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  1 / 481 MEDLINE  
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PMID:28860398
Autor:Cho BK; Kim YM; Choi SM; Park HW; SooHoo NF
Endereço:College of Medicine, Chungbuk National University, Cheongju, South Korea.
Título:Revision anatomical reconstruction of the lateral ligaments of the ankle augmented with suture tape for patients with a failed Broström procedure.
Fonte:Bone Joint J; 99-B(9):1183-1189, 2017 Sep.
ISSN:2049-4408
País de publicação:England
Idioma:eng
Resumo:AIMS: The aim of this prospective study was to evaluate the intermediate-term outcomes after revision anatomical ankle ligament reconstruction augmented with suture tape for a failed modified Broström procedure. PATIENTS AND METHODS: A total of 30 patients with persistent instability of the ankle after a Broström procedure underwent revision augmented with suture tape. Of these, 24 patients who were followed up for more than two years were included in the study. There were 13 men and 11 women. Their mean age was 31.8 years (23 to 44). The mean follow-up was 38.5 months (24 to 56) The clinical outcome was assessed using the Foot and Ankle Outcome Score (FAOS) and the Foot and Ankle Ability Measure (FAAM) score. The stability of the ankle was assessed using stress radiographs. RESULTS: The mean FAOS and FAAM scores improved significantly to 87.5 (73 to 94) and 85.1 (70 to 95) points at final follow-up, respectively (p < 0.001). The mean angle of talar tilt and anterior talar translation improved significantly to 2.8° (0° to 6°) and 4.1 mm (2 to 7) at final follow-up, respectively (p < 0.001). Side to side comparison in stress radiographs at final follow-up showed no significant difference. The revision failed in one patient who underwent a further revision using allograft tendon. CONCLUSION: The revision modified Broström procedure augmented with suture tape is an effective form of treatment for recurrent instability of the ankle following a failed Broström procedure. This technique provides reliable stability and satisfactory clinical outcomes at intermediate-term follow-up. Cite this article: 2017;99-B:1183-9.
Tipo de publicação: JOURNAL ARTICLE


  2 / 481 MEDLINE  
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PMID:28719556
Autor:Leslie BM; Osterman AL; Wolfe SW
Endereço:1Newton-Wellesley Hospital, Newton, Massachusetts 2The Philadelphia Hand Center, King of Prussia, Pennsylvania 3Center for Brachial Plexus and Traumatic Nerve Injury, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY.
Título:Inadvertent Harvest of the Median Nerve Instead of the Palmaris Longus Tendon.
Fonte:J Bone Joint Surg Am; 99(14):1173-1182, 2017 Jul 19.
ISSN:1535-1386
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: The palmaris longus tendon is frequently used as a tendon graft or ligament replacement. In rare instances the median nerve has been inadvertently harvested instead of the palmaris longus for use as a tendon. METHODS: Nineteen cases in which the median nerve had been mistakenly harvested instead of the palmaris longus tendon were collected from members of the American Society for Surgery of the Hand (ASSH) Listserve. Surgeons involved in the subsequent care of the subject who had had an inadvertent harvest were contacted or the chart was reviewed. The reason for the initial procedure, the skill level of the primary surgeon, and when the inadvertent harvest was recognized were documented. When possible, the method of harvest and subsequent treatment were also documented. RESULTS: The most common initial procedure was a reconstruction of the elbow ulnar collateral ligament, followed by basal joint arthroplasty, tendon reconstruction, and reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Only 7 of the inadvertent harvests were recognized intraoperatively; in the remaining 12 cases the nerve was used as a tendon graft. The sensory loss was not recognized as being due to the inadvertent harvest until the first postoperative visit (2 subjects), 3 to 4 weeks (2 subjects), 2 to 3 months (2 subjects), 5 to 7 months (2 subjects), 1 year (1 subject), 3 years (1 subject), or 10 years (1 subject). Preoperative clinical identification of the presence or absence of a palmaris longus did not necessarily prevent an inadvertent harvest. CONCLUSIONS: Knowledge of the relevant anatomy is crucial to avoiding inadvertent harvest of the median nerve instead of the palmaris longus tendon.
Tipo de publicação: JOURNAL ARTICLE


