Ultrasound of Postoperative Ankle Instability: How to Manage with Arthroscopic Reparation or Anatomical Reconstruction of Lateral Ankle Ligaments

Abstract

Surgical repair or reconstruction of lateral ankle ligaments is indicated in patients with persistent ankle instability, with arthroscopic/endoscopic treatment becoming more frequent. Although presurgical imaging of the ankle is always standard procedure, more is needed to understand the evolution of the repaired ligament or the tendinous graft to help improve length of postoperative time and functional results. This review describes the normal ultrasound aspects and possible complications of repaired/reconstructed ankle ligaments after an all-inside endoscopic repair/reconstruction of the anterior talofibular ligament and the calcaneofibular ligament.

Keywords

ultrasound - ankle - surgery - ligament - reconstruction

Publication History

Article published online:
19 November 2024

• References

• 1 Matsui K, Oliva XM, Takao M. et al; ESSKA AFAS Ankle Instability Group. Bony landmarks available for minimally invasive lateral ankle stabilization surgery: a cadaveric anatomical study. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1916-1924
• 2 Ardèvol J, Bolíbar I, Belda V, Argilaga S. Treatment of complete rupture of the lateral ligaments of the ankle: a randomized clinical trial comparing cast immobilization with functional treatment. Knee Surg Sports Traumatol Arthrosc 2002; 10 (06) 371-377
• 3 Krips R, van Dijk CN, Halasi PT. et al. Long-term outcome of anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a multicenter study. Foot Ankle Int 2001; 22 (05) 415-421
• 4 Crombé A, Borghol S, Guillo S, Pesquer L, Dallaudière B. Arthroscopic reconstruction of the lateral ankle ligaments: radiological evaluation and short-term clinical outcome. Diagn Interv Imaging 2019; 100 (02) 117-125
• 5 Vogl TJ, Schmitt J, Lubrich J. et al. Reconstructed anterior cruciate ligaments using patellar tendon ligament grafts: diagnostic value of contrast-enhanced MRI in a 2-year follow-up regimen. Eur Radiol 2001; 11 (08) 1450-1456
• 6 Karlsson J, Bergsten T, Lansinger O, Peterson L. Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am 1988; 70 (04) 581-588
• 7 Schmidt R, Cordier E, Bertsch C. et al. Reconstruction of the lateral ligaments: do the anatomical procedures restore physiologic ankle kinematics?. Foot Ankle Int 2004; 25 (01) 31-36
• 8 Mabit C, Pécout C, Arnaud JP. Ligamentoplasty using the peroneus tertius in the correction of lateral laxity of the ankle. Surgical technique [in French]. Rev Chir Orthop Repar Appar Mot 1996; 82 (01) 70-75
• 9 Paterson R, Cohen B, Taylor D, Bourne A, Black J. Reconstruction of the lateral ligaments of the ankle using semi-tendinosis graft. Foot Ankle Int 2000; 21 (05) 413-419
• 10 van Groningen B, van der Steen MC, Janssen DM, van Rhijn LW, van der Linden AN, Janssen RPA. Assessment of graft maturity after anterior cruciate ligament reconstruction using autografts: a systematic review of biopsy and magnetic resonance imaging studies. Arthrosc Sports Med Rehabil 2020; 2 (04) e377-e388
• 11 SooHoo NF, Shuler M, Fleming LL. American Orthopaedic Foot and Ankle Society. Evaluation of the validity of the AOFAS Clinical Rating Systems by correlation to the SF-36. Foot Ankle Int 2003; 24 (01) 50-55
• 12 Karlsson J, Eriksson BI, Swärd L. Early functional treatment for acute ligament injuries of the ankle joint. Scand J Med Sci Sports 1996; 6 (06) 341-345
