Abstract
Purpose
To evaluate the outcomes of patients with supination-adduction (SAD) type II (OTA/AO 44A2) fractures who had a lateral ankle ligament rupture repaired compared with patients who did not have a lateral ankle ligament repaired using patients who underwent fibula fracture fixation as a control group.
Methods
A retrospective analysis of all 104 patients diagnosed with SAD type II fractures from January 2011 to December 2020 and managed operatively was performed. The patients were divided into three groups: 32 patients with ruptures of the lateral ligaments that were not repaired (group A), 34 patients with ruptures of the lateral ligaments that were repaired (group B), and 38 patients with fibula fracture fixation acting as the control group (group C). The objective outcomes including radiographic findings, the ankle range of motion, the manual ankle stress tests, and complications were gained from the record of the last time in outpatient clinics. The functional outcomes including the identification of functional ankle instability (IdFAI) scores were collected postoperatively at 12-month intervals to assess clinical outcomes. The Manchester Oxford Foot Questionnaire (MOXFQ) and Karlsson scoring scale were also recorded at the last follow-up.
Results
The mean follow-up of the objective and subjective functional outcomes was 23.4 (range, 13–42) and 76.9 (range, 25–134) months, respectively. There was no significant difference in the radiographic findings, the ankle range of motion and complications between the three groups. All ankles were found to be stable using the manual ankle stress test in both group A and group B. The IdFAI scores showed a significant difference between group A and group B (1.12 ± 1.3 vs 0.35 ± 0.69; p < 0.001) in the first year of follow-up and no significant difference after the first year. No differences were noted in MOXFQ scores or Karlsson scores among the groups.
Conclusion
Directly repairing the lateral ligament could minimize the proportion of the first year of postoperative functional ankle instability, although the final stability of the ankle and clinical outcomes were not significantly different in SAD type II fractures.
Level of evidence
Level III, retrospective comparative case series.
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Data availability
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
Benedick A, Kavanagh M, Audet M, Simske NM, Vallier HA (2021) Supination adduction ankle fractures are associated with arthritis and poor outcomes. J Orthop Trauma 35(6):e195–e201
Cao Y, Xu Y, Huang Q, Xu Y, Hong Y, Xu X (2021) Outcomes of ossicle resection and anatomic reconstruction of lateral ligaments for chronic ankle instability with large malleolar accessory ossicles. Foot Ankle Surg 27(7):736–741
Carney J, Ton A, Alluri RK, Grisdela P, Marecek GS (2020) Complications following operative treatment of supination-adduction type II (AO/OTA 44A2.3) ankle fractures. Injury 51(6):1387–1391
Chun TH, Park YS, Sung KS (2013) The effect of ossicle resection in the lateral ligament repair for treatment of chronic lateral ankle instability. Foot Ankle Int 34(8):1128–1133
Dawson J, Doll H, Coffey J et al (2007) Responsiveness and minimally important change for the Manchester-Oxford foot questionnaire (MOXFQ) compared with AOFAS and SF-36 assessments following surgery for hallux valgus. Osteoarthritis Cartilage 15(8):918–931
Furman BD, Olson SA, Guilak F (2006) The development of posttraumatic arthritis after articular fracture. J Orthop Trauma 20(10):719–725
Githens MF, DeBaun MR, Jacobsen KA, Ross H, Firoozabadi R, Haller J (2021) Plafond malreduction and Talar dome impaction accelerates arthrosis after supination-adduction ankle fracture. Foot Ankle Int 42(10):1245–1253
Gribble PA, Bleakley CM, Caulfield BM et al (2016) Evidence review for the 2016 International Ankle Consortium consensus statement on the prevalence, impact and long-term consequences of lateral ankle sprains. Br J Sports Med 50(24):1496–1505
Guo C, Liu Z, Xu Y, Li X, Zhu Y, Xu X (2018) Supramalleolar osteotomy combined with an intra-articular osteotomy for the reconstruction of malunited medial impacted ankle fractures. Foot Ankle Int 39(12):1457–1463
Guo C, Zhu Y, Hu M, Deng L, Xu X (2016) Reliability of measurements on lateral ankle radiographs. BMC Musculoskelet Disord 17:297
