 1- or 2-year follow-up between the two groups.Conclusions: Shorter period and higher rates of return to sport activities and better clinical scores, posture control and muscle strength were achieved in the arthroscopic group at 6 months postoperatively, and no clinical differences were found between arthroscopic and open modified Broström procedure 1 year or 2 years postoperatively. Arthroscopic modified Broström procedure is a reliable procedure for CLAI injuries with the demand for fast exercise recovery.Clinical Registration: ChiCTR1900023999.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

Background: Roughly 30% of patients with chronic lateral ankle instability (CLAI) have long-lasting painful instability requiring surgical intervention. Ligament reconstruction with the traditional open method and using tendon allografts can provide sufficient mechanical stability for severe CLAI. Arthroscopic ligament reconstruction with tendon allograft has recently been introduced to treat CLAI. Purpose: In this study, we describe an arthroscopic ligament reconstruction procedure involving the use of the tendon allograft for patients with CLAI, and we compare the efficacy of this procedure with open ligament reconstruction with tendon allograft. Study Design: Cohort study; Level of evidence, 3. Methods: We enrolled 10 patients (4 men and 6 women) with CLAI (mean age, 37.3 years; range, 16-57 years) who underwent arthroscopic ligament reconstruction with tendon allografting between November 2017 and June 2019. The control group consisted of 10 patients who received open tendon allograft reconstruction. Preoperative and 2-year postoperative functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society ankle-hindfoot scale (AOFAS), Karlsson Ankle Functional Score (KAFS), pain visual analog scale (VAS), 12-Item Short Form Health Survey (SF-12), and Tegner activity score (TAS). Results: The mean operative time was 118 and 110 minutes in the arthroscopic and open groups, respectively. At 2-year follow-up, scores on the AOFAS improved significantly compared with preoperatively, from 71.3 to 96.4 (P =.006) in the arthroscopic group, and from 68.6 to 96.7 (P =.005) in the open group. The postoperative AOFAS, VAS, KAFS, and SF-12 scores did not differ significantly between the 2 groups; however, the TAS score was significantly higher in the arthroscopic reconstruction group compared with in the open group (7 vs 6.1, respectively; P =.01). Conclusion: Arthroscopic ligament reconstruction with tendon allografting resulted in sufficient ankle stability and no donor-site morbidity. This procedure can yield similar functional outcomes to open reconstruction technique and may be an option for the management of CLAI. [ABSTRACT FROM AUTHOR]

Background: Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, studies have described postoperative cast immobilization and the avoidance of weightbearing for a certain period. Accelerated rehabilitation may be helpful for an early return to sport. Purpose: To investigate clinical outcomes of ALLR and accelerated rehabilitation with a minimum duration of postoperative ankle immobilization and proactive early weightbearing. Study Design: Case series; Level of evidence, 4. Methods: This study investigated 23 ankles of 22 patients (11 men, 11 women; mean age, 38.7 years) who underwent ALLR for chronic lateral ankle instability. Postoperative management included the avoidance of weightbearing until postoperative day 3, after which full weightbearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. The following were evaluated: pre- and postoperative instability and pain symptoms, ankle range of motion, anterior drawer distance on stress radiograph, anterior translation measured with a capacitance-type strain sensor, the Ankle-Hindfoot Scale from the Japanese Society for Surgery of the Foot, and the SAFE-Q (Self-Administered Foot Evaluation Questionnaire). Results: Two male patients dropped out and were excluded from analysis. Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in range of motion. There were significant pre- to postoperative improvements in talar tilt angle (from 12.2°-5.6°, P <.01), anterior drawer distance (8.2-4.4 mm, P <.01), and anterior translation (10.5-4.6 mm, P <.01) as well as the Ankle-Hindfoot Scale score (68.8-96.8, P <.01) and all subscales of the SAFE-Q (P ≤.01 for all). Complete return to sport was achieved by 75% of the patients at 8 weeks postoperatively. Conclusion: When accelerated rehabilitation with proactive weightbearing exercises was implemented from postoperative day 3 without ankle immobilization after ALLR, there were significant improvements in objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks. [ABSTRACT FROM AUTHOR]

Ankle sprains are common musculoskeletal injuries which can develop into residual chronic lateral ankle instability. When non-surgical treatments fail, surgical intervention is often indicated. We performed a systematic review of the literature comparing outcome measures of modified Broström repair to suture tape augmentation for lateral ankle stabilization. All studies available in PubMed up to July 2023 were screened. Three randomized controlled trials involving 235 patients met inclusion criteria. All the studies reported on Foot and Ankle Ability Measure, two of the three studies found higher postoperative Sports Activity scores in the suture tape group. Two of the studies reported Foot and Ankle Outcome Score, neither were found to be significantly different. The third study analyzed return to pre-injury level of activity between the two surgical techniques and found a faster return to activity for suture tape compared to modified Broström procedure. Overall, outcome measures show no significant difference between modified Broström and suture tape augmentation., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest, (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Chronic lateral ankle instability (CLAI) is associated with osteoarthritis (OA). However, the characteristics of patients with CLAI who progress to OA are not clear. Measurement of Hounsfield Unit (HU) value on computed tomography (CT) is reported to be useful to evaluate the stress distribution. We aimed to evaluate the stress distribution in the ankle and subtalar joints and factors enhancing it in patients with CLAI. Materials and methods: Thirty-three ankles with CLAI (CLAI group) and 26 ankles without CLAI (control group) were included. A mean age of CLAI was 35.2 years and control was 30.3 years. Color map was created in the ankle and subtalar joint according to the HU values using three-dimensional CT to identify the region with high HU values, and HU values in those regions were measured using two-dimensional CT and compared between control and CLAI groups. In CLAI group, the relationships between HU values and ankle activity score (AAS), OA, talar tilting angle (TTA), cartilage injury were assessed. Results: The HU values in the anteromedial region of the talus and lateral region in the subtalar joint were higher than those in the control. In CLAI, patients with an AAS of ≧ 6, over 10° of TTA, cartilage injury, and OA changes in the medial gutter had significantly higher HU values in the lateral region of the subtalar joint than those with an AAS of ≦5, less than 10° of TTA without cartilage injury and OA change. Conclusions: CLAI patients, especially in the patients with high activity level, large TTA, cartilage injury, and OA changes at the medial gutter, have high HU values in the lateral region of the subtalar joint, which suggests that disruption of the subtalar compensation toward OA will occur. For these patients, instability should be completely eliminated to prevent ankle OA. Level of evidence: Level III, comparative series. [ABSTRACT FROM AUTHOR]

