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Ugeskrift For Laeger Oct 2020Symptomatic ankle arthrosis affects 1-4% of the population, and the most common aetiology is post-traumatic. Symptoms include pain, swelling and reduced range of motion.... (Review)
Review
Symptomatic ankle arthrosis affects 1-4% of the population, and the most common aetiology is post-traumatic. Symptoms include pain, swelling and reduced range of motion. Diagnosis is based on weight-bearing X-rays of the ankle joint, and treatment depends on the arthrosis grade and patient characteristics. Non-operative therapy, i.e. physiotherapy, analgesics, injection therapy and/or braces/orthoses is first-line treatment, as we argue in this review. Arthroscopy can be an effective treatment for some patients, but in case of severe arthrosis, osteotomies, total ankle replacement or arthrodesis may be necessary.
Topics: Ankle; Ankle Joint; Arthrodesis; Humans; Joint Diseases; Osteoarthritis
PubMed: 33046192
DOI: No ID Found -
Clinics in Podiatric Medicine and... Jan 2023Posterior ankle impingement is typically seen in athletes, primarily dancers and soccer players, secondary to dynamic and repetitive push-off maneuvers and forced... (Review)
Review
Posterior ankle impingement is typically seen in athletes, primarily dancers and soccer players, secondary to dynamic and repetitive push-off maneuvers and forced hyperplantarflexion. Posterior ankle impingement results from chronic, repetitive trauma to the posterior ankle capsule, flexor hallucis longus tendon, and/or os trigonum. It is important to perform a thorough workup by isolating and testing the posterior compartment muscles and obtaining proper imaging with radiographs to identify any osseous abnormalities and MRI to evaluate the soft tissue structures. Nonsurgical treatment includes activity modification, physical therapy, and steroid injections.
Topics: Humans; Ankle; Joint Diseases; Ankle Joint; Talus; Syndrome; Magnetic Resonance Imaging
PubMed: 36368844
DOI: 10.1016/j.cpm.2022.07.014 -
The Journal of the American Academy of... Jan 2021Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. This review distills available biomechanical evidence as... (Review)
Review
Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. Current data suggest that accurate assessment of ligament integrity during physical examination requires the ankle to ideally be held in 16° of plantar flexion when performing the anterior drawer test and 18° of dorsiflexion when performing the talar tilt test, respectively. Stress radiographs are limited by their low sensitivity, and MRI is limited by its static nature. Surgically, both arthroscopic and open repair techniques appear biomechanically equivalent in their ability to restore ankle stability, although sufficient evidence is still lacking for any particular procedure to be considered a superior construct. When performing reconstruction, grafts should be tensioned at 10 N and use of nonabsorbable augmentations lacking viscoelastic creep must factor in the potential for overtensioning. Anatomic lateral ligament surgery provides sufficient biomechanical strength to safely enable immediate postoperative weight bearing if lateral ankle stress is neutralized with a boot. Further research and comparative clinical trials will be necessary to define which of these ever-increasing procedural options actually optimizes patient outcome for chronic lateral ankle instability.
Topics: Ankle; Ankle Injuries; Ankle Joint; Humans; Joint Instability; Lateral Ligament, Ankle
PubMed: 33347006
DOI: 10.5435/JAAOS-D-20-00145 -
Seminars in Musculoskeletal Radiology Jun 2023Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with...
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
Topics: Humans; Ankle; Ankle Joint; Collateral Ligaments; Magnetic Resonance Imaging; Sprains and Strains; Joint Instability; Ankle Injuries; Ligaments, Articular
PubMed: 37230124
DOI: 10.1055/s-0043-1767767 -
Clinics in Podiatric Medicine and... Jul 2023The indications and procedures for arthroscopy of the ankle and subtalar joints continues to increase. Lateral ankle instability is a common pathology that may require... (Review)
Review
The indications and procedures for arthroscopy of the ankle and subtalar joints continues to increase. Lateral ankle instability is a common pathology that may require surgery to repair injured structures of patients nonresponsive to conservative management. Common surgical methods generally include ankle arthroscopy with subsequent open approach to repair/reconstruct the ankle ligament(s). This article discusses two different approaches to repairing lateral ankle instability through an arthroscopic approach. The arthroscopic modified Brostrom procedure creates a strong repair with minimal soft tissue dissection, and is a reliable, minimally invasive approach to lateral ankle stabilization. The arthroscopic double ligament stabilization procedure creates a robust reconstruction of the anterior talofibular and calcaneal fibular ligaments with minimal soft tissue dissection.
