Objective To investigate effectiveness of simplified all-arthroscopic Brostr?m technique in treatment of chronic lateral ankle instability in adolescents. Methods A clinical data of 21 adolescent patients with chronic lateral ankle instability, who met the selection criteria and were admitted between June 2023 and May 2024, was retrospectively analyzed. There were 18 males and 3 females with an average age of 16.0 years (range, 13-18 years). There were 9 cases of left ankle joint injury and 12 cases of right ankle joint injury. Anterior talofibular ligament (ATFL) injury was diagnosed by arthroscopy in all patients. There were 11 cases of cartilage injury, 5 cases of avulsion fractures, and 6 cases of ankle impingement syndrome. The time from first sprain to operation ranged from 3-60 months (mean, 12.0 months). The ATFL was repaired and the ankle joint stability was restored by simplified all-arthroscopic Brostr?m technique. Visual analogue scale (VAS) score, Tegner score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson ankle function scale (KAFS) score, Foot and Ankle Outcome Score (FAOS) were used to evaluate ankle pain and function. MRI was used to evaluate the ligament healing. Results All patients were followed up 8-15 months (mean, 12.6 months). After operation, 1 patient suffered from superficial peroneal nerve injury, 1 patient developed anterior scar impingement on the ankle, 2 patients had superficial wound infection, and 1 patient suffered from sprain again. The VAS score, Tenger score, AOFAS score, KAFS score, and FAOS score significantly improved when compared with the preoperative scores (P<0.05). MRI examination showed the ligament healing and good tension. Conclusion For adolescent patients with chronic lateral ankle instability, using simplified all-arthroscopic Brostr?m technique to repair ATFL can effectively alleviate ankle pain, improve stability, and achieve good effectiveness.
ObjectiveTo assess the effectiveness of lateral ligament reconstruction with autogenous partial peroneus longus tendon for chronic lateral ankle instability.MethodsBetween September 2014 and November 2018, 32 patients (32 sides) with chronic lateral ankle instability were treated with lateral ankle ligament reconstruction by using autogenous anterior half of the peroneus longus tendon. There were 25 males and 7 females, with an average age of 28.5 years (range, 20-51 years). The disease duration was 6-41 months (mean, 8.9 months). The preoperative Karlsson-Peterson ankle score was 53.7±9.7. The talar tilt angle was (14.9±3.7)°, and the anterior talar translation was (8.2±2.8) mm. Six patients combined with osteochondral lesion of talus and 4 patients combined with bony impingement.ResultsAll incisions healed by first intention postoperatively. All patients were followed up 12-53 months (mean, 22.7 months). At last follow-up, the Karlsson-Peterson ankle score was 85.2±9.6; the talar tilt angle was (4.3±1.4)°; the anterior talar translation was (3.5±1.1) mm. There were significant differences in all indexes between pre- and post-operation (P<0.05). Seventeen patients were very satisfied with the results, 10 patients were satisfied, 4 patients were normal, and 1 patient was unsatisfied. After operation, the ankle sprain occurred in 7 cases, the tenderness around the compression screws at calcaneus in 5 cases, the anterolateral pain of ankle joint over 6 months in 4 cases. No patient had discomfort around the reciepient sites. At last follow-up, the ultrasonography examination showed that there was no significant difference in the density and diameter between bilateral peroneus longus tendons in 12 cases.ConclusionFor chronic lateral ankle instability, the lateral ankle ligament reconstruction with the autogenous partial peroneus longus tendon is a safe and effective surgical option.
ObjectiveTo explore the clinical efficacy of fascial manipulation (FM) treatment in patients with chronic ankle instability (CAI).MethodsThe clinical data of CAI patients who received rehabilitation treatment in the Department of Rehabilitation Medicine of the Second Hospital of Jilin University from October 2018 to December 2020 were retrospectively collected. According to different treatment methods, patients were divided into balance training (BT) group and FM group. The BT group received BT for 4 weeks, while the FM group received BT for 4 weeks after FM treatment. Propensity score matching (PSM) was used for 1∶1 matching to compare the effects of different treatment options on the dysfunction of CAI patients. Foot and Ankle Ability Measure (FAAM) [including FAAM-activity of daily living (FAAM-ADL), activity of daily living (ADL) self-scoring, FAAM-sports (FAAM-S), and sports self-scoring], center of pressure (COP), foot lift test (FLT) were used to evaluate the changes in balance function and symptoms pre-treatment and post-treatment.ResultsA total of 52 patients were included, including 24 cases in FM group and 28 cases in BT group. Finally, after PSM method, 34 patients were included, 17 cases in each group. Before intervention, there was no significant difference in FAAM, COP and FLT between the two groups (P>0.05). After the intervention, FAAM-ADL, ADL self score, COP and FLT in the FM group were better than those in the BT group (P<0.05); there was no significant difference between FAAM-S and exercise self score (P>0.05). Before and after the intervention, FAAM, COP and FLT were improved in both groups (P<0.05). The improvement of FAAM ADL, ADL self-score and the decrease of COP in FM group were higher than that of the BT group (P<0.05). Comparison of FAAM-S, exercise self score and FLT before and after intervention, there was no significant difference between the two groups (P>0.05).ConclusionBT can improve the function of patients with CAI, and the combination of FM is more effective in improving the ability of daily living and static balance.
