Lateral Ligament Tear: The Case For Acute Ligament Repair James A Nunley, MD Duke University
DISCLOSURE I am a consultant for Wright Medical, Stryker, Exactech, DT Medsurg Orthofix, Treace Medical I receive royalties from Exactech I receive fellowship support from Integra, Breg and Acumed I have no conflicts related to this presentation Duke University Medical Center
What is the Literature Saying? • N = 2 x 50 (atf, 30 atf; atf+cf, 20) conservative treatment surgical repair Br JBJS 66-B, March 1984 • Surgical repair no benefit higher complication rate Duke University Medical Center
What is the Literature Saying ? Duke University Medical Center
What is the Literature Saying ? • N = 2562 adult males Duke University Medical Center
What is the Literature Saying ? Duke University Medical Center
Associated pathology • Komenda & Ferkel (1999) • High incidence of • 54 patients associated intra-articular • 93% had intra-articular pathology pathology • Arthroscopy findings in 28 • Hintermann (2002) patients with chronic ankle • 66% had chondral damage instability: • Hua et al (2010) • 85 patients • 90% had intra-articular pathology • Lee et al (2011) • 28 patients • 100% intra-articular pathology Duke University Medical Center
Lateral Ligament Tear: The Case For Acute Ligament Repair Physical Exam: Mild swelling, 17 year old basketball player dramatic tenderness over with no history of previous the deltoid and lateral ankle injury sustains and No malalignment in the foot inversion ankle sprain at the or ankle beginning of the season. He has a potential scholarship offer but needs to play his senior year Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
MRI FINDINGS IMPRESSION: 1. Rupture of the ATFL and the calcaneofibular ligaments. 2. Partial tear of the anterior fibers of the deltoid ligament with associated bone marrow edema about the middle subtalar facet, consistent with contusion. 3. Bimalleolar soft tissue swelling and hematoma about the ankle with a small joint effusion. Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
Position for the Internal Brace Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
Duke University Medical Center
My Indication for an Acute Repair Free fragment OLT Peroneal tendon tear or dislocation Ligament interposed within joint on MRI Deltoid ligament tear Duke University Medical Center
Lateral Ankle Sprain – Surgery ! Osteochondral Fractures • Remember lesions found in 89% of acute lateral ankle sprains Duke University Medical Center Taga et al: Am J Sports Med 21:120, 1993
Duke University Medical Center
Unstable BIG Lateral Process Fragment Duke University Medical Center
What Does the Literature Say ? Return to Sports Following Acute Repair in Professional Athletes 42 athletes had acute repairs for Grade 3 tears Concomitant injury in 12 (29%) either OLT or deltoid injury Conclusion – Safe and effective in returning to sports in 10 weeks Knee Surg Sports Traumatol Athros 2016 Duke University Medical Center
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