Background: Although varus-tilted distal tibial deformity is an established risk factor for chronic lateral ankle instability (CLAI), no studies have reported whether this deformity influences ankle instability after arthroscopic lateral ankle ligament repair (ALLR) for CLAI. Methods: A total of 57 ankles from 57 patients who underwent ALLR for CLAI were retrospectively analyzed. Tibial articular surface (TAS) angles were measured on preoperative plain radiograph. After 12 months of follow-up, recurrent ankle instability and talar tilt angles on stress radiograph were evaluated as outcomes. Relationships between the TAS angle and these outcomes were assessed. Results: Recurrent ankle instability was observed in 10 ankles. The TAS angles of patients with recurrent instability were significantly lower (85.2 degrees vs 87.9 degrees). The receiver operating characteristic curve analysis revealed that the cutoff value of TAS angle for recurrent instability was 86.2 degrees. Based on this cutoff value, our patients were divided into 2 groups: low-TAS and high-TAS group. Univariate and multivariate analysis revealed that low TAS was an independent risk factor for recurrent ankle instability and greater postoperative talar tilt angles. Conclusion: Varus-tilted distal tibial plafond appears to be a risk factor for recurrent ankle instability after ALLR. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the procedures of reconstruction surgery for chronic lateral ankle instability. We compared single anterior talofibular ligament reconstruction to simultaneous reconstructions of the anterior talofibular and calcaneofibular ligaments. From 2015 to 2019, 14 consecutive patients diagnosed with chronic lateral ankle instability underwent arthroscopic anterior talofibular ligament reconstruction with or without calcaneofibular ligament reconstruction after conservative treatment. Seven patients underwent single anterior talofibular ligament reconstruction (group AT), and 7 patients underwent simultaneous reconstructions of the anterior talofibular ligament and calcaneofibular ligament (group AC). The Japanese Society for Surgery of the Foot scale scores and Karlsson scores significantly improved in all patients 1 year postoperatively. The radiographic measurement of the talar tilt angle and the talar anterior drawer distance at 1 year after surgery were also significantly improved compared to preoperative values. The postoperative talar tilt angle was significantly greater in group AT (median 6°, range 3°-7°) than that in group AC (median 3°, range 2°-5°; p =.038). The postoperative talar anterior drawer distance, Japanese Society for Surgery of the Foot scale score, and Karlsson score were not significantly different between the 2 groups. We found that although the clinical outcomes after the anterior talofibular ligament reconstruction with or without the calcaneofibular ligament reconstruction for chronic lateral ankle instability were good, instability of the talar tilt angle at 1 year postoperatively in patients who underwent single anterior talofibular ligament reconstruction was greater than that in patients who underwent simultaneous anterior talofibular and calcaneofibular ligament reconstructions. [ABSTRACT FROM AUTHOR]

Background: There is minimal literature on the use of suture tape augmentation in the treatment of chronic lateral ankle instability (CLAI), prompting an investigation on its use and effect during surgery of the lateral ankle. Purpose: To evaluate the evidence for the use of suture tape augmentation in the treatment of CLAI and the outcomes after this procedure. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated the use of suture tape for CLAI. Outcome measures included the Foot and Ankle Ability Measure, American Orthopaedic Foot and Ankle Society (AOFAS) score, return to play, and radiological improvement in anterior talar translation and talar tilt angle. Quantitative and qualitative analyses were performed. Results: There were 11 studies (2 with level 2 evidence, 1 with level 3, and 8 with level 4) including 334 patients (334 ankles) that underwent suture-tape augmentation. The mean age was 27.3 years, 67.3% were women, and the mean follow-up was 27.6 months (range, 11.5-38.5 months). The mean weighted postoperative AOFAS score was 95, and 87.7% were able to return to sports. Overall, 9 recurrent instability events (4.1%) were reported. In 3 studies that compared Broström repair and suture tape augmentation, there were no significant differences between the procedures in recurrent instability (mean difference [MD], 0.81 [95% CI, 0.19 to 3.50]; I 2 = 0%; P =.78), Foot and Ankle Ability Measure (MD, 1.24 [95% CI, –3.73 to 6.21]; I 2 = 66%; P =.63), talar tilt angle improvement (MD, –0.07 [95% CI, –0.68 to 0.54]; I 2 = 0%; P =.42), or anterior talar translation improvement (MD, –0.06 [95% CI, –0.69 to 0.56]; I 2 = 0%; P =.77). Conclusion: Suture tape augmentation did not significantly improve clinical or radiological outcomes in the setting of modified Broström repair for CLAI. There is currently insufficient evidence to recommend suture tape augmentation for all patients at this time. [ABSTRACT FROM AUTHOR]

Background: The English version of the Foot Function Index (FFI) is a reliable and valid tool for measuring pain and functional instability due to chronic lateral ankle instability (CLAI). However, its use among Arabic speakers with CLAI is limited because of the unavailability of the Arabic version of the FFI (FFI-Arb). This study aimed to translate, cross-culturally adapt and validate the FFI from the original English version into Arabic. Methods: The FFI questionnaire was translated using the Beaton guidelines. Two-hundred-and-thirty native Arabic-speaking participants with CLAI were recruited from different physiotherapy clinics in Saudi Arabia. The convergent validity of the FFI-Arb was tested using the Spearman correlation with the Arabic version Cumberland ankle instability tool (CAIT-Arab). Test-retest reliability was tested among 92 participants who completed the form again after seven days. Results: Two-hundred-and-thirty participants were enrolled (mean age = 32.09, Standard deviation (SD) = 8.64 years old). There was excellent internal consistency for the three subscales of FFI: pain (0.95), disability (0.97), and activity limitation (0.86), as for the total score (0.98). Convergent validity was analyzed by Spearman rank correlation between the new translated versions of FFI-Arb and CAIT-Arab. The total FFI-Arb and CAIT-Arab scores were moderately correlated (rho = − 0.569; p < 0.001). Subscales of FFI-Arb, such as pain, disability, and activity limitation, were also moderately correlated with CAIT-Arab (rho = − 0.565, rho = − 0.561, rho = − 0.512; p < 0.001). The construct validity was confirmed by principal component analysis (factor analysis) showing a three-factor structure (eigenvalue 1) of FFI-Arb with a total variance of 77.3%. Test-retest reliability was excellent for the total score of the FFI-Arb and all its subscales (interclass correlation coefficient = 0.984–0.999). Conclusions: The FFI-Arb is a reliable and valid tool for Arabic-speaking patients with CLAI. The FFI-Arb can be utilized in hospitals and clinics in Arabic speaking countries. [ABSTRACT FROM AUTHOR]

