Lateral Ligament Tear: The Case For Acute Ligament Repair James A - - PowerPoint PPT Presentation

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Apr 08, 2023 318 likes •592 views

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

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Lateral Ligament Tear: The Case For Acute Ligament Repair

James A Nunley, MD Duke University

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Duke University Medical Center

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

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Duke University Medical Center

What is the Literature Saying?

N = 2 x 50 (atf, 30 atf; atf+cf, 20)

conservative treatment surgical repair

Surgical repair

no benefit higher complication rate

Br JBJS 66-B, March 1984

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Duke University Medical Center

What is the Literature Saying ?

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Duke University Medical Center

What is the Literature Saying ?

N = 2562 adult males

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Duke University Medical Center

What is the Literature Saying ?

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Duke University Medical Center

High incidence of

associated intra-articular pathology

Arthroscopy findings in 28

patients with chronic ankle instability:

Associated pathology

Komenda & Ferkel (1999)
54 patients
93% had intra-articular

pathology

Hintermann (2002)
66% had chondral damage
Hua et al (2010)
85 patients
90% had intra-articular

pathology

Lee et al (2011)
28 patients
100% intra-articular

pathology

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Duke University Medical Center

17 year old basketball player with no history of previous injury sustains and inversion ankle sprain at the beginning of the season. He has a potential scholarship

ffer but needs to play his

senior year Physical Exam: Mild swelling, dramatic tenderness over the deltoid and lateral ankle No malalignment in the foot

r ankle

Lateral Ligament Tear: The Case For Acute Ligament Repair

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Duke University Medical Center

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Duke University Medical Center

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Duke University Medical Center

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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.

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Duke University Medical Center

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Duke University Medical Center

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Duke University Medical Center

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Duke University Medical Center

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Duke University Medical Center

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Duke University Medical Center

Position for the Internal Brace

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Duke University Medical Center

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Duke University Medical Center

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Duke University Medical Center

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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

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Duke University Medical Center

Osteochondral Fractures

Remember

lesions found in 89% of acute lateral ankle sprains

Lateral Ankle Sprain – Surgery !

Taga et al: Am J Sports Med 21:120, 1993

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Duke University Medical Center

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Duke University Medical Center

Unstable BIG Lateral Process Fragment

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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