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Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Over 50 % of the patients with chronic lateral ankle instability present with some degree of intra-articular pathology. To date, no consensus regarding the concomitant ankle arthroscopy procedures along with ankle ligament procedures has been reached. The purpose of current study was to investigate reoperation rates and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures.

Methods

Reoperations and postoperative complications following ankle ligament procedures with and without concomitant arthroscopic procedures were investigated using the PearlDiver Patient Record Database (PearlDiver Technologies, Inc.; Fort Wayne, IN, USA) between 2007 and 2011. Ankle ligament procedures, including ligament repair and reconstruction, and ankle arthroscopic procedures were investigated as primary surgery. Subsequently, the reoperation procedures, including ankle ligament procedures, arthroscopic procedures, autologous osteochondral transplantation, and ankle arthrodesis, as well as wound complications and nerve injury following primary ankle ligament procedures were identified.

Results

In 8014 patients receiving ligament repair, the arthroscopic group had a significantly higher reoperation rate in comparison with the non-arthroscopic group (8.8 vs. 6.5 %, odds ratio: 1.1, [p < 0.01], 95 % confidence interval (CI) 1.2–1.7). However, the non-arthroscopic group included 29 open arthrodesis procedures following the primary surgery, whereas arthroscopic group had none. Of the 8055 patients who received a ligament reconstruction, there was no significant difference in reoperation rate between the groups (5.9 vs. 5.9 %, odds ratio: 1.0, [n.s], 95 % CI 0.8–1.2). As seen in the ligament repair group, the non-arthroscopic group had a 4.9 % rate of ankle arthrodesis as a secondary procedure. Arthroscopic group had a significantly lower rate of wound dehiscence following ankle ligament procedures than non-arthroscopic group.

Conclusion

Concomitant ankle arthroscopy procedures performed with ankle ligament procedures did not decrease the rate of reoperation. However, there was a lower incidence of ankle arthrodesis and a lower rate of wound complications in the arthroscopic group when compared to those in non-arthroscopic group. Based on the results of the study, which analysed 16.069 patients, concomitant ankle arthroscopy is recommended.

Level of evidence

IV.

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References

  1. Bell SJ, Mologne TS, Sitler DF, Cox JS (2006) Twenty-six-year results after Broström procedure for chronic lateral ankle instability. Am J Sports Med 34(6):975–978

    Article  PubMed  Google Scholar 

  2. Best MJ, Buller LT, Miranda A (2015) National trends in foot and ankle arthrodesis: 17-year analysis of the national survey of ambulatory surgery and national hospital discharge survey. J Foot Ankle Surg 54(6):1037–1041

    Article  PubMed  Google Scholar 

  3. Bischof JE, Spritzer CE, Caputo AM, Easley ME, DeOrio JK, Nunley JA, DeFrate LE (2010) In vivo cartilage contact strains in patients with lateral ankle instability. J Biomech 43(13):2561–2566

    Article  PubMed  PubMed Central  Google Scholar 

  4. Caputo AM, Lee JY, Spritzer CE, Easley ME, DeOrio JK, Nunley JA 2nd, DeFrate LE (2009) In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med 37(11):2241–2248

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cha SD, Kim HS, Chung ST, Yoo JH, Park JH, Kim JH, Hyung JW (2012) Intra-articular lesions in chronic lateral ankle instability: comparison of arthroscopy with magnetic resonance imaging findings. Clin Orthop Surg 4(4):293–299

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cho BK, Kim YM, Kim DS, Choi ES, Shon HC, Park KJ (2012) Comparison between suture anchor and transosseous suture for the modified-Broström procedure. Foot Ankle Int 33(6):462–468

    Article  PubMed  Google Scholar 

  7. Choi WJ, Lee JW, Han SH, Kim BS, Lee SK (2008) Chronic lateral ankle instability: the effect of intra-articular lesions on clinical outcome. Am J Sports Med 36(11):2167–2172

    Article  PubMed  Google Scholar 

  8. Colville MR (1998) Surgical treatment of the unstable ankle. J Am Acad Orthop Surg 6(6):368–377

    Article  CAS  PubMed  Google Scholar 

  9. Ferkel RD, Small HN, Gittins JE (2001) Complications in foot and ankle arthroscopy. Clin Orthop Relat Res 391:89–104

    Article  Google Scholar 

  10. Ferkel RD, Chams RN (2007) Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int 28(1):24–31

    Article  PubMed  Google Scholar 

  11. Garrick JG (1977) The frequency of injury, mechanism of injury, and epidemiology of ankle sprains. Am J Sports Med 6:241–242