Background: The arthroscopic modified Broström procedure, with repair of the anterior talofibular ligament and extensor retinaculum, produces good functional outcomes in patients with chronic lateral ankle instability (CLAI). CLAI can be associated with osteochondral lesions of the talus (OLTs). It remains unclear whether associated limited OLTs affect clinical outcomes in such patients. Methods: This retrospective cohort study included 92 CLAI patients with and without OLTs undergoing an all-inside arthroscopic modified Broström procedure from June 2016 to May 2019. The patients were divided into non-lesion group (n = 32) and lesion group (n = 60) according to whether CLAI was associated or not with OLTs. All the osteochondral lesions less than 15 mm in diameter were managed with bone marrow stimulation techniques (arthroscopic microfracture) at the time of the arthroscopic modified Broström procedure. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Function Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results: Increase in all the functional scores (VAS, AOFAS, KAFS, ATT, and AJPS) in both groups was, respectively, recorded 1 year and 2 years after surgery. At the 1-year and 2-year follow-up, there was no significant difference in the VAS, AOFAS, KAFS, ATT, and AJPS scores between the non-lesion and lesion groups. Conclusion: In patients with CLAI who underwent an arthroscopic modified Broström procedure, the presence of limited OLTs (less than 15 mm in diameter), which required arthroscopic microfracture, did not exert any influence on outcome. Level of Evidence: Level III, a retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: There is controversy about whether treatment of chronic lateral ankle instability (CLAI) with osteochondral lesions of the talus (OLT) can be performed concurrently. Purpose: To investigate the midterm results of arthroscopic treatment of CLAI combined with OLT in different surgical settings. It was hypothesized that the outcomes of treating both injuries at the same time would not be inferior to those of staged surgery. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Included were 103 patients with both CLAI and OLT who underwent arthroscopic microfracture surgery and an open, modified Broström-Gould procedure for ligament repair from January 2015 to December 2016. The patients were assigned randomly to a staged group (51 patients) and a single-stage group (52 patients). The staged group underwent arthroscopic debridement of the OLT and microfracture, then rehabilitation for 4 to 6 months before undergoing modified Broström-Gould ligament repair. The single-stage group underwent both procedures simultaneously. Clinical evaluations were performed on the day before surgery and at 12-month, 24-month, and final follow-up periods using the Karlsson-Peterson score, American Orthopaedic Foot & Ankle Society (AOFAS) score, and pain visual analog scale. The Karlsson-Peterson score at 24 months postoperatively was considered the primary outcome. The predefined noninferiority margin for the primary outcome was −5 points. Results: At the final follow-up, 50 patients in the single-stage group and 48 patients in the staged group completed the study. The median lesion size was 0.72 cm2 (interquartile range [IQR], 0.5-1.12 cm2) in the single-stage group and 0.84 cm2 (IQR, 0.7-1.05 cm2) in the staged group. At 12-month follow-up, the single-stage group had a significantly higher median Karlsson-Peterson score (79 [IQR, 70-85] vs 75 [IQR 65-80] for staged; P =.024) and median AOFAS score (85 [IQR, 76-89] vs 79.5 [IQR, 70-87] for staged; P =.045). At 24-month follow-up, the median difference in the Karlsson-Peterson score for single-stage versus staged surgery was 2 points (95% CI, −2 to 5 points), and the confidence interval was greater than the predefined value. Conclusion: At midterm follow-up, there was no clinical difference between single-stage versus staged surgery to treat CLAI with OLT. Single-stage surgery achieved better clinical outcomes than staged surgery at short-term follow-up. [ABSTRACT FROM AUTHOR]

Objective To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium‐ and long‐term follow‐up. Methods From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles, 25 right ankles) aged between 21 and 56 years, with an average age of 32.17 ± 6.35 years, presenting with CLAI, was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07 ± 13.29 months. All patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair of ATFL, with the fixation of one to two anchors. Pre‐ and post‐operative visual analogue scales (VAS), the American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation. Results The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average of 51.25 ± 11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve, blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77 ± 1.36 days. All patients were followed for 24 to 45 months, averaging 33.16 ± 10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow‐up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12 ± 0.13, the AOFAS score increased to 92.53 ± 4.87, and the KAFS score increased to 93.36 ± 6.15. All the follow‐up indexes were significantly different from those before surgery. Conclusion Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable medium‐ and long‐term effect.

Abstract Background The English version of the Foot Function Index (FFI) is a reliable and valid tool for measuring pain and functional instability due to chronic lateral ankle instability (CLAI). However, its use among Arabic speakers with CLAI is limited because of the unavailability of the Arabic version of the FFI (FFI‐Arb). This study aimed to translate, cross‐culturally adapt and validate the FFI from the original English version into Arabic. Methods The FFI questionnaire was translated using the Beaton guidelines. Two‐hundred‐and‐thirty native Arabic‐speaking participants with CLAI were recruited from different physiotherapy clinics in Saudi Arabia. The convergent validity of the FFI‐Arb was tested using the Spearman correlation with the Arabic version Cumberland ankle instability tool (CAIT‐Arab). Test‐retest reliability was tested among 92 participants who completed the form again after seven days. Results Two‐hundred‐and‐thirty participants were enrolled (mean age = 32.09, Standard deviation (SD) = 8.64 years old). There was excellent internal consistency for the three subscales of FFI: pain (0.95), disability (0.97), and activity limitation (0.86), as for the total score (0.98). Convergent validity was analyzed by Spearman rank correlation between the new translated versions of FFI‐Arb and CAIT‐Arab. The total FFI‐Arb and CAIT‐Arab scores were moderately correlated (rho = − 0.569; p

Purpose: Anterior talofibular ligament (ATFL) insufficiency encompasses situations in which (i) frequent sprains cause ATFL loss, as evidenced by ATFL non-visualization on preoperative magnetic resonance imaging; or (ii) minimal healthy ATFL tissue for repair is left after the removal of the large os subfibulare. Suture tape implantation can be indicated for these cases rather than conventional ligament repair. This study was designed to investigate the incidence of post-operative re-sprain in patients who underwent suture tape implantation for ATFL insufficiency, and risk factors influencing the occurrence of post-operative re-sprain were identified., Methods: A total of 68 patients who underwent suture tape implantation for ATFL insufficiency from January 2016 to December 2021 were retrospectively evaluated. The minimum follow-up duration for inclusion was 2 years after surgery. All included patients were divided into two groups according to the presence of post-operative re-sprain during the follow-up period. Multiple clinico-radiographic parameters were measured, and binary logistic regression analysis was performed to determine the factors influencing post-operative re-sprain., Results: Post-operative re-sprain occurred in 19 of the 68 patients (27.9%), and multiple re-sprains persisted in 7 patients (10.3%). Post-operative re-sprain was more likely to occur in patients who smoked after surgery (odds ratio [OR], 3.510), had generalized ligament laxity (OR, 4.364) and engaged in occupations requiring high physical activity levels (OR, 4.421), including soldiers, professional athletes, student-athletes and mailmen., Conclusion: The incidence of multiple post-operative re-sprains was high after suture tape implantation for ATFL insufficiency. Caution is particularly warranted in patients with risk factors, necessitating meticulous attention to their care. Careful consideration of strategies to mitigate risks when performing the surgery is also recommended., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Although the all-inside arthroscopic modified Broström operation (AMBO) and open modified Broström operation (OMBO) for chronic lateral ankle instability (CLAI) showed favorable outcomes up to 1-year short-term follow-up, concerns about the long-term stability of AMBO are still present. Therefore, we aimed to compare midterm outcomes between the 2 methods by extending the observation period., Methods: Fifty-four patients undergoing ankle surgery between August 2013 and July 2017 were included in the AMBO (n = 37) and OMBO (n = 17) groups. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and a visual analog scale (VAS) were used to evaluate the clinical outcomes. Anterior drawer test and talar tilt angle were used to evaluate the radiological outcomes. The mean follow-up duration was 59.69 months., Results: The 2 groups both showed improved clinical and radiological results statistically. In addition, they did not differ in age, sex, or preoperative AOFAS ankle-hindfoot scale score, VAS score, anterior drawer test, or talar tilt angle. No significant difference in the final follow-up postoperative clinical scores or radiological outcomes was observed., Conclusions: AMBO and OMBO as treatments for CLAI did not yield differing clinical or radiological outcomes at a mean follow-up time point of 59.69 months., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2024 by The Korean Orthopaedic Association.)

