Pro: Reconstruction: Stronger, More Stable Result Mark Glazebrook MD - - PowerPoint PPT Presentation

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Pro: Reconstruction: Stronger, More Stable Result Mark Glazebrook MD - - PowerPoint PPT Presentation

Feb 18, 2024 347 likes •809 views

Dalhosie University Halifax Nova Scotia Mark Glazebrook MSc., PhD, MD, FRCS(C), Dip Sports Med Associate Professor Dalhousie University Queen Elizabeth II health sciences Center Halifax, Nova Scotia Panel: 35-Year-Old Recreational Basketball

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Mark Glazebrook

MSc., PhD, MD, FRCS(C), Dip Sports Med

Associate Professor Dalhousie University Queen Elizabeth II health sciences Center Halifax, Nova Scotia

Dalhosie University Halifax Nova Scotia

Pro: Reconstruction: Stronger, More Stable Result Mark Glazebrook MD PhD

Panel: 35-Year-Old Recreational Basketball Player with Recurrent Ankle Sprain Panel Moderator: Phinit Phistikul, MD 2:08 PM

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Mark Glazebrook Disclosure Statement

Mark Glazebrook has received something of value in the past 1 year (≥ $500.00) or served as a Journal review er from a commercial company or institution related directly or indirectly to the subject of this presentation, as noted below.

a = research/institutional support, b = misc. non-income support, c = royalties, d = stock/options, e = consultant/employee f = Journal review er

NAME: DISCLOSURE: COMPANY/SOURCE: 1. Glazebrook e Stryker Wright Inc. 2. Glazebrook a,e Ferring Inc. 3. Glazebrook a,e Cartiva Inc 4. Glazebrook ae Smith & Nephew 5. Glazebrook f Foot & Ankle International 6. Glazebrook f JBJS(A) 7. Glazebrook f The Bone & Joint Journal 8. Glazebrook f CORR 9. Glazebrook Past BOD Member AOFAS

  • 10. Glazebrook

President Elect/BOD Canadian Orthopedics Association (COA)

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Acute Ankle Sprains Inversion injury

Lateral 90% Anterior talofibular ligament (ATFL 70%) Calcaneofibular ligament (CFL 20%) Syndesmotic (High sprain) injuries 10% PTFL and deltoid (w ithout #) - Rare

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Injury to Ligaments

Grade 3 Severe :

  • Complete disruption
  • Obvious Laxity on

exam and paradoxically less tender

  • Signal and structural

changes on MRI w ith torn ends visible and fluid filled gap

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Injury to Ligaments

Grade 3 Severe :

  • Complete disruption
  • Obvious Laxity on

exam and paradoxically less tender

  • Signal and structural

changes on MRI w ith torn ends visible and fluid filled gap

Chronic Ankle Instability (CAI)

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Ankle Instability TREATMENT

Non Operative

RICE from Injury Functional Rehabilitation Peroneal Strengthening Achilles Stretching Proprioception Bracing or High Top Shoe w ear Lateral Wedge Orthotic Taping (Ineffective after ~10 min exercise)

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Ankle Instability TREATMENT

Operative

Open (Traditional) Vs Minimally Invasive (MIS)

Anatomic Repair Non Anatomic Repair Anatomic Reconstruction Non Anatomic Reconstruction

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CAI: OPEN Stabilization Outcomes

Conclusion: OPEN ankle stabilization surgery provides good to excellent results

Procedure Level 1 Level 2 Level 3 Level 4 Level 5 Total Grade of Recommendation Open Anatomic Repair 6 4 7 4 21 B Open Non-anatomic Repair 1 1 I Open Anatomic Reconstruction 1 3 12 2 18 A Open Non-anatomic Reconstruction 1 4 23 1 29 B Internal Brace 1 1 2 I Total 1 7 13 43 7 71

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Less is Better!!

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Less is Better!!

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Less is Better!!

THE SHORT GUY is LESS … Better???