ObjectiveTo compare the effectiveness between modified Brostrom method repair and anatomical reconstruction anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) with single fibular tunnel for chronic lateral ankle instability. MethodsTwenty ankle specimens of fresh cadaver were dissected to provide the anatomic data of ATFL and CFL and to observe the neurovascular distribution. Between January 2008 and December 2011, 48 patients (48 ankles) with chronic lateral ankle instability were randomly divided to groups A and B (n=24). The direct repair of ATFL and CFL by modified Brostrom method was performed in group A, and anatomic doublebundle reconstruction of ATFL and CFL with free semitendinosus tendon autograft in group B. There was no significant difference in sex, age, body mass index, injury side, the causes of injury, interval of injury and operation, talar tilt angle, talus forward shift, ankle plantar flexion, dorsiflexion, valgus, varus, American Orthopaedic Foot and Ankle Society (AOFAS) score, and visual analogue score (VAS) between 2 groups (P>0.05). The image parameters and range of motion were compared between 2 groups after operation; AOFAS and VAS scores were used to evaluate the effectiveness. ResultsAll the incisions healed by first intention in 2 groups; no complication of nerve injury, infection, or skin necrosis was observed. All the patients were followed up 2-5 years (mean, 3.4 years); no subtalar stiffness or recurrent instability occurred during follow-up. The talar tilt angle, talus forward shift, AOFAS score, and VAS score were significantly improved at 2 years after operation when compared with preoperative ones in 2 groups (P<0.05). There was no significant difference in range of motion of ankle plantar flexion, dorsiflexion, and ankle valgus, and VAS score between 2 groups (P>0.05), but group B was significantly better than group A in the range of motion of ankle varus, talar tilt angle, talus forward shift, and AOFAS score (P<0.05). In the each item of AOFAS score, there was no significant difference in pain, abnormal gait, support and autonomic function, ankle flexion and extension, hind foot motion, and alignment between 2 groups (P>0.05), but group B was significantly better than group A in walking, maximum walking distance, and ankle stability (P<0.05). ConclusionThe described technique, which involves anatomic double-bundle reconstruction of the ATFL and CFL with single fibular tunnel and modified incision, is a viable option for treating lateral ankle instability, especially for young patients who need high stability and revision.
Objective To investigate the effectiveness of the suture anchor technique without knots for reconstruction of the anterior talofibular ligament (ATFL) combined with the reinforcement of the inferior extensor retinaculum in treating chronic lateral ankle instability (CLAI). Methods The clinical data of 31 patients with CLAI who were admitted between August 2017 and December 2023 and met the selection criteria were retrospectively analyzed. There were 18 males and 13 females, with an age range from 20 to 48 years (mean, 34.6 years). All patients had a history of repeated ankle sprain, with a disease duration of 6-18 months (mean, 9.65 months). The anterior drawer test and inversion stress test were positive, and tenderness was present in the ligament area. Stress X-ray films of the ankle joint showed a talar tilt angle of (10.00±2.78)° and an anterior talar displacement of (9.48±1.96) mm on the affected side. MRI revealed discontinuity, tortuosity, or disappearance of the ATFL structure. Preoperatively, the visual analogue scale (VAS) score was 5.2±2.1, and the American Orthopaedic Foot and Ankle Society (AOFAS) score was 62.9±7.1. All patients underwent arthroscopic debridement of the ankle joint followed by reconstruction of the ATFL using the suture anchor technique without knots combined with reinforcement of the inferior extensor retinaculum. Postoperatively, pain and function were assessed using the VAS and AOFAS scores. Stress X-ray films were taken to measure the talar tilt angle and anterior talar displacement to evaluate changes in ankle joint stability. Patient satisfaction was assessed according to the Insall criteria. Results All 31 surgeries were successfully completed. One case had wound exudation, while the remaining surgical incisions healed by first intention. Two cases experienced numbness on the lateral aspect of the foot, which disappeared within 1 month after operation. All patients were followed up 15-84 months (mean, 47.2 months). No complication such as anchor loosening, recurrent lateral ankle instability, superficial peroneal nerve injury, rejection reaction, or wound infection occurred postoperatively. The anterior drawer test and inversion stress test were negative at 3 months after operation. Stress X-ray films taken at 3 months after operation showed the talar tilt angle of (2.86±1.72)° and the anterior talar displacement of (2.97±1.32) mm, both of which were significantly different from the preoperative values (t=12.218, P<0.001; t=15.367, P<0.001). At last follow-up, 2 patients had ankle swelling after exercise, which resolved spontaneously with rest; all 31 patients returned to their pre-injury level of sports or had no significant discomfort in daily activities. At last follow-up, 25 patients were pain-free, 4 had mild pain after exercise, and 2 had mild pain after walking more than 2 000 meters. The VAS score was 0.8±0.9 and the AOFAS score was 91.6±4.1, both of which were significantly different from the preoperative scores (t=10.851, P<0.001; t=?19.514, P<0.001). According to the Insall criteria, 24 patients were rated as excellent, 4 as good, and 3 as fair, with a satisfaction rate of 90.3%. Conclusion The suture anchor technique without knots for reconstruction of the ATFL combined with reinforcement of the inferior extensor retinaculum provides satisfactory short- and mid-term effectiveness in treating CLAI.