Background: Stress ultrasonography (US) has been shown to be a valid procedure for evaluating chronic anterior talofibular ligament (ATFL) injury. The ratio of stress/nonstress ATFL length (ATFL ratio) as measured on US is clinically useful; however, there are no published normative data concerning this ratio. Purpose: To report a normative value of the ATFL ratio on US and evaluate the relationships between sex, generalized joint laxity (GJL), and the grade of anterior drawer test (ADT). Study Design: Cross-sectional study; Level of evidence, 3. Methods: The ATFL lengths were prospectively measured in the stress and nonstress positions (manual maximal anterior drawer position) for participants with noninjured ankles from March 2020 to March 2021. GJL was defined as a Beighton score ≥4. A manual ADT was also performed. The ATFL ratio was calculated, and the relationships between sex, GJL, and ADT grade were evaluated. Results: A total of 333 ankles in 184 participants (mean age, 24.5 ± 2.7 years; range, 20-33 years) were eligible for the analysis. GJL was found in 69 ankles (20.7%). The mean ATFL ratio was 1.08 ± 0.04 (95% CI, 1.08-1.09; range, 1.01-1.24), and there was a significant difference between male (1.07 ± 0.04; 95% CI, 1.07-1.08; range, 1.02-1.23) and female (1.09 ± 0.04; 95% CI, 1.08-1.10; range, 1.01-1.24) ankles (P =.001). In male ankles, the ATFL ratio was significantly greater in participants with GJL (1.11 ± 0.06 vs 1.07 ± 0.03; P =.02) or a higher grade of ADT (grade 2 vs grade 1: 1.11 ± 0.06 vs 1.07 ± 0.03, P =.002). These findings were not observed in female ankles. Conclusion: The normative value of the ATFL ratio on stress US was 1.07 ± 0.04 in men and 1.09 ± 0.04 in women. The ATFL ratio was affected by the presence of GJL in men but not in women. These findings will be useful for future studies seeking to establish the cutoff value of the ATFL ratio for diagnosing chronic lateral ankle stability on stress US. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to assess the early clinical and radiographic outcomes for patients who underwent TAA and Anatomic Lateral Ankle Stabilization (ATLAS) using synthetic graft for instability in moderate and severe preoperative varus alignment. Seven ankles with moderate or severe varus alignment underwent TAA with a 3rd generation prothesis (INBONE-2) and ATLAS using synthetic graft between September 2018 and February 2019 at a single institution, and were at least 1 year postoperative (mean 13.3 months, range 12-15). Medical records and charts were reviewed for revisions, reoperations, and complications. Weightbearing radiographs were assessed using tibiotalar alignment parameters preoperatively, and during the latest follow-up. Survivorship for INBONE-2 with ATLAS was 100%; recurrent instability was not observed. Symptomatic talonavicular joint arthritis was recorded for a single patient 12 months postoperatively; no revisions, or reoperations were performed. Coronal alignment improved significantly from 17.7 ± 9.3 (range, 10.1-33.6) to 2.3 ± 1.2 (range, 0.9-4.4) degrees (p <.006), and all ankles achieved neutral alignment in a single stage. Regarding sagittal alignment, 2 ankles (28.5%) were translated anteriorly and the rest were neutral (71.5%) preoperatively. Significant posterior translation was observed and during the latest follow-up, 4 ankles were neutral (57.1%) and 3 posterior (42.9%) (p <.009). Satisfactory outcomes were observed at a minimum of 1-year follow-up for patients with moderate or severe varus alignment who underwent TAA with INBONE-2 and ATLAS. ATLAS may afford advantages over previously described repair techniques. Comparative studies between the Brostrum-Gould and ATLAS are warranted. [ABSTRACT FROM AUTHOR]

Background: This study aimed to examine the psychometric performance of the Foot and Ankle Outcome Score (FAOS) used in Indonesian patients with chronic lateral ankle instability (CLAI). Methods: The FAOS was translated into Indonesian through standardized procedures. Among 224 patients with unilateral CLAI recruited from 14 physical therapy clinics during a 1-year period, reliabilities, construct validities, and responsiveness levels of the FAOS were examined. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure-of-eight, numeric pain rating scale (NPRS), and Short Form (SF)-36 were used to test the construct validities. Results: The five subscales indicated adequate internal consistency (Cronbach's alpha, 0.74 ~ 0.96) and interrater test-retest reliabilities (interclass correlation coefficients, 0.80 ~ 0.94). Subscales of the FAOS moderately converged with those selected measures with similar constructs (r values, 0.32 ~ 0.53), with the exception of the correlation of pain with the NPRS (r , -0.06). Results of the principal component analysis showed that the five-factor structure of the FAOS was appropriate for the Indonesian data, although six items (four in the pain and two in the other symptoms (OSs) subscales) did not perfectly fit their original subscales. Guyatt's responsiveness index for the FAOS's subscales changed in the SF-36's physical function over a 1-month period and ranged 0.37 to 1.27. Conclusions: The Indonesian version of the FAOS demonstrated acceptable reliabilities and responsiveness, and fair construct validities among CLAI patients, although certain items in the pain and OSs subscales may need to be further explored and improved. [ABSTRACT FROM AUTHOR]

Purpose: The Broström-Gould procedure, with the repair of the anterior talofibular ligament (ATFL) combined with the transfer of the extensor retinaculum, is considered the gold standard procedure for the management of chronic lateral ankle instability (CLAI). Lateral ligament reconstruction is considered if the ATFL remnant quality is poor or the ATFL has been damaged beyond the ability to suture it. It remains unclear whether not repairing the ATFL remnant produces comparable functional outcomes to the classical Broström-Gould procedure. Methods: This retrospective cohort study included 84 patients with CLAI undergoing either repair or non-repair of the ATFL remnant using an all-inside arthroscopic Broström-Gould procedure from 2015 to 2018. The Visual Analogue Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) scores, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), Active Joint Position Sense (AJPS), and the rate of return to sports were compared in both groups. Results: All the functional scores (VAS, AOFAS, KAFS, ATT, AJPS) significantly improved in both groups at 1 and 2 years after surgery. At all the follow-up time points, the VAS, AOFAS, KAFS, ATT, AJPS, and the rate of return to sport scores were comparable between the repair and non-repair group. Conclusion: There are no statistically significant differences in postoperative outcomes between ATFL remnant repair and non-repair for the management of CLAI using the all-inside arthroscopic Broström-Gould procedure. From the clinical viewpoint, the present study shows that the potential differences in clinical outcomes between ATFL remnant repair and non-repair are likely not relevant when performing an all-inside arthroscopic Broström-Gould procedure for CLAI. Level of evidence: III. [ABSTRACT FROM AUTHOR]