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Ankle Instability TREATMENT

Operative

Open (Traditional) Vs Minimally Invasive (MIS)

Anatomic Repair Non Anatomic Repair Anatomic Reconstruction Non Anatomic Reconstruction

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Dalhousie University Halifax Nova Scotia Canada

Minimally Invasive Ankle Stabilization

Tokyo, Japan

International Collaboration

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ESSKA AFAS AIG -since 2013-

European Society of Sports Traumatolgy, Knee surgery and Arthroscopy Ankle and Foot Associates Ankle Instability Group

21 active members

from Europe, North & South America, and

Jin Woo Lee (KOR) Woojin Choi (KOR) Satoru Ozeki (JPN) Masato Takao (JPN) Siu Wah Kong (HKG) Jordi Vega (ESP) Ali Gorbanni (FRA) Andy Molloy (FRA) Stephane Guillo (FRA) Thomas Bauer (FRA) Yves Tourne (FRA) Fredrick Michels (BEL) Anthony Perera (UK) James Calder (UK) James W . Stone (USA) John G. Kennedy (USA) Peter Mangone (USA) Jorge Acevedo (USA) Dominic Carreira (USA) Keneth Hunt (USA) Eric Giza (USA) Bas Pinenburg (NLD) Niek van Dijk (NLD) Caio Nery (BRA) Fernando Raduan (BRA) Jorge Batista (ARG) Christopher Peace (SGP) Helder Pereira (PRT) Numo M. Cortereal (PRT) Jon karlsson (SWE) Mark Glazebrook (CAN)

Stephane Guillo (Chair) Thomas Bauer (Vice Chair) Mark Glazebrook (Secretary)

Chicago 2014

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Logical Approach for Rx CIA MIS RECONSTRUCTION

  • 1. Current Literature Review
  • 2. Anatomy Studies
  • 3. Surgical Technique Development
  • 4. Biomechanical Testiing
  • 5. Future Clinical Studies (Safety & Efficacy)
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Current Literature Review

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Current Literature Available on MIS stabilization Techniques

Minimally Invasive Surgical Treatment of Chronic Ankle Instability: A Systematic Comprehensive Evidence Based Review of Current Literature Kentaro Matsui, Bernard Burgesson, Masato Takao, James Stone, Stephane Guillo, ESSKA AFAS Ankle Instability Group, and Mark Glazebrook

Current Evidence for Treatment of Ankle Instability with MIS??

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Surgical Technique Total Papers Level I Level II Level III Level IV Level V Grade of Recommendation For or Against MIS Non A Repair I NA MIS Non A Reconstruction 6 1 2 3 C For Arthroscopic Repair 19 12 7 C For Arthroscopic Reconstruction 6 1 5 C For

Current Evidence MIS Approaches to Ankle Stabilization.

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Surgical Technique Total Papers Level I Level II Level III Level IV Level V Grade of Recommendation For or Against MIS Non A Repair I NA MIS Non A Reconstruction 6 1 2 3 C For Arthroscopic Repair 19 12 7 C For Arthroscopic Reconstruction 6 1 5 C For

Current Evidence MIS Approaches to Ankle Stabilization.

Limited Evidence to Support MIS for Rx of Ankle Instability!! Further Studies Needed !!1

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Anatomy Studies

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Boney Land Marks ATFL & CFL Foot Prints

Bony landmarks available for minimally invasive lateral ankle stabilization surgery : A cadaveric anatomical study Kentaro Matsui Xavier Martin Oliva Masato Takao Bruno Pereira Moto Gomes Martinez Lozano, ESSKAAFAS Ankle Instability Group, Mark Glazebrook

Submitted for Publication

Kentora Matsui MD PhD Teikyo University Tokyo Japan

Spanish/Catalonia Collaboration

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Boney Land Marks ATFL & CFL Foot Prints

Methods:

  • 12 lower extremity cadaveric specimens
  • Detectability of the tubercles tested:
  • Palpation
  • Fluoroscopy
  • Distances from tubercles to the footprint centers

Tubercles not detectable: Provide an alternative means of localizing ATFL and CFL footprints using alternative landmarks.

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Precise Anatomy of ATFL & CFL Traditional ATFL & CFL Anatomy… Not Precise!

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Precise Anatomy of ATFL & CFL ATFL & CFL partially share a common origin Site

ATFL

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Surgical Technique Development

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Dalhousie University Halifax Nova Scotia Canada

“Anti RoLL”

Ankle Reconstruction of Lateral Ligaments

Tokyo, Japan

International Collaboration

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Ankle Reconstruction of Lateral Ligaments

Anti RoLL “A&P Anti RoLL”

Percutaneous Evolution from Open To MINIMALLY INVASIVE

New Arthroscopic Surgical Technique for Ankle Instability: Percutaneous Arthroscopic Reconstruction of Lateral Ligaments (Percutaneous Anti ROLL) Mark Glazebrook, James Stone, Masato Takao, Kentaro Matsuie and Stéphane Guillo ANKLE INSTABILITY GROUP

OPEN Anti RoLL Submited

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Arthroscopic Anti-RoLL A Anti RoLL