ObjectiveTo summarize the current status and progress of the treatment of chronic lateral ankle instability (CLAI). MethodsThe literature about the anatomical repair of CLAI at home and abroad was reviewed and summarized. ResultsBrostr?m and its modified operations are the most common surgical treatment of CLAI. The operations showed satisfactory clinical outcomes in the short-, medium-, and long-term follow-up and low complication rate. Suture anchor technique and arthroscopic techniques are gradually used in Brostr?m and its modified operations with satisfactory short-term effectiveness, but long-term effectiveness needs further observation because of the limitation of the short clinical application time. ConclusionBrostr?m and its modified operations are effective, convenient, and safe to treat CLAI. Based on the researches of biomechanics and dynamic anatomy, the more personalized design of the rehabilitation program is the further research direction.
Objective To compare the short-term effectiveness of repairing distal tibiofibular syndesmosis with metal screws and absorbable screws. Methods A retrospective analysis was performed on the clinical data of 63 patients with ankle fracture combined with injury of the distal tibiofibular syndesmosis admitted between January 2017 and January 2020. Among them, 31 patients were treated with absorbable screw fixation of the distal tibiofibular syndesmosis (research group) and 32 patients were treated with metal screw fixation of the distal tibiofibular syndesmosis (control group). There was no significant difference in gender, age, cause of injury, surgical side, time from injury to operation, fracture type, preoperative visual analogue scale (VAS) score, and American Orthopaedic Foot & Ankle Society (AOFAS) score between the two groups (P>0.05). The operation time and fracture healing time were recorded and compared between the two groups. X-ray film was taken to evaluate the effect of ankle joint reduction and fixation. Olerud-Molander ankle fracture efficacy score (short for OM score), AOFAS score, and VAS score were used to evaluate the effectiveness. Results There was no significant difference in operation time between the two groups (t=?0.683, P=0.497). In the control group, 1 case of delayed healing and 1 case of poor healing occurred in the lateral incision after operation, which healed after dressing change; the rest of the patients had primary healing of the incision. Patients in both groups were followed up 12-24 months, with an average of 13.8 months. In the control group, 1 patient with fracture of pronation and external rotation walked with full weight bearing after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks after operation, the anatomical plate of the lateral malleolus was broken, and the lateral malleolus was fixed again and recovered after 5 months; 1 patient had mild ankle pain after operation, and the pain disappeared after removing the metal screw of the distal tibiofibular syndesmosis at 8 weeks. No complication such as nerve and blood vessel injury occurred in all patients. There was no significant difference in fracture healing time between the two groups (t=?1.128, P=0.264). The AOFAS and VAS scores significantly improved in both groups at 12 months after operation (P<0.05). There was no significant difference between the two groups in the OM scores, and the difference of AOFAS and VAS scores between before and after operation (P>0.05). Conclusion Using absorbable screws to repair the distal tibiofibular syndesmosis can effectively restore the ankle acupoint structure, prevent ankle instability, and restore good ankle function. There is no significant difference in effectiveness between absorbable screws and metal screws, and there is no need for secondary operation to remove screws.