• 13 Taser F, Shafiq Q, Ebraheim NA. Anatomy of lateral ankle ligaments and their relationship to bony landmarks. Surg Radiol Anat 2006; 28 (04) 391-397
• 14 Cordier G, Ovigue J, Dalmau-Pastor M, Michels F. Endoscopic anatomic ligament reconstruction is a reliable option to treat chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 86-92
• 15 Coughlin MJ, Schenck Jr RC. Lateral ankle reconstruction. Foot Ankle Int 2001; 22 (03) 256-258
• 16 Guillo S, Takao M, Calder J, Karlson J, Michels F, Bauer T. Ankle Instability Group. Arthroscopic anatomical reconstruction of the lateral ankle ligaments. Knee Surg Sports Traumatol Arthrosc 2016; 24 (04) 998-1002
• 17 Li X, Killie H, Guerrero P, Busconi BD. Anatomical reconstruction for chronic lateral ankle instability in the high-demand athlete: functional outcomes after the modified Broström repair using suture anchors. Am J Sports Med 2009; 37 (03) 488-494
• 18 Karlsson J, Sancone M. Management of acute ligament injuries of the ankle. Foot Ankle Clin 2006; 11 (03) 521-530
• 19 Vega J, Malagelada F, Manzanares Céspedes MC, Dalmau-Pastor M. The lateral fibulotalocalcaneal ligament complex: an ankle stabilizing isometric structure. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 8-17
• 20 Dalmau-Pastor M, Malagelada F, Kerkhoffs GM, Karlsson J, Guelfi M, Vega J. Redefining anterior ankle arthroscopic anatomy: medial and lateral ankle collateral ligaments are visible through dorsiflexion and non-distraction anterior ankle arthroscopy. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 18-23
• 21 Cordier G, Nunes GA, Vega J, Roure F, Dalmau-Pastor M. Connecting fibers between ATFL's inferior fascicle and CFL transmit tension between both ligaments. Knee Surg Sports Traumatol Arthrosc 2021; 29 (08) 2511-2516
• 22 Dalmau-Pastor M, Malagelada F, Calder J, Manzanares MC, Vega J. The lateral ankle ligaments are interconnected: the medial connecting fibres between the anterior talofibular, calcaneofibular and posterior talofibular ligaments. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 34-39
• 23 Nunes GA, Martinez LM, Cordier G. et al. The ATFL inferior fascicle, the CFL and the PTFL have a continuous footprint at the medial side of the fibula. Knee Surg Sports Traumatol Arthrosc 2023; 31 (11) 5207-5213
• 24 Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 1998; 19 (10) 653-660
• 25 Herzog MM, Kerr ZY, Marshall SW, Wikstrom EA. Epidemiology of ankle sprains and chronic ankle instability. J Athl Train 2019; 54 (06) 603-610
• 26 Hintermann B, Boss A, Schäfer D. Arthroscopic findings in patients with chronic ankle instability. Am J Sports Med 2002; 30 (03) 402-409
• 27 Vega J, Malagelada F, Dalmau-Pastor M. Ankle microinstability: arthroscopic findings reveal four types of lesion to the anterior talofibular ligament's superior fascicle. Knee Surg Sports Traumatol Arthrosc 2021; 29 (04) 1294-1303
• 28 Dalmau-Pastor M, El-Daou H, Stephen JM, Vega J, Malagelada F, Calder J. Clinical relevance and function of anterior talofibular ligament superior and inferior fascicles: a robotic study. Am J Sports Med 2023; 51 (08) 2169-2175
• 29 Esparó J, Vega J, Cordier G. et al. Anterior talofibular ligament's superior fascicle as a cause of ankle microinstability can be routinely identified by ultrasound. Knee Surg Sports Traumatol Arthrosc 2024; 32 (02) 352-360
• 30 Hong CC, Lee JC, Tsuchida A. et al. Individual fascicles of the ankle lateral ligaments and the lateral fibulotalocalcaneal ligament complex can be identified on 3D volumetric MRI. Knee Surg Sports Traumatol Arthrosc 2023; 31 (06) 2192-2198