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Percutaneous Anti-RoLL

New Arthroscopic Surgical Technique for Ankle Instability: Percutaneous Arthroscopic Reconstruction of Lateral Ligaments (Percutaneous Anti ROLL)

Mark Glazebrook, James Stone, Masato Takao, Kentaro Matsuie and Stéphane Guillo

ANKLE INSTABILITY GROUP

Accepted for Publication

P Anti RoLL

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Surgical Technique 5 STEP PROCESS

1. Anti-RoLL Y-Graft Construction 2. Fibula Bone Tunnel (ATFL-CFL) 3. Talar Bone Tunnel (ATFL) 4. Calcaneal Bone Tunnel (CFL) 5. Anti-Roll Y-Graft Delivery & Fixation

New Arthroscopic Surgical Technique for Ankle Instability: Percutaneous Arthroscopic Reconstruction of Lateral Ligaments (Percutaneous Anti ROLL)

Mark Glazebrook, James Stone, Masato Takao, Kentaro Matsuie and Stéphane Guillo

ANKLE INSTABILITY GROUP

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Surgical Technique Construction of the Anatomic Y Graft

Step 1

  • 1. Anti-RoLL Y-Graft

Construction

(Dr Masato Takao Technique)

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PERCUTANEOUS Anti-RoLL FIBULAR PIN PLACEMENT

A D C B

Step 2 Fibula Tunnel ATFL & CFL Origin Site

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PERCUTANEOUS Anti-RoLL TALAR PIN PLACEMENT

A D C B

Step 3 Talar Tunnel ATFL Insertion Site

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PERCUTANEOUS Anti-RoLL CALCANEAL PIN PLACEMENT

A D C B

Step 4 Calcaneal Tunnel CFL Insertion Site

(Approximately 15mm posterior to the anterior edge of the posterior facet and about 15mm inferior to the joint line.)

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PERCUTANEOUS Anti-RoLL Y Graft Passage and Fixation

Y-Graft delivery site A D C E B

Step 5 Anti-Roll Y-Graft Delivery & Fixation

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PERCUTANEOUS Anti-RoLL Final Anatomic Allograft Construct

CF ATF L

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Biomechanical Testing

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Biomechanical Testing

Collaboration Xavier Martin (Barcelona, Catalonia) Masato Takao Satoru Ozeki (Tokyo, Japan) Mark Glazebrook (Halifax, Canada) University of Barcelona Medicine-Anatomy

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Biomechanical Studies (ONGOING)

Using Cadaveric Model Investigate Tensile forces during ankle ROM on: Normal Intact Ankle Ligaments Anti RoLL Reconstruction

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Future Clinical Studies (Safety & Efficacy)

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International Multicenter Prospective Ankle Study Database on Safety and Efficacy Outcomes of Surgical Stabilization (IMPASS EOSS)

ESSKA AFAS Ankle Instability Group

Future Study on MIS Ankle Stabilization Techniques

Examine the SAFETY & CLINCAL OUTCOMES:

  • 1. Traditional Open Ankle Stabilization
  • 2. Minimally Invasive Ankle Stabelization

Repair or Reconstruction technique Study Co-investigator w ishes to include in the database Estimated 20 sites w ith enrollment of 1000 Cases (Data Centralized English Halifax Nova Scotia)

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SLIDE 42

International Multicenter Prospective Ankle Study Database on Safety and Efficacy Outcomes of Surgical Stabilization (IMPASS EOSS)

ESSKA AFAS Ankle Instability Group

Future Study on MIS Ankle Stabilization Techniques

Data collection – ROBUST (VAS) Pain, (SF-12) Health and Quality of Life Outcome (Halasi score) Activity Level (IdFAI score) Ankle Instability (FAAM score) General Function Pre-existing medical problems Beighton score will also be recorded. These data will be analyzed and compared between the surgical procedures in various Level II studies once sufficient data exists.

Welcome to Participate : markglazebr@hotmail.com

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THANK-YOU !!

Special Thanks

James Stone (USA) MASATO TAKAO (Japan) Kentaro Matsui (Japan) Stephane Guillo (France) Xavier Martin (Catalonia/Spain) ESSKA-AFAS Ankle Instability Group1

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Summary

  • Literature to support Open Surg CAI GOOD
  • Literature to support MIS Surg CAI POOR (studies needed)
  • Precise Anatomy of ATFL & CFL established
  • 3 new Anti RoLL Surgical Technique Developed:

Open, Percutaneous & Arthroscopic

  • Biomechanical Testing (Ongoing)
  • Future Clinical Studies (Safety & Efficacy)