Surgical treatment of chronic ankle instability (CAI) typically includes ligament repair or reconstruction. Using preoperative ultrasonography or magnetic resonance imaging (MRI) to choose an appropriate arthroscopic procedure is still difficult. The aim of this study was to evaluate the correlation of imaging studies with arthroscopic findings and support the arthroscopic surgical decision-making process.
One hundred twelve patients with chronic anterior talofibular ligament (ATFL) injuries were treated using the arthroscopic surgical decision-making process from November 2018 to August 2020. Preoperative imaging assessments using dynamic ultrasonography, MRI, and combined methods were applied to categorize the ATFL remnants into three quality grades (\"good,\" \"fair,\" and \"poor\"). Arthroscopic findings were classified into 6 major types (7 subtypes) and used to select an appropriate surgical procedure. Correlations between imaging studies, arthroscopic findings, and surgical methods were evaluated. Diagnostic parameters, clinical outcomes, and complications were also assessed.
There was a significant interobserver agreement in the evaluation of dynamic ultrasonography (0.954, P < 0.001), MRI (0.958, P < 0.001), and arthroscopy diagnosis (0.978, P < 0.001). There was a significant correlation between the modified imaging classifications, arthroscopic diagnostic types, and surgical procedures. The mean follow-up period was 33.58 ± 8.85 months. Significant improvements were documented in postoperative ankle functions when assessed with Karlson-Peterson scores and Cumberland Ankle Instability Tool scores. The risk of complications is also very low.
The modified classifications and surgical decision-making process based on dynamic ultrasonography, MRI, and arthroscopic findings, as proposed in this study, might help in selecting an appropriate arthroscopic surgical procedure for chronic ATFL injuries.

BACKGROUND: Arthroscopic treatment of lateral ankle instability is a recent innovation. In 2014, a prospective study was initiated by the French Society of Arthroscopy demonstrating the feasibility, morbidity and short-term results of arthroscopic treatment of ankle instability.
OBJECTIVE: The functional results of arthroscopic treatment of chronic ankle instability found after one year were maintained in the medium term.
METHODS: The prospective follow-up of the patients included in the initial cohort was continued. The Karlsson and AOFAS scores, as well as patient satisfaction, were assessed. The causes of failure underwent univariate and multivariate analyzes. The results of 172 patients were included (40.2% ligament repairs; 59.7% ligament reconstructions). The average follow-up was 5years. The average satisfaction was 8.6/10, the average Karlsson score was 85 points and the average AOFAS score was 87.5 points. The reoperation rate was 6.4% of patients. The failures were related to an absence of sports practice, a high BMI and female gender. A high BMI and the intense sports practice were associated to ligament repair failure. The absence of sports practice and the intraoperative presence of the anterior talofibular ligament were associated to ligament reconstruction failure.
CONCLUSIONS: Arthroscopic treatment of ankle instability confers high satisfaction in the medium term, as well as long-lasting results with a low reoperation rate. A more detailed evaluation of the failure criteria could help guide the choice of treatment between ligament reconstruction or repair.
METHODS: II.

UNASSIGNED: Modified Broström-Gould (MBG) surgery is frequently used for chronic lateral ankle instability (CLAI). However, conventional postoperative management (CPOM) due to prolonged immobilization may have adverse effects on tendons, ligaments, and joints, causing stiffness. This prospective, randomized controlled trial aimed to determine outcomes among patients randomized to receive CPOM plus ultrasonography-guided triple injections of leukocyte-rich platelet-rich plasma (LR-PRP) compared to patients who receive only CPOM after MBG surgery.
UNASSIGNED: The present study included 40 patients with symptomatic CLAI who were candidates for the MBG surgery. The patients were randomized into 2 groups of 20, the control and PRP groups. In the PRP group, patients were injected with 3 doses of LR-PRP solution using ultrasonographic guidance. In the first injection, 2 mL of LR-PRP was injected near the injury site, and in the second and third injections, 4 mL of LR-PRP was injected in the tibiotalar joint. All patients received a short leg splint for 2 weeks, followed by 4 weeks in a walking boot. The primary outcome measure was the visual analog scale (VAS), and the secondary outcome measures were the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and ankle total range of motion (total ROM). The assessment was performed at baseline and 3 and 6 months after surgery.
UNASSIGNED: The mean VAS and AOFAS scores improved significantly in both groups 6 months after surgery (P < .001). However, the PRP group did not significantly improve in VAS or AOFAS scores compared with the control group. No clinically significant difference was observed between the 2 groups regarding the total ROM scores at month 3.
UNASSIGNED: The application of LR-PRP after MBG surgery did not show any superior clinical or functional improvement over CPOM.
UNASSIGNED: Level II, prospective randomized trial.

