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Mr Simon Moyes - Lateral Ligament Instability

Mr Simon Moyes - Lateral Ligament Instability

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Published by Skylark Creative
Lateral ligament instability is one of the most common ankle problems that Simon Moyes treats using arthroscopic diagnosis and surgery. This article discusses the medical background to arthroscopic surgery for this condition.

Mr Simon Moyes specialises in arthroscopic and minimally invasive treatment for problems of the knee, shoulder, foot and ankle. He uses arthroscopy to carry out effective and accurate diagnoses of joint problems.

Simon Moyes combines the latest in sophisticated technology with his considerable experience as an orthopaedic surgeon.

Based in London, Simon Moyes consults in three different London based locations.

For further information on Simon Moyes please see:
http://www.ankle-arthroscopy.co.uk/about-simon-moyes/
http://www.simonmoyes.com/about.php
Lateral ligament instability is one of the most common ankle problems that Simon Moyes treats using arthroscopic diagnosis and surgery. This article discusses the medical background to arthroscopic surgery for this condition.

Mr Simon Moyes specialises in arthroscopic and minimally invasive treatment for problems of the knee, shoulder, foot and ankle. He uses arthroscopy to carry out effective and accurate diagnoses of joint problems.

Simon Moyes combines the latest in sophisticated technology with his considerable experience as an orthopaedic surgeon.

Based in London, Simon Moyes consults in three different London based locations.

For further information on Simon Moyes please see:
http://www.ankle-arthroscopy.co.uk/about-simon-moyes/
http://www.simonmoyes.com/about.php

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Published by: Skylark Creative on Jun 02, 2009
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01/25/2011

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http://www.ankle-arthroscopy.co.uk/surgeon/lateral_ligament_instability 
Lateral ligament instability
Lateral ligament injury of the ankle is very common (90) with 1 in 10,000sustaining the injury per day it is the commonest ligament injury seen bysurgeons. Repeated lateral ligament injuries interfere with normal daily life(90, 91) and with chronic instability a minor trauma can cause a significantinversion injury with unpredictable outcome (90, 92).Surgery to correct lateral ligament instability was described as early as 1949by Nilsonne who described a peroneus brevis transfer (93). But it wasBrostrom (94) who showed that direct repair of the lateral ligament waspossible even years after acute injury and Hamilton (95) reported 93% goodor excellent results with a modified Brostrom procedure.With lateral ligament tears, it is the anterior talo-fibular ligament that fails first -calcaneo fibular ligament rupture is rare (94). A repair/reconstruction ideallyneeds to reproduce the ATFL in its anatomic position (96) and this is what aBrostrom or Hamilton procedure does.The diagnosis of lateral ligament instability is straightforward - if there is ahistory of instability, the lateral ligaments are tender and moving the ankledemonstrates excessive inversion and an exaggerated anterior draw test.This is when the foot and talusare translocated anteriorly in the mortis and theamount of anterior movement recorded and compared with the normal side .
 
Radiographic lateral stress views can be performed applying set forces of inversion (90). But results of such instability testing can be questionable if thecalcaneofibular ligament is intact and these patients still have instability (97,98)Arthroscopically, there is ballooning of the anterolateral capsule whichappears and feels thinner than normal. One frequently sees scarring of thelateral gutter and syndesmosis with associated loose bodies or ossicles andlateral dome or plafond chondral changes.Treatment is either an open or closed modified Brostrom repair with threeweeks in a below-knee cast then standard physiotherapy. Arthroscopic resultsare as good as open (99).Krips R (100) in 2006 produced an excellent article regarding ankle instabilityinjuries and reconstruction. Takao M (101) in 2005 clearly demonstrated intheir series of 72 patients that arthroscopy can be used to diagnose the causeof residual pain after and ankle sprain in most cases that are otherwiseundiagnosable by clinical examination and imaging. Also Okuda R (102) in2005 interestingly showed in their series of 30 consecutive patients that lateralligament reconstruction can be successful regardless of focal chondral lesionsas long as pre-op weight-bearing x-rays do not show any joint spacenarrowing.
References
(90) Glasgow M, Jackson A, Jamieson A M, ‘Instability of the ankle after injuryto the lateral ligament’ JBJS 1980; 62B:196(91) Sefton G K, George J, Fitton J M, McMullen H, ‘Reconstruction of theanterior talofibular ligament for the treatment of the unstable ankle’ JBJS1979; 61B:352 .(92) Hawkins R B, ‘Arthroscopic repair for chronic lateral ankle instability’ InGuhl J F, ed ‘Foot and ankle arthroscopy’ Thorafore , N J: Slack, 1993: 155.(93) Nilsonne H, ‘Making a new ligament in ankle sprain’ JBJS 1949 ; 31A :380(94) Brostrom L, ‘Sprained ankles : VI. Surgical treatment of ‘chronic’ ligamentruptures’ Acta Chir Scand 1966 ; 132 : 551(95) Hamilton W G, Thomson F M, Snow S W, ‘The modified Brostromprocedure for lateral ankle instability’ Foot Ankle 1993; 14:1(96) Colville M R, Marder R A, Zarins B ‘Reconstruction of the lateral ankleligaments - a biomechanical analysis’ Am J Sports Med 1991 ; 20 :594.(97) Johnson E E, Markolf K L, ‘The contribution of the anterior talofibular ligament to ankle joint laxity’ JBJS 1983; 65A:81 .(98) Ruth C J, ‘The surgical treatment of the fibular collateral ligament of theankle’ JBJS 1961; 43A:229(99) Gollehon D L, Drez D, ‘Ankle arthroscopy - approaches and technique’Orthopaedics 1983; 6:1150(100) Krips R, de Vries J, van Dijk C N, ‘Ankle Instability’ Foot and AnkleClinics 2006; 11:2; 311-29

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