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Background: Deltoid ligament injuries occur in isolation as well as with ankle fractures and other ligament injuries. Both operative treatment and nonoperative treatment are used, but debate on optimal treatment continues. Likewise, the best method of surgical repair of the deltoid ligament remains unclear. Purpose: To determine the biomechanical role of native anterior and posterior components of the deltoid ligament in ankle stability and to determine the efficacy of simple suture versus augmented repair. Study Design: Controlled laboratory study. Methods: Ten cadaveric ankles (mean age, 51 years; age range, 34-64 years; all male specimens) were mounted on a 6 degrees of freedom robotic arm. Each specimen underwent biomechanical testing in 8 states: (1) intact, (2) anterior deltoid cut, (3) anterior repair, (4) tibiocalcaneal augmentation, (5) deep anterior tibiotalar augmentation, (6) posterior deltoid cut, (7) posterior repair, and (8) complete deltoid cut. Testing consisted of anterior drawer, eversion, and external rotation (ER), each performed at neutral and 25° of plantarflexion. A 1-factor, random-intercepts, linear mixed-effect model was created, and all pairwise comparisons were made between testing states. Results: Cutting the anterior deltoid introduced ER (+2.1°; P =.009) and eversion laxity (+6.2° of eversion; P <.001) at 25 degrees of plantarflexion. Anterior deltoid repair restored native ER but not eversion. Tibiocalcaneal augmentation reduced eversion laxity, but tibiotalar augmentation provided no additional benefit. The posterior deltoid tear showed no increase in laxity. Complete tear introduced significant anterior translation, ER, and eversion laxity (+7.6 mm of anterior translation, +13.8° ER and +33.6° of eversion; P <.001). Conclusion: A complete deltoid tear caused severe instability of the ankle joint. Augmented anterior repair was sufficient to stabilize the complete tear, and no additional benefit was provided by posterior repair. For isolated anterior tear, repair with tibiocalcaneal augmentation was the optimal treatment. Clinical Relevance: Deltoid repair with augmentation may reduce or avoid the need for prolonged postoperative immobilization and encourage accelerated rehabilitation, preventing stiffness and promoting earlier return to preinjury activity. [ABSTRACT FROM AUTHOR]

Background: Optimum treatment for acute Achilles tendon rupture results in high mechanical strength, low risk of complications, and return to preinjury activity level. Percutaneous knotless repair is a minimally invasive technique with promising results in biomechanical studies, but few comparison clinical studies exist. Our study purpose was to compare functional outcomes and revision rates following acute Achilles tendon rupture treated between percutaneous knotless repair and open repair techniques. Methods: Patients 18 years or older with an acute Achilles tendon rupture, treated by a single surgeon with either open repair or percutaneous knotless repair, and more than 2 years after surgery were assessed for eligibility. Prospective clinical data were obtained from the data registry and standard electronic medical record. Additionally, the patients were contacted to obtain current follow-up questionnaires. Primary outcome measure was Foot and Ankle Ability Measure (FAAM) activities of daily living (ADL). Secondary outcome measures were FAAM sports, 12-Item Short Form Health Survey (SF-12), Tegner activity scale, patient satisfaction with outcome, complications, and revisions. Postoperative follow-up closest to 5 years was used in this study. Results: In total, 61 patients were included in the study. Twenty-four of 29 patients (83%) in the open repair group and 28 of 32 patients (88%) in the percutaneous knotless repair group completed the questionnaires with average follow-up of 5.8 years and 4.2 years, respectively. We found no significant differences in patient-reported outcomes or patient satisfaction between groups (FAAM ADL: 99 vs 99 points, P =.99). Operative time was slightly longer in the percutaneous knotless repair group (46 vs 52 minutes, P =.02). Two patients in the open group required revision surgery compared to no patients in the percutaneous group. Conclusion: In our study, we did not find significant differences in patient-reported outcomes or patient satisfaction by treating Achilles tendon midsubstance ruptures with percutaneous knotless vs open repair. Level of Evidence: Level IlI, retrospective cohort study. Visual Abstract This is a visual representation of the abstract. [ABSTRACT FROM AUTHOR]

Category: Ankle; Sports Introduction/Purpose: While objective outcome measures assessing foot and ankle function are well established to determine return to sport (RTS) following ankle injuries, psychological factors have been recognized in recent years to be equally important. The Return to Sport after Injury (RSI) scale has become an emergingly useful tool used in assessing psychological readiness to return to sporting activity after various pathologies and their treatment. The Ankle Ligament Reconstruction-Return to Sport after Injury (ALR-RSI) scale is a novel questionnaire and scoring system for the evaluation of psychological readiness to return to sport following lateral ankle ligament reconstruction or repair. Purpose: To systematically review existing literature regarding the ALR-RSI scale and to assess its correlation with RTS and functional outcomes as well as feasibility, reliability, and consistency. Methods: A systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) was conducting using PubMed, Embase and Cochrane Library. Studies that evaluated psychological readiness after ankle ligament reconstruction or repair for the treatment of chronic lateral ankle instability using the ALR-RSI scale were included. The results from each study were pooled, and weighted means and overall rates were calculated. Results: In total, 157 patients (53.2% male, mean age: 34.2 years) from 3 articles were included. Overall, 85.0% of patients reported successful RTS, but only 48.9% of patients returned to the preoperative sporting level. All studies reported a significant difference in psychological scores between patients who returned to sport and those who didn't. The pooled mean functional outcome measures, reported as the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) Score and Karlsson-Peterson Score, were 82.7 (range, 29-100) and 81.7 (range, 25-100), respectively. The ALR-RSI scale demonstrated strong correlations with the AOFAS Score and Karlsson-Peterson Score. Conclusion: Patients who RTS after ankle ligament reconstruction or repair exhibited higher psychological readiness compared to those who didn't return to sport. The ALR-RSI scale showed strong correlations with ankle function. Evaluation of psychological readiness using the ALR-RSI scale may provide an additional tool in the rehabilitation process of athletes that aim to assess RTS after ankle ligament reconstruction or repair. [ABSTRACT FROM AUTHOR]

The article presents a study on the radiographic identification of the primary lateral ankle structures. Topics covered include the anatomic attachment sites of the posterior talofibular ligament (PTFL), calcaneofibular ligament (CFL) and anterior talofibular ligament (ATFL) on standard radiographic views. Also mentioned are radiographic landmarks, lateral ankle instability, and lateral ankle ligament reconstruction.