Topics: Humans; Ankle Joint; Arthroscopy; Fibula; Joint Instability; Lateral Ligament, Ankle
PubMed: 37236686
DOI: 10.1016/j.cpm.2023.03.002 -
Clinics in Podiatric Medicine and... Jul 2023A wide spectrum of pathologies can lead to soft tissue abnormalities within the ankle joint. Many of these disorders can develop into irreversible joint degeneration if... (Review)
Review
A wide spectrum of pathologies can lead to soft tissue abnormalities within the ankle joint. Many of these disorders can develop into irreversible joint degeneration if left untreated. Arthroscopy is frequently used to treat these soft tissue conditions such as instability, synovitis, impingement, arthrofibrosis, and other inflammatory disorders in the rearfoot and ankle. In general, the etiology of these ankle soft tissue disorders can be classified as traumatic, inflammatory, and congenital/neoplastic. Overall, the goal of diagnosing and treating soft tissue pathologies of the ankle is to restore anatomic and physiologic motion, reduce pain, optimize functional return to activity, and decrease the chance of recurrence while minimizing complications.
Topics: Humans; Joint Diseases; Ankle Joint; Arthroscopy; Diagnosis, Differential; Osteoarthritis
PubMed: 37236677
DOI: 10.1016/j.cpm.2023.02.003 -
Clinics in Podiatric Medicine and... Jul 2023
Topics: Humans; Arthroscopy; Ankle; Ankle Joint; Foot Joints; Lower Extremity
PubMed: 37236693
DOI: 10.1016/j.cpm.2023.03.006 -
Clinics in Podiatric Medicine and... Jul 2023Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically,... (Review)
Review
Despite the increasing popularity of total ankle replacement, ankle arthrodesis remains the gold standard for the treatment of end-stage ankle arthritis. Historically, open techniques have been utilized for ankle arthrodesis. There have been many variations and techniques described, including transfibular, anterior, medial, and miniarthrotomy. Inherent disadvantages to these open techniques include postoperative pain, delayed or nonunion, wound complications, shortening, prolonged healing times, and prolonged hospital stays. Arthroscopic ankle arthrodesis provides the foot and ankle surgeon with an alternative to the traditional open techniques. Arthroscopic ankle arthrodesis has demonstrated faster union rates, decreased complications, reduced postoperative pain, and shorter hospital stays.
Topics: Humans; Ankle; Arthroscopy; Arthritis; Ankle Joint; Arthrodesis; Pain, Postoperative; Retrospective Studies; Treatment Outcome
PubMed: 37236683
DOI: 10.1016/j.cpm.2023.02.001 -
Foot and Ankle Clinics Sep 2022
Topics: Ankle; Ankle Joint; Humans; Surgeons
PubMed: 36096561
DOI: 10.1016/j.fcl.2022.04.001 -
The Orthopedic Clinics of North America Oct 2021Ankle fractures are common injuries to the lower extremity with approximately 20% sustaining a concomitant injury to the syndesmosis. Although the deltoid ligament is... (Review)
Review
Ankle fractures are common injuries to the lower extremity with approximately 20% sustaining a concomitant injury to the syndesmosis. Although the deltoid ligament is not formally included in the syndesmotic complex, it plays an important role in the mortise stability. Therefore, its integrity should be always evaluated when syndesmotic injury is suspected. Given the anatomic variability of the syndesmosis between individuals, bilateral ankle imaging is recommended, especially in cases of subtle instability. Diagnostic tests that allow dynamic assessment of the distal tibiofibular joint in the 3 planes are the most reliable in determining the presence of syndesmotic injury.
Topics: Ankle Fractures; Ankle Injuries; Ankle Joint; Humans
PubMed: 34538351
DOI: 10.1016/j.ocl.2021.05.010