暂无摘要。

UNASSIGNED: Nearly 20% of acute ankle sprains progress to chronic lateral ankle instability that requires surgical intervention. In recent years, there has been a growing interest in arthroscopic Broström techniques as an alternative to open surgery.
UNASSIGNED: To review the most up-to-date evidence comparing the outcomes of open and arthroscopic Broström procedures for chronic lateral ankle instability.
UNASSIGNED: Systematic review; Level of evidence, 3.
UNASSIGNED: This review was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant comparative studies in English up to May 2020 were identified. The primary outcomes were (1) functional scores (Karlsson Ankle Function Score and American Orthopaedic Foot & Ankle Society [AOFAS] score) and (2) the 10-point visual analog scale (VAS) score for pain. The secondary outcomes were differences in (1) postoperative anterior drawer and talar tilt, (2) surgical time and complication rate, and (3) time to return to sports and weightbearing.
UNASSIGNED: A total of 408 patients in 8 studies met the inclusion criteria. Of these, 193 (47.3%) patients underwent open surgery, while 215 (52.7%) patients underwent arthroscopic surgery. There were significant differences between the open and arthroscopic repair groups in mean 6-month AOFAS scores (82.4 vs 92.25, respectively; mean difference [MD], 11.36; 95% CI, 0.14-2.56; I 2 = 90%; P = .03), 1-year AOFAS scores (80.05 vs 88.6; MD, -11.96; 95% CI, -21.26 to -2.76; I 2 = 82%; P = .01), 6-month VAS scores (1.7 vs 1.4; MD, -0.38; 95% CI, -0.54 to -0.21; I 2 = 78%; P < .001), and 1-year VAS scores (2.05 vs 1.45; MD, 0.31; 95% CI, 0.09-0.54; I 2 = 0%; P < .001). The mean time to weightbearing was 14.25 and 9.0 weeks in the open and arthroscopic repair groups, respectively (MD, 1.89; 95% CI, 1.24-2.54; I 2 = 99%; P < .001). There were no statistically significant differences in the remaining outcomes evaluated.
UNASSIGNED: While technically more demanding, arthroscopic Broström was superior to open Broström-Gould surgery in postoperative AOFAS scores, VAS pain scores, and time to return to weightbearing. The operative time, complication rate, talar tilt, and anterior drawer tests were excellent and statistically comparable. Long-term clinical trials are required before recommending arthroscopic Broström as the new gold standard.