  3 / 481 MEDLINE  
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PMID:28552041
Autor:Jung HG; Kim NR; Kim TH; Eom JS; Lee DO
Endereço:1 Department of Orthopedic Surgery, Konkuk University School of Medicine, Gwangjin-gu, Seoul, Republic of Korea.
Título:Magnetic Resonance Imaging and Stress Radiography in Chronic Lateral Ankle Instability.
Fonte:Foot Ankle Int; 38(6):621-626, 2017 Jun.
ISSN:1944-7876
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Studies regarding magnetic resonance imaging (MRI) findings of the lateral ankle ligaments in chronic lateral ankle instability and their clinical relevance for surgery are lacking. This study classified the lateral ankle ligament MRI findings of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in chronic lateral ankle instability (CLAI) and correlated these findings with ankle stress radiographs. METHODS: We included 132 ankles with CLAI that underwent ligament reconstructions from 2006 to 2013. The distributions of the ATFL and CFL morphologies were evaluated using the following categories: (1) the amount of thickness: normal/thickened/attenuated/non-visualized, (2) the presence of discontinuity, (3) wavy or irregular contour, and (4) increased signal intensity on T2-weighted images. The relationships between the ligament morphologies and stress radiographs were analyzed. RESULTS: The ATFL was normal in 5 (4%) ankles, thickened in 35 (27%), attenuated in 76 (58%), and non-visualized in 16 (12%), while the CFL was normal in 39 (30%) ankles, thickened in 42 (32%), attenuated in 44 (33%), and non-visualized in 7 (5%). Discontinuity of the ATFL or CFL was observed in 46 (35%) ankles. Wavy or irregular contours were observed in 55 (42%) ATFLs and 37 (28%) CFLs, and signal intensity of both ligaments was increased in 19 (14%) ankles. ATFL ( P < .001) and CFL thickness ( P = .007) correlated with the talar tilt angle. CONCLUSIONS: The MRI findings of CLAI showed several morphologies and specific incidences for each morphology. Attenuated, wavy appearance was the most frequent MRI pattern. Thickness was related to the degree of instability. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Tipo de publicação: JOURNAL ARTICLE


  4 / 481 MEDLINE  
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PMID:28399657
Autor:Phisitkul P; Hosuru Siddappa V; Sittapairoj T; Goetz JE; Den Hartog BD; Femino JE
Endereço:1 Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA.
Título:Cadaveric Evaluation of Dorsal Intermetatarsal Approach for Plantar Plate and Lateral Collateral Ligament Repair of the Lesser Metatarsophalangeal Joints.
Fonte:Foot Ankle Int; 38(7):791-796, 2017 Jul.
ISSN:1944-7876
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Access to the plantar plate has been described using either a plantar approach or an extensive dorsal approach that required complete joint destabilization and often a metatarsal osteotomy. Clinical scenarios related to plantar plate tear vary and the pathologies in early stages are frequently limited to unilateral soft tissue structures; a less invasive operative approach may be possible. A novel approach requiring a release of only the lateral collateral ligament and the lateral half of the plantar plate is presented in this cadaver model; the extent of joint exposure possible is described. The ability to place a secure suture through the lateral collateral ligament and the plantar plate was analyzed. METHODS: Nine fresh-frozen cadaveric specimens were dissected in a randomized fashion across the second to fourth metatarsophalangeal joints through the intermetatarsal space dorsally. Under distraction, soft tissue was sequentially released, including dorsal capsule, lateral collateral ligament, and the lateral half of the plantar plate. Integrity of the extensor tendons, deep transverse intermetatarsal ligament, proximal attachment of the plantar plate, and osseous structures was carefully preserved. The joint exposure was quantified after each step with sizing rods. Using a suture passer, 2-0 nonabsorbable braided sutures were passed into the lateral collateral ligament and the plantar plate, and the construct strength was measured using a tensiometer. RESULTS: Progressive increase in mean joint exposure was noted after each step of soft tissue release with the final exposure of 6 mm after release of the lateral half of the plantar plate. Joint exposures after a capsulotomy and a lateral collateral release were 3 mm and 4 mm, respectively. Under distraction, the unilateral release of soft tissue created a lateral opening of the joint while the proximal phalangeal base adducted and medially deviated. Successful suture passage was noted in all specimens that could sustain a minimum tension of 25 N without a catastrophic failure. There was no statistically significant correlation with age, sex, foot length, and rays of the specimens when joint exposure was considered. CONCLUSION: The dorsal intermetatarsal approach appeared to be feasible for access to the lateral collateral ligament and the lateral half of the plantar plate. The average joint exposure of 6 mm allowed a quality suture passage by a suture passer in both structures in all specimens without the need of a metatarsal osteotomy. CLINICAL RELEVANCE: This operative approach may be appropriate for early stages plantar plate tear when only lateral soft tissue repair is needed. This technique should not preclude conversion to a more extensile operative approach or an additional metatarsal osteotomy if needed. Applicability of this operative approach in cases with more advanced pathologies or involving only medial soft tissue structures requires further studies.
Tipo de publicação: JOURNAL ARTICLE


