CHRONIC ALTERAL ANKLE INSTABILITY/OCDS/ARTHROSCOPY

Question 1

what is the clockwise exam used in the physical exam for chronic lateral ankle instability?

Answer 1

AITFL, ATFL, sinus tarsi, 5th met base/CC joint, CFL/distal fibula, peroneal tendons/fibula

Question 2

alterations in sensorimotor fxn of lateral ankle result in the patient entering a continuum of disability as evidenced by the >30% of ankle sprains that develop into chronic ankle instability and up to 78% of CAI cases that develop post traumatic ankle OA

Answer 2

chronic lateral ankle instability

Question 3

imaging used?

Answer 3

plain film radiograph
-stress XR, better than normal WB to test laxity, but false negatives can occur

MRI-modality of choice

Question 4

associated pathology?

Answer 4

peroneal tenosynovitis, antero/lateral ankle impingement, ankle synovitis-most common

Question 5

conservative therapy for ankle stabilization?

Answer 5

dedicated 6-12 week program

• unless previously failed formal patient
• must focus on proprioceptive central and strength

ankle bracing

sinus tarsi injections

Question 6

what are the surgical candidates for ankle stabilization?

Answer 6

fail formal physical therapy

demonstrate early degenerative arthritis

have associated injuries/pathology causing significant morbidity

Question 7

what are the surgical interventions?

Answer 7

anatomic
-when trying to mimic original location of ankle ligaments, use different augmentation tissues

non-anatomic

• include use of another structure to accomplish fxn of ligament when it is impossible to repair directly
• tenodesis procedures

Question 8

benefits of anatomic repairs? disadvantages?

Answer 8

simplicity of procedure
restoration of normal anatomy and joint kinematics
maintenance of ankle and STJ motion

reliance on potentially poor or lax local tissues
intro of allograft (infection, rejection, etc.)

Question 9

benefits of non anatomic repairs? disadvantages?

Answer 9

can overcome insufficient native tissues
limits ankle and STJ instability

limits ankle and STJ motion
changes joint kinematics
alteration of hind foot biomechanics
too stiff

• all sacrifice peroneal tendons in some way to provide a tenodesis effect across the ankle and STJ
• single ligament-Watson-Jones, Lee, Evans
• double ligament -Christman-snook

Question 10

this technique enhances original ligaments with extensor retinaculum without sacrificing other anatomic structures

90% effective rate in recent studies

Answer 10

Brostrum Gould

Question 11

anatomic vs non anatomic surgical interventions?

Answer 11

anatomic for active populations

non anatomic is for sedentary and failed anatomic repairs

Question 12

indications for ankle arthroscopy?

Answer 12

impingement, OCDs, ankle arthrodesis, loose bodies, ankle instability, septic arthritis, arthrofibrosis, ankle OA, synovitis, and fracture

Question 13

why scope for an ankle arthroscopy?

Answer 13

scope found 95% of intra articular lesions and open procedure only found 20%

arthroscopy useful to confirm abnormal talar tilt when diagnosis of lateral instability was not certain