Update on the treatment of chronic ankle instability and syndesmotic injuries

Current Opinion in Orthopaedics

Volumn 17, Issue 2, 2006, Pages 97-102

  Jackson, Wes ^a,b   McGarvey, William ^a  

^a UNIVERSITY OF TEXAS   (United States)

^b Orthopaedic Foundation   (United States)

Author keywords

Anatomic reconstruction; Ankle instability (lateral, medial, mechanical, functional); High ankle sprain; Osteochondral lesions; Peroneal reaction time; Syndesmosis

Indexed keywords

ANKLE INJURY; ANKLE INSTABILITY; ANKLE LATERAL LIGAMENT; ARTHROSCOPY; BIOMECHANICS; BRACE; CHRONIC DISEASE; CONSERVATIVE TREATMENT; DISABILITY; ENERGY; FOOT INJURY; FREE TISSUE GRAFT; HUMAN; LIGAMENT SURGERY; ORTHOSIS; PHYSIOTHERAPY; PRIORITY JOURNAL; REVIEW; SURGICAL TECHNIQUE; SYNDESMOTIC INJURY; TENDON GRAFT; THERMAL STIMULATION; TREATMENT OUTCOME;

EID: 33646057036     PISSN: 10419918     EISSN: None     Source Type: Journal    
DOI: 10.1097/01.bco.0000192892.19886.fb     Document Type: Review

References (34)