  5 / 481 MEDLINE  
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PMID:28367693
Autor:Cho BK; Park KJ; Park JK; SooHoo NF
Endereço:1 Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University, Cheongju, Korea.
Título:Outcomes of the Modified Broström Procedure Augmented With Suture-Tape for Ankle Instability in Patients With Generalized Ligamentous Laxity.
Fonte:Foot Ankle Int; 38(4):405-411, 2017 Apr.
ISSN:1944-7876
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Although recent biomechanical studies have reported mechanical superiority of augmented anterior talofibular ligament reconstruction using suture-tape, clinical evidence regarding the efficacy of suture-tape augmentation is still insufficient. This prospective study was performed to evaluate the outcomes of the modified Broström procedure augmented with suture-tape for chronic ankle instability with generalized ligamentous laxity, which has been known to be a poor prognostic factor for anatomic ligament repair. METHODS: Twenty-eight patients with generalized ligamentous laxity were followed for more than 2 years after the augmented modified Broström procedures for chronic ankle instability. Generalized ligamentous laxity was defined as a Beighton score ≥4 points. The clinical evaluation consisted of the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM) score. Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical ankle stability. RESULTS: FAOS and FAAM scores had significantly improved from preoperative average 63.2 and 54.3 points to 90.6 and 89.5 points at final follow-up, respectively ( P < .001). Talar tilt angle and anterior talar translation had significantly improved from preoperative average 16.2° and 12.1 mm to 3.6° and 4.2 mm at final follow-up, respectively ( P < .001). Preoperative side-to-side comparison with stress radiographs was significantly different, but this returned to within nonstatistical differences at final follow-up, respectively ( P = .105, .532). Although 6 patients sustained an ankle sprain after operation, only 1 patient (3.6%) showed a recurrence of subjective and mechanical instability. CONCLUSIONS: Suture-tape augmentation for the modified Broström procedure appears to be an effective operative alternative for chronic ankle instability with generalized ligamentous laxity. As one of the methods to improve the clinical outcomes in patients with relative contraindications of the modified Broström repair, this procedure provided reliable stability with the advantages of anatomic ligament repair through the augmentation using suture-tape. LEVEL OF EVIDENCE: Level IV, prospective case series.
Tipo de publicação: JOURNAL ARTICLE


  6 / 481 MEDLINE  
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PMID:28233114
Autor:Song B; Li C; Chen N; Chen Z; Zhang Y; Zhou Y; Li W
Endereço:Department of Sports Medicine, Sun Yat-sen Memorial Hospital, No.107 on Yanjiang Road West, 510120, Guangzhou, Guangdong, China.
Título:All-arthroscopic anatomical reconstruction of anterior talofibular ligament using semitendinosus autografts.
Fonte:Int Orthop; 41(5):975-982, 2017 05.
ISSN:1432-5195
País de publicação:Germany
Idioma:eng
Resumo:PURPOSE: We introduced a new technique of all-arthroscopic anatomical anterior talofibular ligament (ATFL) reconstruction using semitendinosus autografts. METHODS: From June 2012 to June 2013, 28 patients with chronic ATFL rupture underwent arthroscopic anatomic reconstruction of the ATFL. They were divided into the Broström group (n = 16) and reconstruction group (n = 12). The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) was recorded before the operation, 12 months after the operation and 30 months after the operation. Physical examination and radiographs were performed in follow-ups. RESULTS: The patients had higher AOFAS score after the operation in both the Broström group and the reconstruction group. 12 months after operation, the patients in the reconstruction group showed significantly higher AOFAS score and lower VAS score than those in the Broström group (P = 0.003 and 0.001, respectively), while the difference between the two groups was not statistically significant 30 months later (P = 0.425 and 0.323, respectively). Contemporary numbness of the lateral dorsal part of the foot appeared in one (8.3%) patient in the reconstruction group and two (12.5%) patients in the Broström group, and the symptoms diminished after neurotrophic treatment. No other complications, including recurrent instability, were encountered. No donor-side morbidity such as infection or delayed wound healing was observed. CONCLUSIONS: The novel surgical technique enhanced post-operative rehabilitation by providing better ankle joint function than modified Broström procedure at 12 months after operation, while the advantage was not statistically significant 30 months later. The long-term outcome requires further investigation. The technique of all-arthroscopic anatomical ATFL reconstruction using semitendinosus autografts proved to be a viable option for ATFL injuries.
Tipo de publicação: JOURNAL ARTICLE