    Article  Google Scholar 

  12. Gillespie HS, Boucher P (1971) Watson-Jones repair of lateral instability of the ankle. J Bone Joint Surg Am 53(5):920–924

    Article  CAS  PubMed  Google Scholar 

  13. Gregush RV, Ferkel RD (2010) Treatment of the unstable ankle with an osteochondral lesion: results and long-term follow-up. Am J Sports Med 38(4):782–790

    Article  PubMed  Google Scholar 

  14. Guillo S, Bauer T, Lee JW, Takao M, Kong SW, Stone JW, Mangone PG, Molloy A, Perera A, Pearce CJ, Michels F, Tourné Y, Ghorbani A, Calder J (2013) Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res 99(8 Suppl):S411–S419

    Article  CAS  PubMed  Google Scholar 

  15. Harris IA, Mourad M, Kadir A, Solomon MJ, Young JM (2007) Publication bias in abstracts presented to the annual meeting of the American Academy of Orthopaedic Surgeons. J Orthop Surg (Hong Kong) 15(1):62–66

    Article  CAS  Google Scholar 

  16. Hedeboe J, Johannsen A (1979) Recurrent instability of the ankle joint. Surgical repair by the Watson-Jones method. Acta Orthop Scand 50(3):337–340

    Article  CAS  PubMed  Google Scholar 

  17. Hintermann B, Valderrabano V, Boss A, Trouillier HH, Dick W (2004) Medial ankle instability: an exploratory, prospective study of fifty-two cases. Am J Sports Med 32(1):183–190

    Article  PubMed  Google Scholar 

  18. Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Lateral instability of the ankle treated by the Evans procedure. A long-term clinical and radiological follow-up. J Bone Joint Surg Br 70(3):476–480

    Article  CAS  PubMed  Google Scholar 

  19. Kennedy JG, Smyth NA, Fansa AM, Murawski CD (2012) Anatomic lateral ligament reconstruction in the ankle: a hybrid technique in the athletic population. Am J Sports Med 40(10):2309–2317

    Article  PubMed  Google Scholar 

  20. Komenda GA, Ferkel RD (1999) Arthroscopic findings associated with the unstable ankle. Foot Ankle Int 20(11):708–713

    Article  CAS  PubMed  Google Scholar 

  21. Krips R, van Dijk CN, Halasi PT, Lehtonen H, Corradini C, Moyen B, Karlsson J (2001) Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a multicenter study. Foot Ankle Int 22(5):415–421

    Article  CAS  PubMed  Google Scholar 

  22. Lee KT, Park YU, Kim JS, Kim JB, Kim KC, Kang SK (2011) Long-term results after modified Brostrom procedure without calcaneofibular ligament reconstruction. Foot Ankle Int 32(2):153–157

    Article  PubMed  Google Scholar 

  23. Leopold SS, Warme WJ, Fritz Braunlich E, Shott S (2003) Association between funding source and study outcome in orthopaedic research. Clin Orthop Relat Res 415:293–301

    Article  Google Scholar 

  24. Mabit C, Tourné Y, Besse JL, Bonnel F, Toullec E, Giraud F, Proust J, Khiami F, Chaussard C, Genty C, Sofcot (French Society of Orthopedic and Traumatologic Surgery) (2010) Chronic lateral ankle instability surgical repairs: the long term prospective. Orthop Traumatol Surg Res 96(4):417–423

    Article  CAS  PubMed  Google Scholar 

  25. Maffulli N, Del Buono A, Maffulli GD, Oliva F, Testa V, Capasso G, Denaro V (2013) Isolated anterior talofibular ligament Broström repair for chronic lateral ankle instability: 9-year follow-up. Am J Sports Med 41(4):858–864

    Article  PubMed  Google Scholar 

  26. Muijs SP, Dijkstra PD, Bos CF (2008) Clinical outcome after anatomical reconstruction of the lateral ankle ligaments using the Duquennoy technique in chronic lateral instability of the ankle: a long-term follow-up study. J Bone Joint Surg Br 90(1):50–56

