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Surgical management of concurrent lateral ankle instability and osteochondral lesions of the talus increases dynamic sagittal ankle range of motion

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

A biomechanical study, in which imaging modalities are used to strictly include patients with concurrent lateral ankle instability (LAI) and osteochondral lesions of the talus (OLT), is needed to demonstrate the static and dynamic ankle range of motion (ROM) restriction in these patients, and determine whether ankle ROM restriction can be corrected postoperatively.

Methods

Eight patients with concurrent LAI and OLT treated with the arthroscopic modified Broström procedure and microfracture were recruited from June 2019 to January 2020. Patients were assessed using outcome scales, static ankle ROM, and a stair descent gait analysis for dynamic ankle ROM, a day prior to surgery and one year postoperatively. Eight healthy subjects were assessed using the same modalities upon recruitment. Operative outcomes and variables during stair descent were documented and compared among the preoperative, postoperative, and healthy groups. A curve analysis, one-dimensional statistical parametric mapping, was performed to compare the dynamic ankle kinematics and muscle activation curves over the entire normalised time series.

Results

The functional outcomes of patients with concurrent LAI and OLT were significantly worse than those of healthy subjects preoperatively, but were partially improved postoperatively. Patients had decreased static and dynamic ROM preoperatively, and static ROM did not significantly increase postoperatively (preoperative, 39.6 ± 11.3; postoperative, 44.9 ± 7.1; healthy, 52.0 ± 4.6; p = 0.021). Patients showed increased dynamic ankle flexion ROM (preoperative, 41.2 ± 11.6; postoperative, 53.6 ± 9.0; healthy, 53.9 ± 3.4; p = 0.012) postoperatively, as well as increased peroneus longus activation (preoperative, 35.8 ± 12.0; postoperative, 55.4 ± 25.1; healthy, 71.9 ± 13.4; p = 0.002) and muscle co-contraction of the tibialis anterior and peroneus longus (preoperative, 69.4 ± 23.4; postoperative, 88.4 ± 9.3; healthy, 66.2 ± 18.1; p = 0.045).

Conclusions

Patients with concurrent LAI and OLT had decreased static and dynamic sagittal ankle ROM and altered neuromuscular activation patterns. The arthroscopic modified Broström procedure and microfracture did not significantly increase the static sagittal ankle ROM. However, the dynamic sagittal ankle ROM, peroneus longus activation and muscle co-contraction of the tibialis anterior and peroneus longus increased postoperatively.

Level of evidence

IV.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The present study was supported by grants from the Huashan Hospital, Fudan University (Grant No. 2021QD037), the National Natural Science Foundation of China (Grant No. 81772295 and 82172378) and the Science and Technology Commission of Shanghai Municipality (Grant No. 19ZR1407400). The authors would like to thank Dr. Yunchao Zhu for his comments on data analyses.

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Author notes

  1. Shengxuan Cao and Chen Wang have contributed equally to this study.

Authors and Affiliations

  1. Department of Orthopedics, Huashan Hospital, Fudan University, No.12, Middle Wulumuqi Road, Jingan District, Shanghai, China

    Shengxuan Cao, Chen Wang, Chao Zhang, Jiazhang Huang, Xu Wang & Xin Ma

  2. Gait and Motion Analysis Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China

    Shuyun Jiang & Yan Yu

  3. Department of Orthopedics, Shanghai Tongren Hospital, Shanghai, China

    Gonghao Zhang

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  1. Shengxuan Cao
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Contributions

SC and CW contributed to the writing of the original draft. SJ and YY contributed to the software. GZ contributed to the methodology. CZ and JH contributed to the formal analysis. XW contributed to review and editing. XM contributed to conceptualization.

Corresponding author

Correspondence to Xin Ma.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by Huashan Hospital, Fudan University (No. 2016-036). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Supplementary Information

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167_2022_6993_MOESM1_ESM.jpg

Ankle kinematics during stair descent gait cycle. a, b, c. Mean ankle dorsiflexion/plantarflexion, inversion/eversion, and internal/external rotation angle trajectories with standard deviation clouds during the stair descent gait cycle. d, e, f, g, h, i, j, k, l. SPM analyses indicates the absence of statistical significance among the comparisons, as indicated by dashed lines above and below 0. DF, dorsiflexion. IV, inversion. IR, internal rotation. Preop, preoperative patients. Postop, postoperative patients (JPG 1083 KB)

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Cao, S., Wang, C., Jiang, S. et al. Surgical management of concurrent lateral ankle instability and osteochondral lesions of the talus increases dynamic sagittal ankle range of motion. Knee Surg Sports Traumatol Arthrosc 30, 3888–3897 (2022). https://doi.org/10.1007/s00167-022-06993-6

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