Chronic lateral ankle instability often causes adults to require a surgical intervention with subsequent physical therapy to assist with returning to their prior level of function. This systematic review is hoping to provide an up to date understanding of surgical procedures performed to correct chronic lateral ankle instability and establish a protocol for others to follow when treating adults who are status-post chronic lateral ankle instability surgery. This review looked at level I to III research studies that included surgical interventions to correct chronic lateral ankle instability as well as a rehabilitation protocol. This study found implementation of a rehabilitation protocol after surgical intervention could improve balance and subjective functional outcomes. It also determined that early weight-bearing may allow for early strengthening as range of motion returns faster. Further research is required utilizing larger randomized studies to better evaluate the outcomes of specific rehabilitation protocols in this patient population. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical and radiological outcome between the modified Broström repair with augmentation using suture tape (MBA) and the modified Broström repair (MB) for patients with chronic lateral ankle instability. Methods A retrospective study was performed in Ningbo No. 6 Hospital. The study included 53 patients who underwent surgical treatment from March 2014 to July 2016 and were followed for 2 years. A total of 25 patients underwent modified Broström repair with augmentation using suture tape, and 28 patients were treated with modified Broström repair. Patients were evaluated using the American Orthopedic Foot and Ankle Scale (AOFAS) hindfoot scale, the Foot and Ankle Ability Measure (FAAM) score, range of motion (ROM), and the visual analogue scale (VAS). The talar tilt angle (TTA) and anterior talar translation (ATT) were used to evaluate the mechanical stability. All radiological outcomes were measured by two orthopaedic surgeons, with the measurements repeated 3 days later. Results The mean age of the patients was 26.6 ± 17.8 years in the MBA group and 28.1 ± 19.4 years in the MB group, and no statistical difference in preoperative data was found between two groups. There were significant differences before and after the operation within the groups. Both groups achieved satisfactory outcomes, and significant improvements (VAS, FAAM, AOFAS, TTA, and ATT) were observed between the 1‐year follow‐up and final follow‐up (P

Background: The modified Broström (MB) procedure has long been the mainstay for the treatment of chronic lateral ankle instability (CLAI). Recently, suture tape (ST) has emerged as augmentation for this repair. The clinical benefit of such augmentation has yet to be fully established. The purpose of this study was to determine if ST augmentation provides an advantage over the traditional MB. Methods: Adult patients were identified for inclusion in the study based on indications for primary lateral ligament reconstruction for CLAI. The primary outcome measure was time to return to preinjury level of activity (RTPAL). Secondary outcome measures included complications, ability to participate in an accelerated rehabilitation protocol (ARP), patient-reported outcomes (PROs), and visual analog pain scale (VAS). A total of 119 patients with CLAI were enrolled and randomized to the MB (59 patients) or ST (60 patients) treatment arm. Results: Average RTPAL was 17.5 weeks after MB and 13.3 weeks after ST (P <.001). At 26 weeks, 12.5% of patients in the MB group and 3.6% of patients in the ST group had not managed RTPAL (P =.14). The complication rate was 8.5% in the MB group vs 1.7% in the ST group (P =.12). Four patients in the MB group failed to complete the ARP vs 1 in the ST group (P =.144). Conclusion: Results from this multicenter, prospective, randomized trial suggest that ST augmentation allows for earlier RTPAL than MB alone. ST augmentation may support successful accelerated rehabilitation and did not result in increased complications or morbidity. Level of Evidence: Level II, prospective comparative study. [ABSTRACT FROM AUTHOR]

Background: Ankle stress radiographs are important tools for evaluating chronic lateral ankle instability. The consistency of a patient's ankle condition as it affects the reliability of ankle stress radiographs has never been evaluated. Purpose: To investigate the consistency and reliability of ankle stress radiographs in patients with chronic lateral ankle instability without an ankle injury during the study period. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Included were patients with chronic lateral ankle instability who underwent 2 repeated ankle stress radiographs between January 2014 and July 2019; those with an ankle injury during the study period were excluded. The tibiotalar tilt angle on varus stress radiographs and anterior translation of the talus on anterior drawer stress radiographs were measured at initial presentation and final follow-up examination. Interobserver reliability and consistency of ankle stress radiographs were analyzed using the intraclass correlation coefficient (ICC). Results: A total of 45 patients (mean ± standard deviation age, 36.4 ± 13.4 years; 18 men and 27 women; follow-up duration, 9.1 ± 3.2 months) were included. The mean ± standard deviation tibiotalar tilt angle and anterior talar translation at initial presentation were 10.8° ± 5.2° and 6.9 ± 2.7 mm, respectively. The interobserver reliabilities of the tibiotalar tilt angle and anterior talar translation were excellent (ICC = 0.926 [95% CI, 0.874-0.959] and 0.911 [95% CI, 0.766-0.961], respectively). The consistency between the initial and final radiographs was good for tibiotalar tilt angle (ICC = 0.763 [95% CI, 0.607-0.862]) and poor for anterior talar translation (ICC = 0.456 [95% CI, 0.187-0.660]). Conclusion: Although the interobserver reliability of the radiographic measurements was excellent, the consistency of the ankle stress radiographs was not as acceptable. Surgeons need to be cautious when deciding whether to operate on a patient with chronic lateral ankle instability based on a single ankle stress radiograph. [ABSTRACT FROM AUTHOR]

Background: To investigate whether generalized ligamentous laxity (GLL) really is a contraindication for use of the modified Broström operation to treat chronic lateral ankle instability (CLAI).Methods: Case series and cohort studies of the clinical outcomes of the use of the modified Broström operation to treat patients with CLAI and GLL were systematically reviewed and a meta-analysis conducted.Results: A total of 447 patients (458 ankles) from 2 case series and 3 cohort studies were systematically analyzed, with mean follow-up times that ranged from 12 to 108 months. Postoperative foot and ankle values analyzed included foot and ankle outcome scores, foot and ankle ability measurements, Karlsson-Peterson ankle scores, American orthopedic foot and ankle society (AOFAS) ankle-hindfoot scores, Tegner activity level scores, anterior talar translations (ATT), talar tilt angles (TTA) and adverse events. Reliable postoperative ankle stability was achieved in CLAI patients with GLL in the 2 case series without major complications. Suture-tape augmentation combined with a modified Broström operation was employed in 1 case series, and the modified Broström operation was only performed in CLAI patients with GLL if the contralateral uninjured ankle showed normal TTA and ATT in another case series. In the 3 cohort studies, 2 reported poorer outcomes and a significantly greater failure rate in patients with GLL compared with those without GLL, and 1 reported equivalent clinical results. In the further pooled data analysis, there was a significant difference in the postoperative TTA value between the GLL and non-GLL groups (SMD: 0.885, 95% CI [0.599-1.171], P = 0.000; I2 = 98%, P = 0.000). The incidence of postoperative recurrent instability was significantly higher in the GLL group (RR: 6.265, 95% CI [2.563-15.309], P = 0.000; I2 = 0%, P = 0.985). Two studies reported the preoperative Beighton score in 7 ankles with postoperative recurrent instability, 6 of which had a preoperative Beighton score ≥7.Conclusions: GLL may not be a contraindication to the modified Broström operation being used to treat CLAI. However, some augmentation operations may be combined with the classic modified Broström operation, especially for those patients with preoperative Beighton scores ≥7, or with abnormal ATT and TTA in the contralateral ankle. This assertion should be further confirmed by a prospective, large-sample cohort and control study focused on this special population who are at a higher risk of developing postoperative instability.Level Of Clinical Evidence: Level 3. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesion of the talus (OLT) is commonly found as a concomitant pathologic lesion in a large proportion of patients with chronic lateral ankle instability (CLAI). This study investigated which characteristics in a patient with CLAI increase the risk for OLT. Methods: Three hundred sixty-four patients who underwent a modified Brostrom operation for their CLAI were reviewed retrospectively. The characteristics of each patient and variables associated with OLTs were investigated. Statistical analyses were performed to determine the effect of each potential predictor on the incidence of OLT, and to evaluate the associations between the patient characteristics and variables associated with OLTs. Results: Patients with OLTs were more frequently female (female vs male: 63.1% vs 43.9%, P = .003). In addition, the lesion sizes were larger in female patients (female vs male: 113.9+24.9 mm² vs 100.7 + 18.0 mm², P = .002), and medial lesions were more common in female patients (female vs male; 93.3% vs 81.8%, P = .036). The lesion sizes were larger in patients with a wider talar tilt angle (P < .001), and patients with a medial OLT showed a wider talar tilt angle (12.0+2.0 degrees vs 10.3 + 2.2 degrees, P = .002). Conclusion: In this CLAI patient cohort, we found female patients to be at greater risk for OLTs than male patients. Furthermore, CLAI female patients with concomitant OLT had on average a larger lesion size, more frequent OLT medial position, and were associated with wider talar tilt angles, suggesting that females had more intrinsic ankle instability than males. [ABSTRACT FROM AUTHOR]