1. Sammarco VJ. Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res 2001; 397:123-132.
2. Komenda GA, Ferkel RD. Arthroscopic findings associated with the unstable ankle. Foot Ankle Int 1999; 20:708-713.
3. Hinterman B, Boss A, Schafer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 2002; 30:402-409.
4. Coughlin MJ, Schenck RC, Grebing BR, Treme G. Comprehensive reconstruction of the lateral ankle for chronic instability using a free gracilis graft. Foot Ankle Int 2004; 25:231-241. An excellent clinical review of 29 anatomic reconstructions using free tendon graft. The subjective and objective outcome measures suggest a significant reduction in pain and instability. This study demonstrates that an anatomic repair with free tendon augmentation can, in the short term, reliably achieve stability without compromising motion.
5. Clanton TO, Paul P. Syndesmosis injuries in athletes. Foot Ankle Clin North Am 2002; 7:529-549.
6. Mosier-LaClair S, Pike H, Pomeroy G. Syndesmosis injuries: acute, chronic, new techniques for failed management. Foot Ankle Clin North Am 2002; 7:551-556.
7. Hopkinson WJ, St Pierre P, Ryan JB, et al. Syndesmosis sprains of the ankle. Foot Ankle Int 1990; 10:325-330.
8. Baltopoulos P, Tzagarakis GP, Kaseta MA. Midterm results of a modified Evans repair for chronic lateral ankle instability. Clin Orthop Relat Res 2004; 422:180-185. A review of 27 patients after a tenodesis procedure utilizing the peroneus brevis (Modified Evans). The authors' results demonstrate the overall satisfactory results of this procedure for ligament reconstruction despite the associated alterations in hindfoot biomechanics.
9. Mizel MS, Hecht PS, Marymont JV, Temple HT. Evaluation and treatment of chronic ankle pain. J Bone Joint Surg Am 2004; 86:622-632.
10. Santilli V, Frascarelli MA, Paoloni M, et al. Peroneus longus muscle activation pattern during gait cycle in athletes affected by functional ankle instability. A surface electromyographic study. Am J Sports Med 2005; 33:1183-1187. An interesting study into understanding the controversial etiology of functional instability. The results indicate that a proprioceptive deficit in peroneal activity may have a significant contribution.
11. Pijnenburg ACM, Bogaard K, Krips R, et al. Operative and functional treatment of rupture of the lateral ligament of the ankle. J Bone Joint Surg Br 2002; 85:525-530.
12. Hinterman B, Valderrabano V, Boss A, et al. Medial ankle instability. An exploratory, prospective study of fifty-two cases. Am J Sports Med 2004; 32:183-190. The authors arthroscopically evaluated and treated 79 ankles with medial instability. There were a high number of associated findings, suggesting that a combination of injuries might lead to residual disability.
13. DiGiovanni BF, Partal G, Baumhauer JF. Acute ankle injury and chronic lateral instability in the athlete. Clin Sports Med 2004; 23:1-19. An excellent review of the literature of both acute and chronic lateral ankle injuries. It addresses a spectrum of topics from anatomy, biomechanics, and pathology, to diagnosis, non-operative, and operative treatments of these injuries.
14. Schmidt R, Gergroü H, Friemert B, et al. The peroneal reaction time. Reference data in a healthy sample population. Foot Ankle Int 2005; 26:382-386. This study presents normal anthropometric data on PRT in 120 male patients. PRT varied from 40 to 101 ms, with means from 64 to 70 ms. Height, weight, BMI, and number of sports activities did not have a significant influence on PRT.
15. Konradsen L, Ravn JB. Prolonged peroneal reaction time in ankle instability, Int J Sports Med 1991; 12:290-292.
16. Guyton GP. Chronic ankle instability. In: Richardson EG, editor. Orthopaedic knowledge update. Rosemont, IL: AAOS; 2004. pp. 103-111.
17. Schmidt R, Benesch S, Friemert B, et al. Anatomical repair of lateral ligaments in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2005; 13:231-237. A prospective study reinforcing the good results achievable with anatomic reconstruction techniques, as well as the utility of pedography and measures of peroneal reaction time in outcome evaluation.
18. Trepman E, Lutter LD, Richardson EG, et al. Special report. Highlights of the twentieth annual summer meeting of the American orthopaedic foot and ankle society, Seattle, Washington, July 29-31, 2004. Foot Ankle Int 2005; 26:416-425.
19. Fernandes N, Allison GT, Hopper D. Peroneal latency in normal and injured ankles at varying angles of perturbation. Clin Orthop Relat Res 2000; 375:193-200.
20. Osborne MD, Chen LS, Laskowski ER, et al. The effect of ankle disk training on muscle reaction time in subjects with a history of ankle sprain. Am J Sports Med 2001; 29:627-632.
21. Takao M, Oae K, Uchio Y, et al. Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft. Am J Sports Med 2005; 33:814-823. The authors employed the use of standard stress radiographs to determine whether to reconstruct one or both of the lateral ankle ligaments utilizing interference screw fixation and free tendon autograft with overall good clinical results.
22. Krips R, van Dijk CN, Halasi PT, et al. Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint. A multicenter study. Foot Ankle Int 2001; 22:415-421.
23. Schmidt R, Cordier E, Bertsch C, et al. Reconstruction of the lateral ligaments. Do the anatomical procedures restore physiologic ankle kinematics? Foot Ankle Int 2004; 25:31-36. An interesting in-vitro analysis of the biomechanics of lateral ligament reconstruction. The results indicate that although anatomic ligament reconstruction most closely restores the natural biomechanics of the talo-crural and subtalar joints, there remains a subtle yet significant amount of residual instability.
24. Miller RA, DeCoster TA, Mizel MS. What's new in foot and ankle surgery. J Bone Joint Surg Am 2005; 87:909-917.
25. Brodsky AR, O'Malley MJ, Bohne WH, et al. An analysis of outcome measures following the Broström-Gould procedure for chronic lateral ankle instability. Foot Ankle Int 2005; 26:816-819. The authors performed a retrospective review of 73 consecutive patients after a Broström-Gould repair, and evaluated outcomes with AOFAS and SF-36 scores. Functional instability was more frequently reflected by the SF-36 score.
26. Paterson R, Cohen B, Taylor D, et al. Reconstruction of the lateral ligaments of the ankle using semitendinosis graft. Foot Ankle Int 2000; 21:413-419.
27. Okuda R, Kinoshita M, Morikawa J, et al. Arthroscopic findings in chronic lateral ankle instability. Do focal chondral lesions influence the results of ligament reconstruction? Am J Sports Med 2005; 33:35-42. Arthroscopic evidence of focal chondral damage was found in 63% of ankles prior to lateral ligament reconstruction. Subjective and objective evaluations at follow-up demonstrated no correlation between chondral lesions and outcome.
28. Takahashi T, Nakahira M, Kaho K, Kawakami T. Anatomical reconstruction of chronic lateral ligament injury of the ankle using pedicle tendon of the extensor digitorum longus. Arch Orthop Trauma Surg 2003; 123:175-179.
29. Takao M, Uchio Y, Naito K, et al. Arthroscopic assessment for intra-articular disorders in residual ankle disability after sprain. Am J Sports Med 2005; 33:686-692. This paper once again reinforces the utility of arthroscopy in diagnosing and treating residual ankle disability after injury. There were a significant number of associated findings, many of which were diagnosed by arthroscopy alone.
30. Berlet GC, Saar WE, Ryan A, Lee TH. Thermal-assisted capsular modification for functional ankle instability. Foot Ankle Clin North Am 2002; 7:567-576.
31. Maiotti M, Massoni C, Tarantino U. The use of arthroscopic thermal shrinkage to treat chronic lateral ankle instability in young athletes. Arthroscopy 2005; 21:751-757. A case series reporting the preliminary short-term results of arthroscopic thermal capsular shrinkage performed in 22 athletes. The authors suggest that this procedure, used in an appropriate patient, can achieve similar results as traditional open procedures, yet with decreased morbidity and faster recovery time.
32. Thornes B, Walsh A, Hislop M, et al. Suture-endobutton fixation of ankle tibio-fibular diastasis: a cadaver study. Foot Ankle Int 2003; 24:142-146.
33. Marqueen T, Owen J, Nicandri G, et al. Comparison of the syndesmotic staple to the transsyndesmotic screw. A biomechanical study. Foot Ankle Int 2005; 26:224-230. An in-vitro biomechanical study comparing two types of surgical fixation for syndesmotic injuries. The results indicate comparable results from both devices, but with more normal kinematics achieved by the staple construct.
34. Thornes B, Shannon F, Guiney AM, et al. Suture-button syndesmosis fixation. Accelerated rehabilitation and improved outcomes. Clin Orthop Relat Res 2005; 431:207-212. A prospective study on a small number of patients presenting a novel surgical technique for syndesmosis stabilization, which has several theoretical advantages over traditional trans-syndesmotic screw fixation.