Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
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Chronic Lateral Ankle Instability

만성 외측 발목 불안정

  • Kim, Dae-Wook (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Sung, Ki-Sun (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김대욱 (성균관대학교 의과대학 삼성서울병원 정형외과학교실) ;
  • 성기선 (성균관대학교 의과대학 삼성서울병원 정형외과학교실)
  • Received : 2018.05.14
  • Accepted : 2018.05.29
  • Published : 2018.06.15
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Abstract

Chronic lateral ankle instability is a major complication of acute ankle sprains, which can cause discomfort in both daily and sports activity. In addition, it may result in degenerative changes to the ankle joint in the long term. An accurate diagnostic approach and successful treatment plan can be established based on a comprehensive understanding of the concept of functional and mechanical instability. The patients' history and correct physical examination would be the first and most important step. The hindfoot alignment, competence of the lateral ligaments, and proprioceptive function should be evaluated. Additional information can be gathered using standard and stress radiographs. In addition, concomitant pathologic conditions can be investigated by magnetic resonance imaging. Conservative rehabilitation composed of the range of motion, muscle strengthening, and proprioceptive exercise is the main treatment for functional instability and mechanical instability. Regarding the mechanical instability, surgical treatment can be considered for irresponsible patients after a sufficient period of rehabilitation. Anatomic repair (modified $Brostr{\ddot{o}}m$ operation) is regarded as the gold standard procedure. In cases with poor prognostic factors, an anatomical reconstruction or additional procedures can be chosen. For combined intra-articular pathologies, arthroscopic procedures should be conducted, and arthroscopic lateral ligament repair has recently been introduced. Regarding the postoperative management, early functional rehabilitation with short term immobilization is recommended.