The open Broström-Gould procedure for the repair of lateral ankle ligament remains the gold standard in operative management of chronic ankle instability. Nevertheless, the arthroscopic technique has been gaining attention among foot and ankle surgeons in the past decade. Our study aimed to compare the clinical outcomes of patients who underwent the arthroscopic and open Brostom-Gould technique over a 12-month follow-up period.
We retrospectively reviewed the database in a tertiary hospital foot and ankle registry from 2015 to 2019. We then performed a 1:1 matching of 26 ankles that underwent the arthroscopic Broström-Gould technique to 26 ankles with the open technique, all performed by a fellowship-trained foot and ankle surgeon, for age, sex, and body mass index. To assess clinical outcomes, visual analog scale scores, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scores, and Short Form 36 Health Survey scores were collected at the preoperative and 6- and 12-month follow-up visits, respectively.
The arthroscopic group demonstrated significantly less pain in the perioperative period (arthroscopic, 1.0 ± 1.2; open, 2.4 ± 2.2; P = .015) and had higher AOFAS scores at 6 months (arthroscopic, 87.2 ± 11.1; open, 73.5 ± 21.9; P = .028) and 12 months (arthroscopic, 94.2 ± 10.0; open, 70.9 ± 33.1; P = .020). No complications were reported in either group. Twenty patients (76.9%) in the arthroscopic group had preoperative intra-articular abnormalities compared with 24 patients (92.3%) in the open group.
The arthroscopic Broström-Gould technique produced better clinical outcomes than the open technique at 12 months of follow-up.
Level III, retrospective comparative series.

OBJECTIVE: Lateral ligament repair, specifically the modified Broström-Gould (BG) procedure, has been described for patients with chronic ankle instability (CAI) after failure of nonoperative management. However, there is minimal data about native in vivo ankle bone kinematics and how repairs such as the BG procedure affect the kinematics. The objective of this review is to appraise existing literature that used biplane radiography to measure in vivo kinematics of the ankle in healthy, CAI, and BG populations.
RESULTS: Results showed that the tibiotalar joint contributes more to dorsi/plantarflexion, the subtalar joint contributes more to inversion/eversion and internal/external rotation, and that both joints are capable of complex three-dimensional (3D) motion. Preliminary data suggests that demanding activities (as opposed to walking) are necessary to elicit kinematic differences between healthy and CAI populations. Results also indicate that the BG procedure restores static kinematics and range of motion. All but one of the studies identified in this review collected static, quasi-stance, or partial gait capture data. The strength of our current knowledge is low given the small sample sizes, exploratory nature of previous work, and lack of rigorous experimental design in previous studies. Future directions include development of an improved protocol for establishing coordinate systems in the ankle bones, continued development of a database of normal kinematics during a variety of activities, and large-scale, longitudinal studies of CAI and BG patients.

BACKGROUND: The most frequent sequel to the ankle sprain is the instability of the lateral ligament complex; the results of surgical treatment have not been evaluated with multiple scales simultaneously. The objective of the study was to assess the clinical and functional results with three scales in patients with lateral instability of ankle undergoing Broström-Gould technique, using for fixation, anchors with suture to distal fibula.
METHODS: The design of the study was cross-sectional and descriptive; we included patients with lateral instability of ankle and partial or complete rupture of the APA or CP ligament subject to repair with Broström-Gould technique. Magnetic resonance imaging was performed to confirm the diagnosis; clinical and functional outcomes were determined with three scales: EVA, SF-36 and AOFAS. Patients were evaluated at six months, or more, after the surgical procedure.
RESULTS: We included 13 patients; quality of life (SF-36 questionnaire) showed a good result with average score of 90; 10 (77%) patients showed excellent results in function, absence of pain and alignment of the ankle (AOFAS 90-100). Also found significant improvement in pain (presurgical EVA: 6, compared with 1 in the postoperative period).
CONCLUSIONS: The surgical procedure showed excellent results, in the short term with resolution of pain and ankle stability.
BACKGROUND: La secuela más frecuente del esguince de tobillo es la inestabilidad del complejo ligamentario lateral; los resultados del tratamiento quirúrgico no han sido evaluados con varias escalas simultáneamente. El objetivo del estudio fue evaluar los resultados clínicos y funcionales con tres escalas en pacientes con inestabilidad lateral de tobillo sometidos a plastía de Broström-Gould, utilizando para su fijación anclas con sutura al peroné distal.
UNASSIGNED: El diseño del estudio fue transversal y descriptivo; se incluyeron pacientes con inestabilidad lateral de tobillo y ruptura parcial o completa del ligamento PAA y/o PC, sometidos a reparación con plastía de Broström-Gould. Se realizó resonancia magnética nuclear para confirmar el diagnóstico; los resultados clínicos y funcionales se determinaron con tres escalas: EVA, SF-36 y AOFAS. Los pacientes fueron evaluados a los seis meses o más posteriores al procedimiento quirúrgico.
RESULTS: Se incluyeron 13 pacientes; la calidad de vida (cuestionario SF-36) arrojó un resultado bueno con promedio de 90; 10 (77%) pacientes mostraron resultados excelentes en la función, ausencia de dolor y alineación del tobillo (AOFAS 90-100). Asimismo, se observó mejoría importante en el dolor (EVA prequirúrgico: 6, comparado con 1 en el período postquirúrgico).
CONCLUSIONS: El procedimiento quirúrgico demostró excelentes resultados en el corto plazo con resolución del dolor y estabilidad del tobillo.

