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Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement

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Osteochondral Tissue Engineering

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 1059))

Abstract

Ankle sprain is amongst the most frequent musculoskeletal injuries, particularly during sports activities. Chronic ankle instability (CAI) resulting from an ankle sprain might have severe long-lasting consequences on the ankle joint. Despite the fact that most patients will respond favourably to appropriate conservative treatment, around 20% will develop symptomatic CAI with sense of giving away and recurrent sprains leading to functional impairment. “Classical” surgical repair by Brostrom-like surgery in one of its many modifications has achieved good results over the years. Recently, major advances in surgical techniques have enabled arthroscopic repair of ankle instability with favourable outcome while also enabling the treatment of other concomitant lesions: loose bodies, osteochondral defects (OCDs) or ankle impingement. Moreover, when the tissue remnant does not permit a repair technique, anatomic reconstruction by means of using a free graft has been developed. In many cases, OCDs occur as a consequence of CAI. However, traumatic and non-traumatic aetiologies have been described. There is no evidence favouring any surgical treatment over another concerning OCDs. Considering lower cost and limited aggression, microfracture is still the most frequent surgical approach. Herein, the authors describe their algorithm in the treatment of these conditions. Similarly, anterior or posterior impingement might be linked with CAI. These are clinical syndromes based on clinical diagnosis which are currently managed arthroscopically upon failure of conservative treatment.

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Authors and Affiliations

  1. 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine,, Avepark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, Portugal

    Hélder Pereira

  2. ICVS/3B’s – PT Government Associated Laboratory, Braga/Guimarães, Portugal

    Hélder Pereira

  3. Orthopedic Department of Póvoa de Varzim – Vila do Conde Hospital Centre, Póvoa de Varzim, Portugal

    Hélder Pereira

  4. Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of Excellence, Murcia/Madrid, Spain

    Hélder Pereira

  5. International Centre of Sports Traumatology of the Ave, Taipas, Portugal

    Hélder Pereira

  6. Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands

    Gwendolyn Vuurberg

  7. Academic Center for Evidence Based Sports Medicine, Amsterdam, The Netherlands

    Gwendolyn Vuurberg

  8. Amsterdam Collaboration for Health and Safety in Sports, Amsterdam, The Netherlands

    Gwendolyn Vuurberg

  9. Clinique du Sport, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg

    Pietro Spennacchio

  10. Clinical Department Club Atletico Boca Juniores and CAJB – Centro Artroscopico, Jorge batista SA, Buenos Aires, Argentina

    Jorge Batista

  11. Aspetar Orthopaedic and Sports Medicine Hospital, Department of Orthopaedic Surgery, Aspire Zone, Doha, Qatar

    Pieter D’Hooghe

  12. Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Kenneth Hunt

  13. Ripoll y De Prado Sports Clinic: Murcia-Madrid FIFA Medical Centre of Excellence, Murcia/Madrid, Spain

    Niek Van Dijk

  14. Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands

    Niek Van Dijk

  15. Academic Center for Evidence Based Sports Medicine, Amsterdam, The Netherlands

    Niek Van Dijk

  16. Amsterdam Collaboration for Health and Safety in Sports, Amsterdam, The Netherlands

    Niek Van Dijk

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  1. Hélder Pereira
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  4. Jorge Batista
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  5. Pieter D’Hooghe
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  6. Kenneth Hunt
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  1. 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal

    J. Miguel Oliveira

  2. 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal

    Sandra Pina

  3. 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco, Guimarães, Portugal

    Rui L. Reis

  4. Polymeric Nanomaterials and Biomaterials Department, Institute of Polymer Science and Technology, Spanish Council for Scientific Research (CSIC), Madrid, Spain

    Julio San Roman

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Pereira, H. et al. (2018). Surgical Treatment Paradigms of Ankle Lateral Instability, Osteochondral Defects and Impingement. In: Oliveira, J., Pina, S., Reis, R., San Roman, J. (eds) Osteochondral Tissue Engineering. Advances in Experimental Medicine and Biology, vol 1059. Springer, Cham. https://doi.org/10.1007/978-3-319-76735-2_4

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