  7 / 481 MEDLINE  
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PMID:28209448
Autor:Touloupakis G; Theodorakis E; Favetti F; Nannerini M
Endereço:Department of Orthopaedics, Aurelia Hospital, Rome, Italy.
Título:Management of post-traumatic elbow instability after failed radial head excision: A case report.
Fonte:Chin J Traumatol; 20(1):59-62, 2017 Feb.
ISSN:1008-1275
País de publicação:China
Idioma:eng
Resumo:Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures. However, diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation. We present the case of a 21-years old female treated with excision after radial head fracture, resulting in elbow instability. The patient underwent revision surgery after four weeks. We believe that ligament reconstruction without radial head substitution is a safe alternative choice for Mason III radial head fractures accompanied by complex ligament lesions.
Tipo de publicação: CASE REPORTS; JOURNAL ARTICLE


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PMID:28072472
Autor:Maeda M; Maeda N; Takaoka T; Tanaka Y
Endereço:Maeda Orthopedic Clinic, Nara, Japan.
Título:Sonographic Findings of Chondral Avulsion Fractures of the Lateral Ankle Ligaments in Children.
Fonte:J Ultrasound Med; 36(2):421-432, 2017 Feb.
ISSN:1550-9613
País de publicação:England
Idioma:eng
Resumo:In this series, we aimed to describe the sonographic findings of chondral avulsion fractures that develop concomitant with lateral ankle ligament injury in children. We performed stress sonography during a manual anterior drawer stress procedure of the ankle in 9 skeletally immature patients who had recently had a lateral ankle sprain. Echo videos were obtained through the course of treatment, and all videos were reviewed. We elucidated the common features of chondral avulsion fractures of the lateral ankle ligaments in the children. The features of avulsion fractures on conventional sonography included absence of a fracture with hyperechoic spots (sonographic occult fracture type), cortical discontinuity with hyperechoic spots (cortical disruption fracture type), fracture line in the cortical bone (double-line fracture type), and a step-off deformity of the cortical bone with cartilage (displaced fracture type). In contrast, the features of chondral fractures on stress sonography included abnormal motion of the chondral lesions and mobility/fluidity of hyperechoic spots along the chondral fracture site. The presence of hyperechoic spots around the chondral lesion is an important sonographic sign for diagnosing chondral fractures concomitant with ankle lateral ligament injury. Hence, we believe that stress sonography should be considered for the detection of chondral fractures concomitant with radiographically negative ankle lateral ligament injuries in skeletally immature patients with lateral ankle pain and ankle sprains, if hyperechoic spots are present in the cartilage of the distal fibula.
Tipo de publicação: JOURNAL ARTICLE