Gurav RS, Ganu SS, Panhale VP (2014) Reliability of the Identification of Functional Ankle Instability (IdFAI) Scale Across Different Age Groups in Adults. N Am J Med Sci 6(10):516–518
Haller JM, O’Toole R, Graves M et al (2015) How much articular displacement can be detected using fluoroscopy for tibial plateau fractures? Injury 46(11):2243–2247
Haller JM, Ross H, Jacobson K, Ou Z, Rothberg D, Githens M (2020) Supination adduction ankle fractures: Ankle fracture or pilon variant? Injury 51(3):759–763
Haraguchi N, Toga H, Shiba N, Kato F (2007) Avulsion fracture of the lateral ankle ligament complex in severe inversion injury: incidence and clinical outcome. Am J Sports Med 35(7):1144–1152
Holzer N, Salvo D, Marijnissen AC et al (2015) Radiographic evaluation of posttraumatic osteoarthritis of the ankle: the Kellgren-Lawrence scale is reliable and correlates with clinical symptoms. Osteoarthritis Cartilage 23(3):363–369
Karlsson J, Peterson L (1991) Evaluation of ankle joint function: the use of a scoring scale. Foot 1(1):15–19
Kerkhoffs GM, Handoll HH, de Bie R, Rowe BH, Struijs PA (2007) Surgical versus conservative treatment for acute injuries of the lateral ligament complex of the ankle in adults. Cochrane Database Syst Rev (2):CD000380
McConnell T, Tornetta P 3rd (2001) Marginal plafond impaction in association with supination-adduction ankle fractures: a report of eight cases. J Orthop Trauma 15(6):447–449
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170
Morley D, Jenkinson C, Doll H et al (2013) The Manchester-Oxford Foot Questionnaire (MOXFQ): development and validation of a summary index score. Bone Joint Res 2(4):66–69
Pijnenburg AC, Bogaard K, Krips R, Marti RK, Bossuyt PM, van Dijk CN (2003) Operative and functional treatment of rupture of the lateral ligament of the ankle. A randomised, prospective trial. J Bone Joint Surg Br 85(4):525–530
Roos KG, Kerr ZY, Mauntel TC, Djoko A, Dompier TP, Wikstrom EA (2017) The epidemiology of lateral ligament complex ankle sprains in national collegiate athletic association sports. Am J Sports Med 45(1):201–209
Simon J, Donahue M, Docherty C (2012) Development of the Identification of Functional Ankle Instability (IdFAI). Foot Ankle Int 33(9):755–763
Takao M, Miyamoto W, Matsui K, Sasahara J, Matsushita T (2012) Functional treatment after surgical repair for acute lateral ligament disruption of the ankle in athletes. Am J Sports Med 40(2):447–451
Thompson C, Schabrun S, Romero R, Bialocerkowski A, van Dieen J, Marshall P (2018) Factors contributing to chronic ankle instability: a systematic review and meta-analysis of systematic reviews. Sports Med 48(1):189–205
Torrano-Orduña HB, King-Martinez AC, Cuellar-Avaroma A et al (2022) AOFAS and Karlsson-Peterson scales in evaluating patients treated with modified Broström-Gould and suture tape augmentation for ankle instability: a performance analysis. J Foot Ankle 16(2):119–125
van den Bekerom MP, Kerkhoffs GM, McCollum GA, Calder JD, van Dijk CN (2013) Management of acute lateral ankle ligament injury in the athlete. Knee Surg Sports Traumatol Arthrosc 21(6):1390–1395
White WJ, McCollum GA, Calder JD (2016) Return to sport following acute lateral ligament repair of the ankle in professional athletes. Knee Surg Sports Traumatol Arthrosc 24(4):1124–1129
Yasuda T, Shima H, Mori K, Tsujinaka S, Neo M (2017) Simultaneous reconstruction of the medial and lateral collateral ligaments for chronic combined ligament injuries of the ankle. Am J Sports Med 45(9):2052–2060
Zhang J, Zhang Y, Liang J, Liu P, Zhao H (2021) Pathoanatomy and clinical outcomes following operative treatment of supination adduction type II medial malleolus fractures-a cohort study. Ann Palliat Med 10(7):7802–7812
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The authors gratefully acknowledge all collaborating researchers in collecting information during this study. We would also like to thank the subjects whose participation made this study possible.
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Guo, C., Xu, Y., Cao, Y. et al. Does a rupture of the lateral ankle ligament need to be repaired in supination-adduction type II (OTA/AO 44A2) fractures?. Arch Orthop Trauma Surg 144, 229–237 (2024). https://doi.org/10.1007/s00402-023-05044-0
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DOI: https://doi.org/10.1007/s00402-023-05044-0