    Article  CAS  PubMed  Google Scholar 

  27. O’Loughlin PF, Murawski CD, Egan C, Kennedy JG (2009) Ankle instability in sports. Phys Sportsmed. 37(2):93–103

    Article  PubMed  Google Scholar 

  28. Petersen W, Rembitzki IV, Koppenburg AG, Ellermann A, Liebau C, Brüggemann GP, Best R (2013) Treatment of acute ankle ligament injuries: a systematic review. Arch Orthop Trauma Surg 133(8):1129–1141

    Article  PubMed  PubMed Central  Google Scholar 

  29. Prisk VR, Imhauser CW, O’Loughlin PF, Kennedy JG (2010) Lateral ligament repair and reconstruction restore neither contact mechanics of the ankle joint nor motion patterns of the hindfoot. J Bone Joint Surg Am 92(14):2375–2386

    Article  PubMed  PubMed Central  Google Scholar 

  30. Sammarco VJ (2001) Complications of lateral ankle ligament reconstruction. Clin Orthop Relat Res 391:123–132

    Article  Google Scholar 

  31. Scherer RW, Langenberg P, von Elm E (2001) Full publication of results initially presented in abstracts. Cochrane Database Syst Rev 18:2. doi:10.1002/14651858.MR000005.pub3

    Google Scholar 

  32. Schmal H, Pilz IH, Henkelmann R, Salzmann GM, Südkamp NP, Niemeyer P (2014) Association between intraarticular cytokine levels and clinical parameters of osteochondritis dissecans in the ankle. BMC Musculoskelet Disord 22(15):169

    Article  Google Scholar 

  33. Simonson DC, Roukis TS (2014) Safety of ankle arthroscopy for the treatment of anterolateral soft-tissue impingement. Arthroscopy 30(2):256–259

    Article  PubMed  Google Scholar 

  34. Tourné Y, Mabit C, Moroney PJ, Chaussard C, Saragaglia D (2012) Long-term follow-up of lateral reconstruction with extensor retinaculum flap for chronic ankle instability. Foot Ankle Int 33(12):1079–1086

    Article  PubMed  Google Scholar 

  35. van der Rijt AJ, Evans GA (1984) The long-term results of Watson-Jones tenodesis. J Bone Joint Surg Br 66(3):371–375

    Article  PubMed  Google Scholar 

  36. van Dijk CN, van Bergen CJ (2008) Advancements in ankle arthroscopy. J Am Acad Orthop Surg 16(11):635–646

    Article  PubMed  Google Scholar 

  37. van Dijk CN, Bossuyt PM, Marti RK (1996) Medial ankle pain after lateral ligament rupture. J Bone Joint Surg Br 78(4):562–567

    PubMed  Google Scholar 

  38. Wainright WB, Spritzer CE, Lee JY, Easley ME, DeOrio JK, Nunley JA, DeFrate LE (2012) The effect of modified Broström-Gould repair for lateral ankle instability on in vivo tibiotalar kinematics. Am J Sports Med 40(9):2099–2104

    Article  PubMed  PubMed Central  Google Scholar 

  39. Waterman BR, Owens BD, Davey S, Zacchilli MA, Belmont PJ Jr (2010) The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 92(13):2279–2284

    Article  PubMed  Google Scholar 

  40. Werner BC, Burrus MT, Park JS, Perumal V, Gwathmey FW (2015) Trends in ankle arthroscopy and its use in the management of pathologic conditions of the lateral ankle in the united states: a national database study. Arthroscopy 31(7):1330–1337

    Article  PubMed  Google Scholar 

  41. Zwiers R, Wiegerinck JI, Murawski CD, Fraser EJ, Kennedy JG, van Dijk CN (2015) Arthroscopic treatment for anterior ankle impingement: a systematic review of the current literature. Arthroscopy 31(8):1585–1596

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hospital for Special Surgery, 523 East 72nd Street, Suite 507, New York, NY, 10021, USA

    Youichi Yasui, Christopher D. Murawski, Adi Wollstein & John G. Kennedy

  2. Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Youichi Yasui

  3. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Christopher D. Murawski & Adi Wollstein

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  1. Youichi Yasui
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  2. Christopher D. Murawski
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  3. Adi Wollstein
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  4. John G. Kennedy
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Correspondence to John G. Kennedy.

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Yasui, Y., Murawski, C.D., Wollstein, A. et al. Reoperation rates following ankle ligament procedures performed with and without concomitant arthroscopic procedures. Knee Surg Sports Traumatol Arthrosc 25, 1908–1915 (2017). https://doi.org/10.1007/s00167-016-4207-x

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  • DOI: https://doi.org/10.1007/s00167-016-4207-x

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