BACKGROUND: Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the \"Inside-Out\" variant of the fully arthroscopic Broström-Gould technique.
METHODS: Twenty six patients were included: 20 male and 6 female, aged 19-60 years, mean 41 years. All patients had positive \"anterior drawer\" and \"talar tilt\" tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair. Two arthroscopic surgery portals were used; the anteromedial and anterolateral. After careful inspection of the joint, the anterior surface of the fibula was cleaned to resect the remains of the anterior talo-fibular ligament. An anchor with two sutures was placed on the anterior aspect of the fibula, 1cm from the distal apex of the malleolus. The sutures were passed through the remnant of the anterior talo-fibular ligament as well as the extensor retinaculum using special curved needles. Duncan knots were used to tie the ligament and the inferior extensor retinaculum while the ankle was kept in a neutral position. Patients were kept immobilized non-weight bearing for 2 weeks and were then allowed to start weight bearing in a removable protective boot for 4 weeks. The patients were able to return to sporting activities 6 months after surgery.
RESULTS: After a mean follow-up of 27 months (range 21-36 months), patients were functionally evaluated using the American Orthopedics Foot and Ankle Society (AOFAS) ankle score. The mean preoperative value was 58 points, while the mean postoperative value increased to 90 points. One patient had paresthesia in the superficial fibular nerve area, which resolved spontaneously.
CONCLUSIONS: Despite the limited cohort and the relatively short follow-up period, the use of the \"inside-out\" arthroscopic technique may be considered as a valid option for the treatment of chronic ankle instability.

Ankle sprains are the most common athletic injury. One of five chronic lateral ankle instability patients will require surgery, making operative outcomes crucial. The purpose of this study is to determine if operative method influences failure and complication rates in chronic lateral ankle ligament repair surgery.
We retrospectively reviewed 119 cases (118 patients) of lateral ankle ligament surgery between 2006 and 2016. Patient charts and operative reports were examined for demographics, use and timing of ankle arthroscopy, ligament fixation method, type of surgical incision, presence of calcaneofibular ligament repair, and operative technique. Impact of operative methods on failure (one-year minimum follow-up) and complication outcomes was explored using Chi-square test of independence (or Fisher\'s exact test). Statistical significance was set at p less than .05.
Mean age at surgery was 40 (range, 18-73) years. Mean follow-up was 51 (range, 12-260) weeks. Failure rate was 8.4% (10/89 cases) while complication rate was 17.6% (21/119). Failure rate did not differ significantly between any data subgroups (p > .05). Single stage arthroscopy was associated with a significantly lower complication rate (11%, 4/37) than double-stage arthroscopy (47%, 9/19) (p < .01) as was suture anchor ligament fixation (9%, 6/67) compared to direct suture ligament fixation (29%, 15/52) (p < .01).
Failure rate was not impacted by any of the studied variables. Use of suture anchors and concurrent ankle arthroscopy may be favourable options to achieve fewer complications in chronic lateral ankle instability repair surgery.