Keywords

References

  1. van Rijn RM, van Os AG, Bernsen RM, Luijsterburg PA, Koes BW, Bierma-Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008;121:324-31.e6. https://doi.org/10.1016/j.amjmed.2007.11.018
  2. DiGiovanni CW, Brodsky A. Current concepts: lateral ankle instability. Foot Ankle Int. 2006;27:854-66. https://doi.org/10.1177/107110070602701019
  3. Freeman MA. Instability of the foot after injuries to the lateral ligament of the ankle. J Bone Joint Surg Br. 1965;47:669-77.
  4. Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: evolution of the model. J Athl Train. 2011;46:133-41. https://doi.org/10.4085/1062-6050-46.2.133
  5. Gribble PA, Delahunt E, Bleakley C, Caulfield B, Docherty C, Fourchet F, et al. Selection criteria for patients with chronic ankle instability in controlled research: a position statement of the International Ankle Consortium. Br J Sports Med. 2014;48:1014-8. https://doi.org/10.1136/bjsports-2013-093175
  6. Caprio A, Oliva F, Treia F, Maffulli N. Reconstruction of the lateral ankle ligaments with allograft in patients with chronic ankle instability. Foot Ankle Clin. 2006;11:597-605. https://doi.org/10.1016/j.fcl.2006.05.003
  7. Louwerens JW, Ginai AZ, van Linge B, Snijders CJ. Stress radiography of the talocrural and subtalar joints. Foot Ankle Int. 1995;16:148-55. https://doi.org/10.1177/107110079501600308
  8. Cho JH, Lee DH, Song HK, Bang JY, Lee KT, Park YU. Value of stress ultrasound for the diagnosis of chronic ankle instability compared to manual anterior drawer test, stress radiography, magnetic resonance imaging, and arthroscopy. Knee Surg Sports Traumatol Arthrosc. 2016;24:1022-8. https://doi.org/10.1007/s00167-015-3828-9
  9. Maffulli N, Ferran NA. Management of acute and chronic ankle instability. J Am Acad Orthop Surg. 2008;16:608-15. https://doi.org/10.5435/00124635-200810000-00006
  10. Ajis A, Maffulli N. Conservative management of chronic ankle instability. Foot Ankle Clin. 2006;11:531-7. https://doi.org/10.1016/j.fcl.2006.07.004
  11. Donovan L, Hertel J. A new paradigm for rehabilitation of patients with chronic ankle instability. Phys Sportsmed. 2012;40:41-51.
  12. Karlsson J, Lansinger O. [Lateral instability of the ankle joint (1). Non-surgical treatment is the first choice--20 per cent may need ligament surgery]. Lakartidningen. 1991;88:1399-402. Swedish.
  13. Karlsson J, Bergsten T, Lansinger O, Peterson L. Surgical treatment of chronic lateral instability of the ankle joint. A new procedure. Am J Sports Med. 1989;17:268-73; discussion 273-4. https://doi.org/10.1177/036354658901700220
  14. 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;25:48-53. https://doi.org/10.1177/036354659702500109
  15. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ. Comparison between suture anchor and transosseous suture for the modified-Brostrom procedure. Foot Ankle Int. 2012;33:462-8. https://doi.org/10.3113/FAI.2012.0462
  16. Lee KT, Lee JI, Sung KS, Kim JY, Kim ES, Lee SH, et al. Biomechanical evaluation against calcaneofibular ligament repair in the Brostrom procedure: a cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2008;16:781-6. https://doi.org/10.1007/s00167-008-0557-3
  17. Jeong BO, Kim MS, Song WJ, SooHoo NF. Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Brostrom procedures. Foot Ankle Int. 2014;35:1137-42. https://doi.org/10.1177/1071100714543645
  18. Corte-Real NM, Moreira RM. Arthroscopic repair of chronic lateral ankle instability. Foot Ankle Int. 2009;30:213-7. https://doi.org/10.3113/FAI.2009.0213
  19. Guelfi M, Zamperetti M, Pantalone A, Usuelli FG, Salini V, Oliva XM. Open and arthroscopic lateral ligament repair for treatment of chronic ankle instability: a systematic review. Foot Ankle Surg. 2018;24:11-8. https://doi.org/10.1016/j.fas.2016.05.315
  20. Kerkhoffs GM, Kennedy JG, Calder JD, Karlsson J. There is no simple lateral ankle sprain. Knee Surg Sports Traumatol Arthrosc. 2016;24:941-3. https://doi.org/10.1007/s00167-016-4043-z
  21. Shakked RJ, Karnovsky S, Drakos MC. Operative treatment of lateral ligament instability. Curr Rev Musculoskelet Med. 2017;10:113-21. https://doi.org/10.1007/s12178-017-9391-x
  22. Schenck RC Jr, Coughlin MJ. Lateral ankle instability and revision surgery alternatives in the athlete. Foot Ankle Clin. 2009;14:205-14. https://doi.org/10.1016/j.fcl.2009.01.002
  23. Matheny LM, Johnson NS, Liechti DJ, Clanton TO. Activity level and function after lateral ankle ligament repair versus reconstruction. Am J Sports Med. 2016;44:1301-8. https://doi.org/10.1177/0363546515627817
  24. Sha Y, Wang H, Ding J, Tang H, Li C, Luo H, et al. A novel patient-specific navigational template for anatomical reconstruction of the lateral ankle ligaments. Int Orthop. 2016;40:59-64. https://doi.org/10.1007/s00264-015-2817-4
  25. Vuurberg G, Pereira H, Blankevoort L, van Dijk CN. Anatomic stabilization techniques provide superior results in terms of functional outcome in patients suffering from chronic ankle instability compared to non-anatomic techniques. Knee Surg Sports Traumatol Arthrosc. Published online November 14, 2017; doi: 10.1007/s00167-017-4730-4.
  26. Park JS, Kim BS. Risk factors for failure after lateral ankle ligament repair. J Korean Foot Ankle Soc. 2016;20:62-6. https://doi.org/10.14193/jkfas.2016.20.2.62
  27. Viens NA, Wijdicks CA, Campbell KJ, Laprade RF, Clanton TO. Anterior talofibular ligament ruptures, part 1: biomechanical comparison of augmented Brostrom repair techniques with the intact anterior talofibular ligament. Am J Sports Med. 2014;42:405-11. https://doi.org/10.1177/0363546513510141
  28. Cho BK, Park KJ, Park JK, SooHoo NF. Outcomes of the modified Brostrom procedure augmented with suture-tape for ankle instability in patients with generalized ligamentous laxity. Foot Ankle Int. 2017;38:405-11. https://doi.org/10.1177/1071100716683348
  29. Knop C, Knop C, Thermann H, Blauth M, Bastian L, Zwipp H, et al. [Treatment of recurrence of fibular ligament rupture. Results of a prospective randomized study]. Unfallchirurg. 1999;102:23-8. German. https://doi.org/10.1007/s001130050368
  30. Pearce CJ, Tourne Y, Zellers J, Terrier R, Toschi P, Silbernagel KG, et al. Rehabilitation after anatomical ankle ligament repair or reconstruction. Knee Surg Sports Traumatol Arthrosc. 2016;24:1130-9. https://doi.org/10.1007/s00167-016-4051-z

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