• 31 Vega J, Guelfi M. Arthroscopic assessment and treatment of medial collateral ligament complex. Foot Ankle Clin 2021; 26 (02) 305-313
• 32 Colin F, Barbier O, Cordier G. Role of surgery in the management of lesions of the medial collateral ligament of the ankle. Orthop Traumatol Surg Res 2020; 106 (8S): S195-S199
• 33 Cordier G, Lebecque J, Vega J, Dalmau-Pastor M. Arthroscopic ankle lateral ligament repair with biological augmentation gives excellent results in case of chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 108-115
• 34 Takao M, Oae K, Uchio Y, Ochi M, Yamamoto H. Anatomical reconstruction of the lateral ligaments of the ankle with a gracilis autograft: a new technique using an interference fit anchoring system. Am J Sports Med 2005; 33 (06) 814-823
• 35 Guillo S, Cordier G, Sonnery-Cottet B, Bauer T. Anatomical reconstruction of the anterior talofibular and calcaneofibular ligaments with an all-arthroscopic surgical technique. Orthop Traumatol Surg Res 2014; 100 (8, Suppl): S413-S417
• 36 Matsui K, Takao M, Tochigi Y, Ozeki S, Glazebrook M. Anatomy of anterior talofibular ligament and calcaneofibular ligament for minimally invasive surgery: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25 (06) 1892-1902
• 37 Michels F, Matricali G, Wastyn H, Vereecke E, Stockmans F. A calcaneal tunnel for CFL reconstruction should be directed to the posterior inferior medial edge of the calcaneal tuberosity. Knee Surg Sports Traumatol Arthrosc 2021; 29 (04) 1325-1331
• 38 Michels F, Matricali G, Guillo S, Vanrietvelde F, Pottel H, Stockmans F. An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL. Knee Surg Sports Traumatol Arthrosc 2020; 28 (01) 124-131
• 39 Michels F, Guillo S, Vanrietvelde F, Brugman E, Stockmans F. Ankle Instability Group. How to drill the talar tunnel in ATFL reconstruction?. Knee Surg Sports Traumatol Arthrosc 2016; 24 (04) 991-997
• 40 Boudahmane S. Intérêt et limites de l'exploration des lésions ostéochondrales du dôme talien en échographie. In: Brasseur JL. ed. Actualités en échographie de l'appareil locomoteur. Paris, France: Sauramps Medical; 2020: 98-107
• 41 Cao S, Wang C, Ma X, Wang X, Huang J, Zhang C. Imaging diagnosis for chronic lateral ankle ligament injury: a systemic review with meta-analysis. J Orthop Surg Res 2018; 13 (01) 122-128
• 42 Dallaudière B. Echographie post opératoire après ligamentoplastie de cheville. In: Brasseur JL. ed. Actualités en échographie de l'appareil locomoteur. Paris, France: Sauramps Medical; 2022: 123-132
• 43 Amiel D, Kleiner JB, Roux RD, Harwood FL, Akeson WH. The phenomenon of “ligamentization”: anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res 1986; 4 (02) 162-172
• 44 Chien AJ, Jacobson JA, Jamadar DA, Brigido MK, Femino JE, Hayes CW. Imaging appearances of lateral ankle ligament reconstruction. Radiographics 2004; 24 (04) 999-1008
• 45 Beldame J, Charpail C, Sacco R, Lalevée M, Duparc F. Advantages of ultrasound identification of the distal insertion of the calcaneofibular ligament during ligament reconstructions. Surg Radiol Anat 2023; 45 (08) 1063-1068
• 46 Cordier G, Boudahmane S, Ovigue J, Michels F, Araujo Nunes G, Dallaudière B. MRI assessment of tendon graft after lateral ankle ligament reconstruction: does ligamentization exist?. Am J Sports Med 2024; 52 (03) 721-729
• 47 de Rousiers A, Rougereau G, Rousselin B. et al. Adaptation of the signal noise quotient MRI classification for graft ligamentization analysis following ATFL and CFL anatomical reconstruction: validation of the SNQA. Foot Ankle Surg 2023; 29 (03) 243-248