Lateral Ankle Instability Surgical Treatment: A Comparison between Primary Repair and Revision Surgery

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Hudson, BS; S. Lee, BS; Z. Pinter, BS; S. Bergstresser, BS; M. Johnson, MD; A. Shah, MD.

1 Lateral Ankle Instability Surgical Treatment: A Comparison between Primary Repair and Revision Surgery B. Sahranavard, MD; C. de Cesar Netto, MD, PhD; C. Jones, BS; I. Araoye, MS; P. Hudson, BS; S. Lee, BS; Z. Pinter, BS; S. Bergstresser, BS; M. Johnson, MD; A. Shah, MD. Department of Orthopaedic Surgery, University of Alabama at Birmingham AOFAS Annual Meeting, Seattle, 2017

2 Disclosures The author(s) declare no conflicts of interest with respect to the research, authorship, and publication of this project. The author(s) did not receive financial support for this research.

3 Lateral Ankle Instability Estimated incidence of ankle sprains is 2 million per year: 40% of all sports injuries Up to 34% of patients resprain their ankle in 3-year period Persistent instability in up to 33% of patients. Some studies predict as much as 70%. Risk factors include: Males between the age of 15 to 24 Females between the age of 30 to 99 Increased BMI Hindfoot or midfoot malalignment General laxity

4 Treatment of Ankle Instability Most acute sprains initially treated nonoperatively Immobilization, bracing, PT Surgical treatment (Broström-Gould) indicated after failure of non-operative treatment Technically easy while preserving subtalar motion and achieves full range of ankle motion > 85% of patients with good outcomes

5 Study Objectives To compare patient s characteristics and complication rates of primary repair versus revision surgical procedures for lateral ankle instability.

6 Methods In this IRB approved retrospective study, we reviewed the charts of patients who underwent surgical treatment for lateral ankle instability from 2010 to A total of 233 patients were included. 162 female and 71 male, with a mean age of 48.4 (range: 19-65) years. Average follow-up was 48.4 (range: 6-55) weeks.

7 Methods Patients were separate into two groups based on their primary vs. revision surgery status: 200 (85.8%) primary cases 33 (14.2%) revision cases Procedures done by 4 different surgeons were reviewed based on: Age, gender, BMI, procedure type and number of incisions, comorbidities, and complications.

8 Methods Data was compared between primary repair and revision surgery groups using T-test P < 0.05 was considered significant

9 Results The Broström-Gould procedure was used in 69.5% of the primary repairs and 63.6% of the revision surgeries. CFL repair performed in 68% of primary repairs and 81.8% of revision surgeries. No significant differences found between the two groups regarding comorbidities: Smoking (23.4% vs. 27.2%) Diabetes (6.8% vs. 6.0%) BMI (28.5% vs. 24.2%)

10 Results Significantly higher incidence of complications in the revision group (48.4%) when compared to the primary repair group (24.0%) Sural neuritis (15.1% vs. 3.4%) Superficial peroneal neuritis (12.1% vs. 4.5%) Skin problems (9% vs. 7.4%)

11 Conclusion Patients who undergo revision procedures have significantly higher incidence of complications than those who undergo primary repair. No significant difference were found between the two groups in regards to smoking status, diabetes, and BMI.

12 Reference Shakked R, Sheskier S. Acute and Chronic Lateral Ankle Instability Diagnosis, Management, and New Concepts. Bull Hosp Jt Dis (2013). 2017;75(1): Xu HX, Choi MS, Kim MS, Park KS, Lee KB. Gender Differences in Outcome After Modified Broström Procedure for Chronic Lateral Ankle Instability. Foot Ankle Int. 2016;37(1):64-9. Waterman BR, Owens BD, Davey S, et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am Oct 6;92(13): Maffulli N, Ferran NA. Management of acute and chronic ankle instability. J Am Acad Orthop Surg Oct;16(10): Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle. 1980;1(2):84-9. Delahunt E, O'driscoll J, Moran K. Effects of taping and exercise on ankle joint movement in subjects with chronic ankle instability: a preliminary investigation. Arch Phys Med Rehabil. 2009;90(8): Usuelli FG, Mason L, Grassi M, Maccario C, Ballal M, Molloy A. Lateral ankle and hindfoot instability: a new clinical based classification. Foot Ankle Surg. 2014;20(4):231-6.

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