Abstract Background This study aimed to examine the psychometric performance of the Foot and Ankle Outcome Score (FAOS) used in Indonesian patients with chronic lateral ankle instability (CLAI). Methods The FAOS was translated into Indonesian through standardized procedures. Among 224 patients with unilateral CLAI recruited from 14 physical therapy clinics during a 1‐year period, reliabilities, construct validities, and responsiveness levels of the FAOS were examined. Active and passive range of motion of ankle dorsiflexion or plantiflexion, figure‐of‐eight, numeric pain rating scale (NPRS), and Short Form (SF)‐36 were used to test the construct validities. Results The five subscales indicated adequate internal consistency (Cronbach's alpha, 0.74 ~ 0.96) and interrater test‐retest reliabilities (interclass correlation coefficients, 0.80 ~ 0.94). Subscales of the FAOS moderately converged with those selected measures with similar constructs (r values, 0.32 ~ 0.53), with the exception of the correlation of pain with the NPRS (r, ‐0.06). Results of the principal component analysis showed that the five‐factor structure of the FAOS was appropriate for the Indonesian data, although six items (four in the pain and two in the other symptoms (OSs) subscales) did not perfectly fit their original subscales. Guyatt's responsiveness index for the FAOS's subscales changed in the SF‐36's physical function over a 1‐month period and ranged 0.37 to 1.27. Conclusions The Indonesian version of the FAOS demonstrated acceptable reliabilities and responsiveness, and fair construct validities among CLAI patients, although certain items in the pain and OSs subscales may need to be further explored and improved.

Purpose: The purpose of this systematic review and network meta-analysis was to compare the efficacy of different surgical treatments, including open and arthroscopic modified Broström procedures (MB), anatomical reconstructions, and suture tape augmentations (STA), for chronic lateral ankle instability (CLAI)., Methods: We conducted a systematic search for comparative studies that included adult patients with CLAI who underwent open MB, arthroscopic MB, reconstruction with autografts or allografts, and STA. We used a random-effects model to present the NMA results, with mean differences and 95 % confidence intervals (CI) for continuous measures and relative ratios with 95 % CI for dichotomous variables. Surface under the cumulative ranking curve analysis (SUCRA) was used for treatment ranking., Results: The results, based on surface under the cumulative ranking curve analysis, showed that arthroscopic MB likely improves functional outcomes the most as measured by change in American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores. Anatomical graft reconstructions with allografts or autografts demonstrated greater reduction in anterior talar translation (ATT) and talar tilt angle (TTA). Arthroscopic MB and STA were associated with fewer complications., Conclusions: Arthroscopic MB may be associated with better functional outcomes, while anatomical reconstructions appear to provide greater improvements in stability for CLAI. Additionally, arthroscopic techniques seem to have lower complication risks compared to open procedures. These potential differences in outcomes and risks between techniques could help guide surgical decision-making., Competing Interests: Competing interests The authors declare that they have no competing interests., (Copyright © 2024 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Objective: To compare the clinical outcomes of horizontal mattress suture vs free‐edge suture in the all‐inside arthroscopic Broström–Gould procedure. Methods: This retrospective cohort study included 68 chronic lateral ankle instability (CLAI) patients who underwent either a horizontal mattress suture or a free‐edge suture all‐inside arthroscopic Broström–Gould procedure from January 2014 to January 2017. Patients were divided into two groups based on the suture fashion during the all‐inside arthroscopic Broström–Gould procedure. In the horizontal mattress suture group (n = 31), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in horizontal mattress suture fashion. In the free‐edge suture group (n = 37), anchor sutures were used to suture the ATFL, capsule, and inferior extensor retinaculum in free‐edge suture fashion. The Visual Analogue Scale (VAS) score, the American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), the rate of return to sports, and ankle proprioceptive recovery were compared in both groups. Results: The operative times and duration of hospitalization between the two groups were comparable (all P > 0.05). The VAS, AOFAS, ATT, the rate of return to sports, and ankle proprioceptive recovery were comparable between the horizontal mattress suture and free‐edge suture groups at 1 and 2 years after surgery. Patients of the free‐edge suture group achieved better KAFS 1 and 2 years after the surgery compared with those of the horizontal mattress suture group. In both groups, incisions were healed by first intention, and complications such as infection, implant reactions, tendon injury, and nervous or vascular injuries were not observed. The ankle proprioceptive recovery in horizontal mattress suture and free‐edge suture groups showed no significant differences at 1 and 2 years after surgery. The mean time of the return to full activity for patients in the horizontal mattress suture group was 10.38 ± 2.02 (range 8 to 12) weeks vs 8.63 ± 2.31 (range 8 to 12) weeks for those in the free‐edge suture group (P = 0.001, power = 0.907). The exercise participation rates were comparable between groups (P > 0.05). At the 2‐year follow‐up, all patients regained normal activities and ankle stability, and no recurrence of CLAI or revision surgery was recorded. Conclusion: All‐inside arthroscopic Broström–Gould surgery for the treatment of CLAI ensures a better functional effect (KAFS) and better recovery time when free‐edge suture is used instead of horizontal mattress suture. [ABSTRACT FROM AUTHOR]

Background: The anterior talofibular ligament and the calcaneofibular ligament are 2 of the most frequently injured structures in sports, being damaged in 30% to 45% of all sports injuries. Most reconstructive procedures are successful but can deteriorate with time and can lead to low-grade radiographic degeneration. Methods: We operated on 26 consecutive patients from 2001 to 2008 who had failed previous surgical procedures for the lateral ligamentous complex of the ankle, with an average of 104 (range, 75-140) months. Results: The overall functional rating was excellent in 14 ankles, good in 10, fair in 1, and poor in 1. Twenty-four patients (92.3%) were satisfied with the procedure and 15 (57.7%) were able to return to their preinjury level of activity. Local complications were detected in 2 patients who presented with skin necrosis; 1 patient developed severe reflex sympathetic dystrophy. Conclusion: Revision surgery for the management of failure after surgical treatment of chronic lateral ankle instability is under debate, and the literature is devoid of clinical studies with long-term follow-up. The technique described offers a high rate of long-term excellent and good results, with a low rate of complications and a good rate of return to preinjury level. Level of Evidence: Level IV, retrospective case series. [ABSTRACT FROM AUTHOR]

