Second-Look Arthroscopic Findings and Clinical Outcomes After Management of Intra-Articular Lesions in Acute Ankle Fractures with Arthroscopy

Category: Ankle, Arthroscopy, Trauma Introduction/Purpose: Anatomically successful surgical reduction of ankle fractures does not always result in a clinically favorable outcome. The purpose of the present study was to compare initial and second look arthroscopic finding of acute ankle fracture and to evaluate clinical outcomes. Methods: A total of 39 patients (40 ankles, 20 male, 20 female) who underwent surgery for ankle fracture between March 2009 and August 2016 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Intra-articular lesions (osteochondral lesion, loose body, injury of ligaments and fibrosis) were evaluated via ankle arthroscopy. Arthroscopic finding of osteochondral lesion were classified using the Ferkel and Cheng staging system, and cartilage repair was assessed using the international Cartilage Repar System (ICRS). Clinicial outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Visual Analogue Scale (VAS) Results: Chondral lesions were found in 26 ankles (65%) with initial arthroscopic finding of acute ankle fracture. Newly discovered chondral lesions in second-look arthroscopy was 15 cases. Accoding to the Ferkel and Cheng staging at second-look arthroscopy, 4 of 23 ankles with chondral lesions of talus was getting worse (more than stage D). In terms of ICRS overall repair grades, 4 ankle (15%) were abnormal (grade III). Diffuse synovitis and arthrofibrosis were found in 12 and 7 ankles respectively in second-look arthroscopy. Correlation were found between AOFAS scores, VAS and intra-articular lesions with second-look arthroscopy. Conclusion: Second-look arthroscopic examination combined with treatment of intra-articular lesion arising from ankle fracture surgery may consider to improve clinical outcomes

Suture-Tape Augmentation for Chronic Ankle Instability

Category: Ankle Introduction/Purpose: This retrospective study was performed to evaluate the clinical outcomes of internal brace technique using suture tape for chronic ankle instability. Methods: twenty-three patients were followed for more than 2 years after suture tape augmentation for lateral ankle instability. Twenty five patients were followed for more than 2 years after modified Brostrom procedure. The clinical results after using two techniques were evaluated and compared using Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot and Ankle Society (AOFAS) score, Olarud and Molander score, Hamilton score and Visual Analogue Scale (VAS). Anterior talar translation and talar tilt angle were obtained from stress radiographs to evaluate the mechanical ankle stability. Results: There was no significant difference in VAS at final follow-up (P < .325). There was no significant difference in FAOS at final follow-up (P < .242). There was no significant difference in AOFAS score at final follow-up (P < .418). There was no significant difference in Olarud and Molander score at final follow-up (P < .244). According to the Hamilton score, 14 cases (93%) in internal brace group and 23 cases (92%) achieved satisfactory functional results. Talar tilt angle and anterior talar translation had improved to an average of 2.2 degrees and 4.4 mm in internal brace group and 2.7 degrees and 5.4 mm in modified Brostrom group, respectively, at final follow-up, and there was no significant difference (P < .128, < .226, respectively). There were no complications such as skin irritation and wound infection. Conclusion: Suture tape augmentation has shown the potential for stabilizing the lateral ankle ligmament complex as an alternative to direct repair. Functional, objective, and subjective outcomes were excellent in all cases and no complications were seen postoperatively. To confirm the above further, it is appropriate to conduct a larger study