Peroneus brevis tendon injury in chronic ankle instability.

Objective: To compare the surgical outcome of patients with chronic lateral ligament injury of the ankle, with and without an associated peroneus brevis tendon injury. Methods: This retrospective comparative study was based on epidemiological analysis and the American Orthopedic Foot and Ankle Society (AOFAS) scores of patients diagnosed with chronic ankle instability who were treated surgically with the Broström-Gould technique. The medical records of 50 patients treated in an orthopedics service between January 2012 and January 2020 were analyzed. The patients were divided into two groups: those with and without a peroneus brevis tendon injury. The following data were also collected: sex, age, comorbidities, and AOFAS score in the pre- and postoperative period (between 90-120 days), as well as other epidemiological data. Results: Sixteen patients (32%), whose mean age was 43 years and 76% of whom were female, presented with a peroneus brevis tendon injury. The right side (54%) was more commonly affected. The main comorbidities were obesity (14%), slight pes cavus (12%), diabetes mellitus (4%) and depression (4%). The mean improvement in AOFAS score was 41 points. There was a marginal difference in final AOFAS score (p=0.03) between the groups. Conclusion: The Broström-Gould Technique proved effective for treating chronic lateral ligament injury regardless of an associated peroneus brevis tendon injury. However, the final postoperative results were significantly worse in patients with a peroneus brevis tendon injury than in those without one. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

Location and Morphology of Acute Lateral Ligament Injury of the Ankle

Category: Ankle, Sports, Trauma Introduction/Purpose: Acute ankle ligament injuries are usually treated non-operatively, even if the injury is severe. However, when chronic ankle instability is symptomatic, operative treatment is required. When planning local repair, the condition of the remaining ligament is important. We surgically treated acute severe lateral ligament injuries in 103 ankles and investigated the locations of the injuries in the anterior talofibular (ATF) and calcaneofibular (CF) ligaments, subdividing each into three parts. This paper should facilitate more precise planning of the surgical reconstruction procedure. Methods: From 2006 to 2014, 1,042 patients visited our outpatient clinic with a diagnosis of acute lateral ligament injury of the ankle. In total, 103 feet underwent surgical treatment and the locations of the ATF and CF ligament ruptures were investigated. The rupture location in the ATF ligament was subclassified as fibular side, body, or talar side, while for the CF ligament it was classified as fibular side, body, or calcaneal side. Results: The ATF ligament was ruptured on the fibular side in 38 feet (36.9%), body in 30 feet (29.1%), and talar side in 35 feet (34.0%). The CF ligament was ruptured on the fibular side in 15 feet (14.6%), body in 26 feet (25.2%), and calcaneal side in 62 feet (60.2%). Conclusion: Almost all surgical reports on lateral ligament reconstruction procedures (Brostrom et al.) describe ATF ligament repair and advancement on the fibular side, although only one-third of the ligaments were injured on the fibular side in our series. About two-thirds of the CF ligaments had damage to the calcaneal side structure of the entheses. When CF ligament repair is needed, surgeons should be aware of our finding that this ligament was ruptured at the fibular attachment in only 15% of cases, and on the calcaneal side in 60%. This knowledge should lead to better results of surgical reconstruction.

The Broken “Ring of Fire”: A New Radiological Sign as Predictor of Syndesmosis Injury?

Background: Subcircumferential periosteal edema above the ankle joint is frequently present on magnetic resonance imaging (MRI) with syndesmosis injuries but has not been previously reported. Fluid height within the interosseous membrane also has not previously been shown to be associated with syndesmosis injury severity. Purpose: To investigate whether a new sign on MRI and measurement of the length of fluid within the interosseous membrane above the ankle may be used to enable identification of a syndesmosis injury and allow differentiation from lateral ligament injury. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Three groups of patients (those with an isolated syndesmosis injury [SI group], isolated lateral ligament injury [LLI group], and no injury [NI group]) who had an ankle MRI for another reason were identified from a patient notes database and the MRI scans retrieved. The scans were anonymized and independently assessed by 8 clinicians (surgeons and radiologists) who were blinded to the diagnosis. The maximum length of fluid above the ankle within the intraosseous membrane was measured for each patient. The presence or absence of distal anterior, lateral, and posterior tibial periosteal edema was recorded (broken “ring of fire”). Results: Measurement of the length of fluid above the ankle had excellent intraobserver reliability (intraclass correlation coefficient, 0.97; 95% CI, 0.93-0.99) but poor interobserver reliability. Fluid extended higher in both the LLI group ( P = .0043) and SI group ( P = .0058) than the NI group, but there was no significant difference between the LLI and SI groups ( P = .3735), indicating that this measurement cannot differentiate between the injuries. The presence of the broken “ring of fire” around the distal tibia was significantly more frequent in the SI group when compared with both LLI and NI groups ( P < .00001). The sensitivity of this sign is 49%, but when present, this sign has a 98% specificity for syndesmosis injury. Conclusion: The presence of tibial subcircumferential periosteal edema 4 to 6 cm above the ankle joint (the “ring of fire”) is highly suggestive of a syndesmosis injury. This new radiological sign can assist with early identification of such injuries. The measurement of height of fluid above the ankle within the interosseous membrane is variable and cannot differentiate severe ankle sprains from high ankle sprains involving the syndesmosis.

Effectiveness of Neuromuscular Training Program In Young Athletes Suffering From Lower Lateral Ankle Ligament Injury

The perception and execution of musculoskeletal control and movement are mediated primarily by the central nervous system and involve the integration of 3 main subsystems: somatosensory, vestibular, and visual. Balance performance and its measurement are influenced by these subsystems.This present study was carried out to investigate the effectiveness of, neuromuscular controlled training exercises comprising bosu-ball balance training and conventional physiotherapy exercise training protocols on the level of stability, balance and proprioception in the athletes, diagnosed with lateral ligament injury of ankle joint. The Y Balance test was used as a reliable and valid tool for quantitative balance assessment. Thirteen players (aged between 19 to 26 years, Mean age = 23.2; SD = 2.46) suffering from grade II & grade III lateral ligament injury were recruited from the OPD of the department of Orthopaedics, of the Hosptial of Universiti Sains Malaysia.All of the participants were subjected to pre-intervention or baseline assessments, comprising of Y-balance test and assessment of proprioception employing Biodex 4 Isokinetic Equipment. Thereafter participants were introduced with neuromuscular controlled training program, which was imparted for 12 sessions (30 min/day; 2 days/wk. for 6 wk.). Findings of the study revealed that 6 weeks of neuromuscular exercises training significantly improved the balance and some significant aspects of proprioception observed amongst the young athletes diagnosed with ankle lateral ligament injury.