Surgical management for chronic lateral ankle ligament instability is useful when patients have failed nonoperative modalities. Open anatomic reconstruction is an effective method of stabilization. Ankle arthroscopy is a recommended to address intra-articular disorder before stabilization. An anatomic approach provides full range of motion, stability, and return to sport and activity. Allograft or suture tape augmentation can be useful for patients with generalized ligamentous laxity, patients with high body mass index, and elite athletes. Allograft reconstruction may be especially useful in revision procedures. Arthroscopic approach to lateral ankle ligament stabilization may provide good outcomes, with long-term data still limited. [ABSTRACT FROM AUTHOR]

BACKGROUND: At present, DWI, DTI, T1-mapping, T2-mapping, and T2*-mapping are commonly used in cartilage functional imaging sequences in both scientific research and clinic. T2-mapping is often used for the quantitative analysis of cartilage, but it was obviously limited due to the long scanning time and poor experience of the patient. OBJECTIVE: To quantitatively evaluate the talar cartilage injury degree of chronic lateral ankle instability patients by sequence optimized T2-mapping quantitative imaging technique. METHODS: Totally 53 cases of chronic ankle instability (case group) and 46 healthy subjects (control group) were from the Second Affiliated Hospital of Inner Mongolia Medical University. They underwent conventional Magnetic Resonance Imaging and optimal T2-mapping quantitative imaging scanning. The total talar cartilage was divided into six compartments: internal anterior, internal medial, internal posterior, lateral anterior, lateral center and lateral posterior. Six T2 values were totally taken as each partition had one T2 value. The experiment was approved by the Ethics Committee of Inner Mongolia Medical University. RESULTS AND CONCLUSION: The T2 values of internal anterior, internal medial, internal posterior areas of case group were higher than those of control group (P < 0.05). The T2 values of lateral anterior, lateral center and lateral posterior areas had no significant difference between the two groups (P > 0.05). The results showed that the talus cartilage injury mainly occurred in the internal talus in patients with chronic lateral ankle instability. The cartilage damage degree could be quantitatively evaluated by magnetic resonance T2-mapping imaging technique. It is possible that T2-mapping based on sequence optimization can be used in functional image routine scan. [ABSTRACT FROM AUTHOR]

Chronic ankle instability predominantly occurs due to multiple exercise-related diseases. Conservative treatment methods regarding this condition have not effectively improved in recent years, which is why more focus has been put on exploring different novel reconstruction procedures of the lateral ankle ligament for the treatment of chronic ankle instability.Objectives: This study aims to obtain the overall effectiveness of various lateral ankle ligament reconstruction methods for chronic ankle ligament instability.Methods: We gathered data from PubMed and EMBASE databases using the keywords: ankle, malleolar, and reconstruction. Newcastle - Ottawa quality assessment was carried out for the obtained studies; effect volume combination and image drawing were performed by Stata14, and Excel was used for data statistics.Results: A total of 12 articles were included in the quantitative analysis by performing full-text reading and data inclusion. Among them, 476 patients (485 ankle joints) were treated. The results showed that the overall valid efficiency of "excellent" was 59% and "good" lateral ligament reconstruction was 26%, I2=87.3%, P = 0.000; the subgroup analysis anatomic reconstruction group I2=0.0%, P = 0.993; the autograft group I2=0.0%, P = 1.000; allograft group I2=0.0%, P = 0.993.Conclusion: Reconstruction of the lateral ankle ligament is a relatively stable treatment for chronic ankle instability. [ABSTRACT FROM AUTHOR]

Background: Anterior talofibular ligament (ATFL) reconstruction is routinely undertaken to manage chronic lateral ankle instability (CLAI). This study evaluated the effects on clinical outcome of preserving or not preserving the ATFL remnant when reconstructing the ATFL.Methods: From January 2015 to July 2017, 53 CLAI patients with ATFL injury were randomized to undergo either a remnant-preserving (preservation of ATFL) or a non-preserving (no preservation of ATFL) anatomic reconstruction of the ATFL using an ipsilateral free semitendinosus tendon autograft. The Visual Analogue Scale (VAS) score, the American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), Anterior Talar Translation (ATT), and ankle proprioceptive recovery in both groups were compared.Results: All patients were followed up for at least 2 years, VAS, AOFAS, KAFS, ATT and ankle proprioception between two the groups were not statistically significant different.Conclusion: There are no differences at 2.5 years in postoperative ankle function, stability and proprioceptive recovery when an ipsilateral free semitendinosus tendon autograft is used to manage CLAI regardless of preservation of the remnant ATFL. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic lateral ankle ligament repair for chronic lateral ankle instability (CLAI) yields good clinical results. However, the healing process of the ligament after anatomical repair remains unclear. This study evaluated the functional and patient-based outcomes for CLAI patients who underwent arthroscopic lateral ankle ligament repair and the morphological condition of the repaired anterior talofibular ligament (ATFL). Methods: We retrospectively reviewed 47 patients (50 ankles) who underwent arthroscopic lateral ankle ligament repair for CLAI (mean follow-up, 14 months). The Japanese Society for Surgery of the Foot Ankle-Hindfoot (JSSF) scale score and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed preoperatively and 12 months postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 and 12 months postoperatively to evaluate the ATFL. The functional and patient-based outcomes were compared between the group with repaired ATFLs and high signal intensity and the group with repaired ATFLs and low signal intensity. Results: The mean JSSF score improved significantly from 72.3 ± 11.6 preoperation to 95.3 ± 5.4 at 12 months postoperation. The MRI findings at 12 months postoperation showed that each repaired ATFL had a linear band structure from the talar to the fibular attachment site, and 41 of 50 ankles (82%) had low signal intensity of the ligament. On the SAFE-Q, the social functioning scores at 12 months postoperation were significantly higher in the low signal intensity group than in the high signal intensity group. Conclusion: Arthroscopic lateral ankle ligament repair for CLAI yielded good functional and patient-based outcomes and restored the morphological condition of the ATFL. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Aim: The aim of this article is to evaluate the method of anatomical stabilization of a chronically unstable ankle with augmentation with a fibular periosteal graft. Patients and Methods: A total of 7 men and 7 women with chronic ankle instability, with an median age of 37 years (20-61 years), were treated by surgically transposed fibular periosteal graft. The transposed periosteal flap is fixed by anchors or transoseal sutures on the talus and calcaneus, in reconstruction of the anterior talofibular and calcaneofibular ligaments. All patients were analyzed with AOFAS and FADI scores before surgery and at least one year after surgery. Results: Preoperative AOFAS increased from median 47 (17-82) to median 95 (84-100) after stabilization with periosteal fibular lobe (p <0.05). The median preoperative FADI was 89.2 (13.8-95.2), and after surgery, the median FADI was 95 (79.5-98.8) (p <0.05). Fourteen patients returned to their regular life and sports activities. Anatomical ankle stabilization methods give better functional results than non-anatomical methods. The periosteal tissue from the fibula is firm and remodels perfectly, forming a whole ligament after a year. Most studies of different techniques of using fibular periosteal graft, in lateral ankle stabilisation regardless of the type of fixation, give excellent functional results. Conclusion: The lateral ankle stabilization method with periosteal fibular graft is a reliable method of treating chronic lateral ankle instability. [ABSTRACT FROM AUTHOR]