Objective To investigate the morphological characteristics of the os subfibulare (OSF) and evaluate its clinical association with chronic ankle instability (CAI). Methods Imaging data of 130 patients with OSF between January 2015 and August 2025 were retrospectively analyzed, including 82 males and 48 females with a mean age of 30.6 years (range, 10-80 years). Patients were divided into CAI group (n=74) and non-CAI group (n=56). X-ray films were used for screening, while CT images were used to measure the parameters related to the shape and spatial location of the OSF, including the maximum diameter, maximum area, distance from the OSF center to the fibular tip, distance from OSF to the talus, and the angle between the OSF and the fibular long axis. OSFs were classified as regular or irregular. MRI categorized OSF location into three zones based on ligament attachment sites: zone Ⅰ [anterior talofibular ligament (ATFL)], zone Ⅱ (calcaneofibular ligament), and zone Ⅲ (posterior talofibular ligament). Bone interface fluid signal, bone marrow edema, and ATFL injury were recorded. The patients with CAI were stratified and analyzed to compare the differences in the location, shape and spatial localization of the OSF (the maximum diameter of OSF, the distance from the OSF center to the fibular tip, the angle between the OSF and the fibular long axis) and MRI signs between different genders and between different affected sides. ResultsCT measurements showed that, compared with the non-CAI group, the CAI group exhibited differences in spatial localization of the OSF. The distance from the OSF center to the fibular tip was significantly greater in the CAI group (P<0.05), whereas the distance from OSF to the talus, and the angle between the OSF and the fibular long axis showed no significant difference (P>0.05). Regarding morphology and size, the maximum diameter of OSF was significantly larger in the CAI group (P<0.05), while no significant difference was found in maximum area of OSF or morphological type (P>0.05). MRI findings showed that OSFs were predominantly located in zone Ⅰ in both groups, followed by zones Ⅱ and Ⅲ. There was no significant difference in distribution between groups (P>0.05). The incidences of bone marrow edema, bone interface fluid signal, and ATFL injury were significantly higher in the CAI group than in the non-CAI group (P<0.05). Within the CAI group, no significant difference was observed between genders or affected sides in terms of OSF location, morphology, spatial parameters, or MRI findings (P>0.05). Conclusion Patients with CAI showed a larger maximum OSF diameter and a greater distance from the OSF center to the fibular tip, and were more frequently accompanied by MRI findings such as bone marrow edema, bone interface fluid signal, and ATFL injury. These imaging characteristics may help evaluate the relationship between OSF and CAI from an imaging perspective.
Objective To evaluate the effectiveness of arthroscopic anterior talofibular ligament (ATFL) repair with retaining of avulsion fragments at the fibular insertion site in treatment of ATFL injury. Methods A retrospective case series was conducted on 135 patients who underwent arthroscopic ATFL repair with retaining of avulsion fragments at the fibular insertion site between September 2019 and December 2024. The analysis included 72 males and 63 females, with a mean age of 29 years (range, 12-61 years). Concomitant pathologies included osteochondral lesions of the talus in 21 cases, calcaneofibular ligament injury in 41 cases, and tarsal sinus syndrome in 43 cases. The mean duration of symptoms was 10 months (range, 8-60 months). The talus tilt test was positive or suspected positive in 41 patients before operation. Pre- and post-operative evaluations of pain relief and functional recovery of ankle joint were performed using pain visual analogue scale (VAS) score, American Orthopedic Foot & Ankle Society (AOFAS) score, and Foot & Ankle Outcome Score (FAOS) (including 5 subscales: symptoms, pain, activities of daily living, sport, and quality of life). Ankle stability was evaluated using anterior drawer test [measuring anterior talar translation (ATT)] and talus tilt test. Additionally, time to return to sports, recurrent ankle sprain, and complications were recorded as well. ResultsThe mean operation time was 40 minutes (range, 30-50 minutes), and the mean intraoperative blood loss was 2 mL (range, 1-3 mL). All patients were followed up 12-75 months (mean, 44 months). All incisions achieved primary healing, and no complication such as infection, neurovascular or tendon injury, or thrombosis was observed. At last follow-up, VAS score significantly decreased when compared with preoperative value, AOFAS score and all FAOS subscale scores significantly increased, ATT measured on anterior drawer test significantly reduced (all graded as 0). All differences were significant (P<0.05). Patients who tested positive or suspected positive in preoperative talus tilt test were all negative at last follow-up. Patients returned to sports at a mean of 9 months (range, 3-18 months) postoperatively. Twelve patients (8.9%) experienced recurrent ankle sprain due to sports-related injury after returning to sports and all recovered with conservative management without revision surgery. Conclusion Arthroscopic ATFL repair with retaining of avulsion fragments at the fibular insertion site can restore ankle stability, significantly relieve pain, restore motor ability, have an enhanced recovery and achieve satisfactory activity recovery.