old STG Lateral Ankle Instability 2022 student 2.pdf

Someone w of instab feeling Chronic Lateral Ankle Instability Sean T. Grambart DPM FACFAS Assistant Dean of Clinical Affairs, DMU-CPMS Past-President, American College of Foot and Ankle Surgeons Objectives » Demonstrate knowledge of the etiology of ankle instability » Recognize imaging techniques to...

Someone w of instab feeling Chronic Lateral Ankle Instability Sean T. Grambart DPM FACFAS Assistant Dean of Clinical Affairs, DMU-CPMS Past-President, American College of Foot and Ankle Surgeons Objectives » Demonstrate knowledge of the etiology of ankle instability » Recognize imaging techniques to identify instability of the ankle » Demonstrate knowledge of the management of ankle instability Ankle Injuries » Among the most common injuries presenting to primary care providers and emergency departments. » Approximately 2 million ankle sprains occur in the USA annually. » Ankle sprains can result in significant time lost to disability. » Repeated sprains can result in chronic ankle instability, degenerative joint changes, and chronic pain. Czajka CM, Tran E, Cai AN, DiPreta JA. Ankle sprains and instability. Med Clin North Am. 2014 Mar;98(2):313-29. Lateral Anatomy inf Extensor Retin o very important blis crosses peronealtendons Lateral Anatomy calc fib Lateral Anatomy enteral tato calc dig Chronic Ankle Instability » Acute ankle sprains can lead to chronic ankle instability – Biomechanical causes: Pathologic laxity – Recurrent ankle sprains keengetting consistent sprains on monithy oryearly Basis – Connective soft tissue disorder Czajka CM, Tran E, Cai AN, DiPreta JA. Ankle sprains and instability. Med Clin North Am. 2014 Mar;98(2):313-29. General Recovery most 6 weeks to 3 months Up to 42% of patient will still have some feeling of instability at 1 year 3-34% Re-Sprains Poor Prognostic Factor Training 3 or more times per week are conservative treatment Types of Instability feel like lis is goingout structura Functional Instability Mechanical Instability proprioceptive proprioception Damage to N Defjimiting insursPresence of symptoms of Patients who have giving way without demonstrable clinical or radiographic ligamentous laxity signs of laxity Symptoms… Functional or Mechanical » Repetitive episodes of “giving way” » History severe ankle sprain or multiple ankle sprains » Sense of “looseness” Function me 4h » Apprehension about their next instability ᵗ episode couch s a » Difficulties with walking on uneven ground once» Pain is not a predominant symptom Trio share Physical Exam Talar Tilt Area’s of Tenderness Evaluate strength of peroneal tendons Evaluate proprioception via modifiedRomberg test modified where stand up on one leg time Clinical Stress Exam when on affected Anterior Drawer ant drawer test Gmore specific than MRI Dorsified site into slightDertlantarflex Biomechanical and Structural Etiologies Correct the Deforming force ✓Fixed calcaneal Varus ✓Tibial Varum ✓Rigid plantarflexed first ray ✓Phasic overactivity of the anterior and posterior tibial tendons ✓Calcaneal and Talar Torsional abnormalities as will lead to failure Physical Exam Varus Call Deform I Hypermobility 7 thumb to wrist test Stress Exam anterior Drawer done w tray talar tilt do common peroneal N Block Must talar t.ie sa more than 5 stay f lateral talo calc Subtalar Joint Instability Not as common as fat ankle instab STJ Instability Diagnosed as: – Medial displacement of more than 5mm of the talus to the calcaneus – Talocalcaneal tilt of more than 5° Brostrom , ACTA Chir Scand, 132: 551-565 1966 MRIs t.imiisiii.isfitnarsia and Not Dynamic Associated Injuries Found in Chronic Lateral Ankle Instability Benedict F. DiGiovanni, Carlos J. Fraga, Bruce E. Cohen and Michael J. Shereff Foot Ankle Int 2000 21: 809 Conservative Treatment » Taping and Bracing are both effective, Iota especially in preventing recurrent sprains feed to » Bracing is more cost effective and faster » Semirigid braces with stirrup design » Proprioception effective for preventive training » Peroneal Strengthening » Plyometric training Box Jump Stabilizes core aswell 91 Nothing to do w MRI Indications for Surgical Intervention ✦Non-Operative failure still have issues ✦Pain with “giving away” prob impingement ✦Mechanical / Functional instability ✦Positive stress test syn or osteoidon not done anymore tissue ftp ge overtishten ST Yeavr.at useallograft Treatment of Chronic Ankle Instability » Surgical Treatment – Indirect Repair (Historical) A – Watson-Jones B – Evans C – Chrisman-Snook – Sacrifice the PB Czajka CM, Tran E, Cai AN, DiPreta JA. Ankle sprains and instability. Med Clin North Am. 2014 Mar;98(2):313-29. 2 incisio 1long incision or Brostrom and BrostromGould is primary repair of anterior talof his or Calef big Treatment of Chronic Ankle Instability » Surgical Treatment – Direct repair Brostrom took inferior extensor retin and attached it to repair inweasing site reinforcement Schnirring-Judge, Molly. Perlman, Michael D. Chapter 35: Chronic Ankle Conditions. McGlamry’s Comprehensive Guide to Foot and Ankle Surgery, Third Edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2013. Treatment of Chronic Ankle Instability » Surgical Treatment – Direct repair Brostrom-Gould – 60% increase in strength Schnirring-Judge, Molly. Perlman, Michael D. Chapter 35: Chronic Ankle Conditions. McGlamry’s Comprehensive Guide to Foot and Ankle Surgery, Third Edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2013. slightly plantFlex and ever Contraindications for Brostrom orvery hypermobile » Failed Brostrom » Generalized Laxity » Poor Tissue/BMI too high BMI wont work well Secure tendon w Anatomic Reconstruction » Surgical Treatment – Indirect Repair (Contemporary) Autograft uses suture good tod ant.asrei oftalaunec – split PL free graft (Dockery) internalBracing Biotenodesis screw since its Allografts Willo – Fresh-frozen PL Synthetics – Arthrex Internal Brace take torecreate if rail youhave allograft as backup plan » Post Operative Course – – – – NWB for 2 – 4 weeks (Splint then cast once edema is controlled) Walking cast/CAM boot for 2 – 4 weeks Physical therapy at 6 – 8 weeks Running – 3 months at the earliest internal Bracing is a bit quicker