Background: The all-inside arthroscopic Broström-Gould technique gained particular attention among clinicians and researchers due to its high rate of satisfactory results. Thus far, there is a lack of evidence regarding the differences in clinical outcomes between the use of 1 anchor and 2 anchors. The purpose of this study was to compare the differences in clinical function and activity levels in patients treated with 1 or 2 anchors in all-inside arthroscopic Broström-Gould surgery for chronic lateral ankle instability (CLAI). Methods: The data of 75 patients with CLAI (unilateral) admitted from May 2013 to July 2016 were retrospectively analyzed. All patients were treated with all-inside arthroscopic Broström-Gould surgery. The patients were divided into a single-anchor group (n = 36) and double-anchor group (n = 39) according to the number of anchors used. There was no statistical difference in general characteristics between the 2 groups before surgery. After 36 to 72 months of follow-up, the pain visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Foot and Ankle Outcome Score (FAOS) were used to evaluate and compare the clinical function results between the 2 groups. Results: The incidence of wound complications; reaction to the suture; injury to the nerve, blood vessel, or tendon; and length of postoperative hospitalization were similar between the 2 groups. At the last follow-up, there was no significant difference in the VAS and AOFAS scores between single- and double-anchor groups, but the KAFS and FAOS in the double-anchor group were significantly higher than in the single-anchor group. Additionally, more patients in the double-anchor group returned to preinjury sports activities. Conclusion: All-inside arthroscopic Broström-Gould surgery for the treatment of CLAI yielded a better functional effect and better recovery to preinjury mobility when 2 anchors were used instead of a single anchor. Level of Evidence: Level III, comparative study. [ABSTRACT FROM AUTHOR]

This study aimed to examine the factors affecting the clinical outcomes of anterior talofibular ligament (ATFL) repair surgery with arthroscopy for chronic lateral ankle instability (CLAI). From 2015 to 2018, 18 consecutive patients diagnosed with CLAI after conservative treatment for ≥3 months underwent arthroscopic ATFL repair surgery using the Broström-Gould technique. Clinical scores at 1 year postoperatively on the Karlsson scoring scale (median, 85 points) and the Japanese Society for Surgery of the Foot scale (median, 90 points) were significantly improved compared with preoperative scores (median, 50 and 66 points; p <.001 and <.001, respectively). The median period to start jogging was 2 and 6 months for patients without (n = 11) and with (n = 7) cartilage damage, respectively, showing a significant difference (p =.006). Four patients with cartilage damage could not return to preinjury sports within 1 year after surgery. In the stress radiographs, the talar tilt angle (TTA) significantly improved from a median of 6° preoperatively to a median of 3.5° postoperatively (p =.002). Talar anterior drawer distance (TAD) significantly improved from a median of 6.5 mm preoperatively to a median of 4.1 mm postoperatively (p <.001). There was no significant difference in TTA or TAD between patients without and with cartilage damage. The period to start jogging postoperatively was significantly correlated with postoperative TTA and TAD. It is suggested that the postoperative period to start activities was delayed because of the larger postoperative TTA and TAD. According to our results, the postoperative period to start activities may depend on cartilage damage and instability remaining postoperatively. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the functional outcomes of arthroscopic anatomical repair of anterior talofibular ligament (ATFL) in the treatment of chronic lateral ankle instability (CLAI) during medium‐ and long‐term follow‐up. Methods: From September 2014 to August 2017, the data of 37 patients (23 males, 14 females; 12 left ankles, 25 right ankles) aged between 21 and 56 years, with an average age of 32.17 ± 6.35 years, presenting with CLAI, was retrospectively analyzed. Among them, 32 injuries were caused by sprain and five injuries were caused by car accidents. The course of the disease lasted for 12 to 60 months, with an average of 26.07 ± 13.29 months. All patients had intact skin around the ankle and no skin lesions. All patients underwent arthroscopic anatomical repair of ATFL, with the fixation of one to two anchors. Pre‐ and post‐operative visual analogue scales (VAS), the American Orthopaedic Foot and Ankle Society Ankle‐Hindfoot Score (AOFAS), and the Karlsson Ankle Functional Score (KAFS) were compared to evaluate the curative effect of the operation. Results: The operation was successful in all 37 cases. The operation time ranged from 40 to 75 min, with an average of 51.25 ± 11.49 min. After surgery, all incisions healed in stage I and there were no complications such as nerve, blood vessel and tendon injury, implant rejection, or suture rejection. Hospital stays of postoperative patients were 3 to 5 days, with an average of 3.77 ± 1.36 days. All patients were followed for 24 to 45 months, averaging 33.16 ± 10.58 months. For three patients with CLAI combined with mild limitation of subjective ankle movement, joint activity was normal after rehabilitation function exercise and proprioceptive function training for 2 months. At the final follow‐up, ankle pain had disappeared completely. The ankle varus stress test and ankle anterior drawer test were both negative. Range of joint motion was good. There was no lateral instability of the ankle and all patients returned to normal gait. The mean VAS score decreased to 1.12 ± 0.13, the AOFAS score increased to 92.53 ± 4.87, and the KAFS score increased to 93.36 ± 6.15. All the follow‐up indexes were significantly different from those before surgery. Conclusion: Arthroscopic anatomical repair of ATFL for CLAI is precise, with less surgical trauma and reliable medium‐ and long‐term effect. [ABSTRACT FROM AUTHOR]

Background: The os subfibulare is usually asymptomatic and found incidentally on radiographs. However, sometimes it may cause subfibular pain and may be associated with chronic lateral ankle instability (CLAI). We hypothesized that os subfibulare could interrupt the talofibular space causing impingement, resulting in chronic pain and functional instability around the lateral malleolus. The purposes of this study were to analyze morphologic characteristics of os subfibulare, and to evaluate the clinical significance of the os subfibulare in patients with CLAI. Methods: Between November 2011 and April 2015, 70 patients who had both computed tomography (CT) and magnetic resonance imaging (MRI) among 252 patients who visited our hospital with the symptom of lateral ankle instability were included in this study. The location of the ossicle was classified into 3 zones in reference to the attachment site of the lateral ankle ligaments. The impingement was classified into 2 groups according to the presence of talofibular encroachment. Digital radiographs were used to measure the ossicle width and shape determined by the length and width on an magnetic resonance (MR) image. Results: The most common shape of ossicles was oval, and the most common location of ossicles was at the anterior talofibular ligament (ATFL) attachment site. Sixty-one percent of patients showed talofibular impingement on coronal MR images. In 48 cases, the dimension of fibula plus os subfibulare was larger than that of the contralateral normal fibula. The larger size and talofibular impingement of the ossicle were associated with greater need for operative treatment in patients with ankle instability. Conclusion: The morphologic analysis of the os subfibulare revealed that there might be impingement of the talofibular space by the ossicle in some patients. We suggest that morphologic characteristics of the os subfibulare should be considered when selecting treatment options in patients with CLAI and os subfibulare. Level of Evidence: Level III, retrospective comparative series. [ABSTRACT FROM AUTHOR]