  9 / 481 MEDLINE  
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PMID:28061547
Autor:Jolman S; Robbins J; Lewis L; Wilkes M; Ryan P
Endereço:1 Madigan Army Medical Center, Tacoma, WA, USA.
Título:Comparison of Magnetic Resonance Imaging and Stress Radiographs in the Evaluation of Chronic Lateral Ankle Instability.
Fonte:Foot Ankle Int; 38(4):397-404, 2017 Apr.
ISSN:1944-7876
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: In patients who develop chronic ankle instability, clinicians often obtain magnetic resonance imaging (MRI) as part of the evaluation prior to operative referral. The purpose of this study was to analyze the diagnostic efficacy of MRI in the diagnosis of chronic lateral ankle instability. Our hypothesis was that magnetic resonance imaging would not be a specific diagnostic tool in the evaluation of chronic lateral ankle instability. MATERIALS AND METHODS: A retrospective chart review of 187 consecutive patients (190 ankles) was performed. Inclusion criteria for the study group required a primary complaint of instability that required operative repair or reconstruction, a documented clinical evaluation consistent with instability, stress radiographs, and MRI. Stress radiographs and clinical examinations for the study group and a control group were reviewed independently by both a musculoskeletal radiologist and a board-certified orthopaedic foot and ankle surgeon. Predictive values in terms of sensitivity, specificity, and prevalence were performed. In total, 112 patients (115 ankles) were identified who underwent an operative reconstruction of their lateral ligaments with a history, physical examination, and stress radiographs consistent with lateral ankle instability. A control group was selected consisting of 75 patients seen in the foot and ankle clinic with a diagnosis other than lateral ankle instability. Thirty-seven of the patients in the control group had stress radiographs performed in the clinic to rule out instability as part of their evaluation, and this allowed for an evaluation of the efficacy of stress radiographs in addition to MRI. Statistical analysis was performed using predictive values from sensitivity, specificity, and prevalence. RESULTS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in regards to MRI in the evaluation of patients found to have clinical lateral ankle instability and those who did not had statistical significance. Sensitivity of MRI was 82.6%, specificity was 53.3%, NPV was 66.7%, and PPV was 73%. Since 37 patients in the control group also had stress radiographs, a subanalysis was performed to identify the same values with stress radiographs. Sensitivity, specificity, NPV, and PPV were 66%, 97%, 48%, and 98.7%, respectively. The overall accuracy within this study was 71% for MRI and 74% for stress radiographs. CONCLUSION: This study demonstrated that MRI has high sensitivity but low specificity in the evaluation of clinical ankle instability. While MRI has value as a screening tool for concomitant ankle pathology, it should not be considered diagnostic in terms of lateral ankle instability. LEVEL OF EVIDENCE: Level III, retrospective cohort, comparative series.
Tipo de publicação: JOURNAL ARTICLE


  10 / 481 MEDLINE  
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PMID:27993094
Autor:De Dea M; L Loizou C; Allen GM; Wilson DJ; Athanasou N; Uchihara Y; Cooke P; Cosker T
Endereço:1 Department of Radiology, St Lukes Radiology, Oxford, UK.
Título:Talonavicular ligament: prevalence of injury in ankle sprains, histological analysis and hypothesis of its biomechanical function.
Fonte:Br J Radiol; 90(1071):20160816, 2017 Mar.
ISSN:1748-880X
País de publicação:England
Idioma:eng
Resumo:OBJECTIVE: To assess the prevalence of injury of the talonavicular ligament (TNL) in ankle sprains, its anatomy and the stability of the talonavicular joint (TNJ) before and after dividing the TNL in a cadaver. METHODS: During a prospective study of 100 patients to assess the outcome of ankle injuries, we noted high incidence of TNL injuries; we will discuss here the TNL findings. Each patient had undergone ultrasound and cone beam CT examination of the ankle. Six TNLs were dissected off fresh-frozen cadaveric feet for histological analysis. In further six cadaveric feet, the stability of the TNJ was assessed by mechanical stress before and after division of the TNL; movement at the joint was assessed by measuring the distance between the talus and navicular bone [talonavicular distance (TD)] using ultrasound. The TD was measured on ten randomly selected ultrasound images by three independent observers and repeated twice by a single observer to determine the inter- and intraobserver reliability. RESULTS: 21% of the patients had an injury to the TNL. Histological examination demonstrated a dense connective tissue composed of bundles of collagen in parallel arrangement along the ligament length. The interobserver and intraobserver reliability of the TD showed almost perfect agreement. Displacement at the TNJ after stress with the TNL intact measured 0.18 ± 0.08 cm and 0.29 ± 0.07 cm (p < 0.005) when divided. CONCLUSION: The TNL is surprisingly commonly injured in ankle sprains. Its anatomy and histology suggest a role in tensile force transmission during the windlass mechanism in gait. Advances in knowledge: Injury to the TNL is common and has not been described. Its anatomy suggests resistance to tensile forces and its injury allows excessive movement at the TNJ.
Tipo de publicação: JOURNAL ARTICLE



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