Comparison of outcomes in patients with generalized ligamentous laxity and without generalized laxity in the arthroscopic Modified Broströ m

Transcription

1 Comparison of outcomes in patients with generalized ligamentous laxity and without generalized laxity in the arthroscopic Modified Broströ m Operation for Chronic Lateral Ankle Instability

2 NO CONFLICT TO DISCLOSE Comparison of outcomes in patients with generalized ligamentous laxity and without generalized laxity in the arthroscopic Modified Broström Operation for Chronic Lateral Ankle Instability Young Koo Lee, MD Jungwoo Yoo, MD Keon Hee Yun, MD Ji Yong Park, MD

3 All-inside Arthroscopic MBO vs Open MBO Stiffness No difference Torque to failure Degree to failure P = P = P = Lee at al, Knee Surg Sports Taumatol Arthrosc (2016) 24:

4 All-inside Arthroscopic MBO vs Open MBO The clinical outcome The radiologic outcome No difference Lee at al, Foot & Ankle Int (10)

5 GLL = Risk Factor Inferior outcomes compared normal laxity after ligament surgery (repair or reconstruction) Karlsson at al, Am J sports Med 1997 The patient with failure after MBO showed GLL. Petrera et al, Am J Sports Med Purpose GLL VS No GLL in Chronic Ankle Instability All-inside Arthroscopic MBO?

6 Jan 2013 ~ Nov 2015, 99 patients (99 ankles) Inclusion criteria Giving way sensation Persistent pain Recurrent instability after conservative Tx. Failing return to normal activity (> 6 months) Exclusion criteria Genetic connective tissue disorders Fracture of the affected ankle Previous ankle surgery Deformity of the foot and ankle

7 Radiologic Evaluations Stress radiographs (150N, using Telometer equipment) Measurement of the Talar tilt angle by two orthopedic surgeons Operative Techniques All procedures were performed by a single surgeon All-Inside arthroscopic MBO

8 Preop Laxity AOFAS No Laxity months 12 months Δ AOFAS Laxity No Laxity Preop Laxity Laxity VAS No Laxity months 12 months Δ VAS No Laxity Baseline to 6 months Baseline to 12 months Baseline to 6 monthsbaseline to 12 months

9 Talar tilt angle ΔTalar tilt angle Talar tilt angle Laxity No Laxity ΔTalar tilt angle Laxity No Laxity Preop months Baseline to 12 months

10 Subtalar motion should be limited if GLL is present. Coville, Instr Course Lect Over-tightening of the IER may cause stiffness in the posterior subtalar joint. Dalmau-Pastor et al, Knee Surg Sports Traumatol Arthrosc 2016 We performed over-tightening and included more extensive arc of the IER for laxity group.

11 The key finding of this study No statistically significant difference Laxity Group vs No Laxity Group The suggestions of this study GLL = No risk factor after the arthroscopic MBO Arthroscopic MBO could be the primary surgery in the patients who have GLL

12 1. Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5): Birrell FN, Adebajo AO, Hazleman BL, Silman AJ. High prevalence of joint laxity in West Africans. Br J Rheumatol. 1994;33(1): Colville MR. Reconstruction of the lateral ankle ligaments. Instr Course Lect. 1995;44: Dalmau-Pastor M, Yasui Y, Calder JD, Karlsson J, Kerkhoffs GM, Kennedy JG. Anatomy of the inferior extensor retinaculum and its role in lateral ankle ligament reconstruction: a pictorial essay. Knee Surg Sports Traumatol Arthrosc. 2016;24(4): Gould N, Seligson D, Gassman J. Early and late repair of lateral ligament of the ankle. Foot Ankle. 1980;1(2): Karlsson J, Eriksson BI, Bergsten T, Rudholm O, Sward L. Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. Am J Sports Med. 1997;25(1): Kim ES, Lee KT, Park JS, Lee YK. Arthroscopic anterior talofibular ligament repair for chronic ankle instability with a suture anchor technique. Orthopedics. 2011;34(4). 8. Lee KT, Kim ES, Kim YH, Ryu JS, Rhyu IJ, Lee YK. All-inside arthroscopic modified Brostrom operation for chronic ankle instability: a biomechanical study. Knee Surg Sports Traumatol Arthrosc. 2016;24(4): Messer TM, Cummins CA, Ahn J, Kelikian AS. Outcome of the modified Brostrom procedure for chronic lateral ankle instability using suture anchors. Foot Ankle Int. 2000;21(12): Pearsall AW, Kovaleski JE, Heitman RJ, Gurchiek LR, Hollis JM. The relationships between instrumented measurements of ankle and knee ligamentous laxity and generalized joint laxity. J Sports Med Phys Fitness. 2006;46(1): Petrera M, Dwyer T, Theodoropoulos JS, Ogilvie-Harris DJ. Short- to Medium-term Outcomes After a Modified Brostrom Repair for Lateral Ankle Instability With Immediate Postoperative Weightbearing. Am J Sports Med. 2014;42(7): Seckin U, Tur BS, Yilmaz O, Yagci I, Bodur H, Arasil T. The prevalence of joint hypermobility among high school students. Rheumatol Int. 2005;25(4): Xu HX, Lee KB. Modified Brostrom Procedure for Chronic Lateral Ankle Instability in Patients With Generalized Joint Laxity. Am J Sports Med. 2016;44(12):