• 대한족부족관절학회지
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• 제14권1호
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• pp.41-46
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• 2010

Purpose: Anterior drawer and varus stress test are commonly used for radiologic evaluation of chronic lateral ankle instability. However, there are controversies regarding the method of measurement and the normal value. This study was performed to investigate radiologic normal values in normal Korean adults and to analyze differences by age and gender. Materials and Methods: Sixty Korean adults were recruited and divided in three groups (20 in their twenties, 20 in their thirties, 20 in their forties). There were 10 males and 10 females in each group. The selection criteria were no history of ankle injury and no evidence of instability on physical examination. Radiologic measurement of varus talar tilt and anterior talar translation were performed through anterior and varus stress radiographs using Telos device (150N force). The measurement was repeated twice by three researchers, and intraobserver reproducibility and interobserver reliability were analyzed. The average talar tilt and anterior talar translation were obtained. Results: Talar tilt and anterior talar translation on ankle stress radiographs had good intraobserver reproducibility and interobserver reliability. Talar tilt was average $3.7^{\circ}$ and $5.1^{\circ}$ in male and female of twenties of age, $3.9^{\circ}$ and $4.8^{\circ}$ in their thirties, $3.4^{\circ}$ and $4.5^{\circ}$ in their forties. Anterior talar translation was average 3.5 mm and 4.2 mm in their twenties, 4.1 mm and 3.8 mm in their thirties, 3.6 mm and 4.1 mm in their forties. There was no significant difference in talar tilt and anterior talar translation by age. However, there was significant difference in talar tilt by gender. Conclusion: Normal range of talar tilt angle in Korean adults was below $8.3^{\circ}$, and normal range of anterior talar translation was below 7.6 mm. It seems to be able to serve as a good reference for radiologic evaluation and for treatment of chronic lateral ankle instability.

• 대한족부족관절학회지
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• 제27권4호
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• pp.137-143
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• 2023

Purpose: Autologous osteochondral transplantation (AOT) is indicated for patients with a large osteochondral lesion of the talus (OLT), accompanying subchondral cyst, and the failure of bone marrow stimulation (BMS) procedures. Despite the many reports on the clinical results of surgical treatment for medial osteochondral lesions, those of lateral lesions are rare. This paper reports the intermediate-term clinical outcomes after AOT for lateral OLTs. Materials and Methods: Twenty-one patients with lateral OLTs were followed up for at least three years after AOT. The clinical evaluations comprised the Foot and Ankle Outcome Score (FAOS) and Foot and Ankle Ability Measure (FAAM). The radiographic assessment included the irregularity of the articular surface (subchondral plate), the progression of degenerative arthritis, and the changes in talar tilt angle and anterior talar translation. Results: The mean FAOS and FAAM scores improved significantly from 42.1 to 89.5 and 39.5 to 90.6 points, respectively, at the final follow-up (p<0.001). The radiological evaluation revealed two cases (9.5%) of articular step-off ≥2 mm and 1 case (4.8%) of progressive arthritis. The mean talar tilt angle and anterior talar translation improved significantly. As postoperative complications, there was one case of a local wound problem, one case of superficial peroneal nerve injury, and one case of donor site morbidity. At a mean follow-up of 62.3 months, no patient showed a recurrence of instability or required reoperation for OLT. Conclusion: AOT for the lateral OLTs demonstrated satisfactory intermediate-term clinical outcomes, including daily and sports activity abilities. Most OLT could be accessed through lateral ligament division and capsulotomy, and the incidence of iatrogenic complications, such as recurrent sprains or chronic instability, was minimal. AOT appears to be an effective and relatively safe treatment for patients with large lateral osteochondral lesions unresponsive to conservative therapy, with subchondral cysts, or with failed primary BMS.

• 대한정형외과스포츠의학회지
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• 제10권1호
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• pp.35-40
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• 2011

목적: 만성 발목 관절 외측 불안정성 환자에 대한 기계적 불안정성의 평가에서 스트레스 방사선검사의 진단적 유용성을 알아보고자 하였다. 대상 및 방법: 본원에서 변형 Brostrom 술식을 시행받은 환자들 중 수술 소견상 외측 측부인대(전 거비 인대)의 완전 파열이 확인되었던 42예를 대상으로 하였다. 대조군으로는 발목 관절 손상의 과거력이 없고 이학적 검사상 불안정성 소견을 보이지 않는 정상 한국인 성인 총 60명(120예)을 모집하였다. Telos 기구를 이용한 전방 전위 및 내반 스트레스 검사를 시행한 뒤, 거골 경사각과 거골 전방전위 정도를 계측하였다. 대조군에서 얻어진 정상범위를 기준으로 스트레스 방사선검사의 민감도, 특이도, 양성 예측도, 음성 예측도를 분석하였다. 결과: 스트레스 방사선검사 상 정상 한국인 성인에서의 거골 경사각은 평균 $4.2{\pm}2.1$도, 거골 전방전위는 평균 $3.9{\pm}1.9$ mm로 계측되었다. 95% 신뢰한계 분석을 이용한 정상 범위의 설정시 거골 경사각의 정상 범위는 8.3도 이하, 거골 전방전위는 7.6 mm 이하로 분석되었다. 이 수치를 기준값으로 하는 경우 발목 관절 스트레스 방사선검사 상 거골 경사각의 민감도는 57%, 특이도는 97%, 양성 예측도는 89%, 음성 예측도는 86% 였고, 거골 전방전위의 민감도는 69%, 특이도는 97%, 양성 예측도는 91%, 음성 예측도는 90% 였다. 결론: 만성 발목 관절 외측 불안정성 환자에 대한 기계적 불안정성의 평가에서 스트레스 방사선검사는 비교적 우수한 특이도 및 양성, 음성 예측도를 보였으나 민감도는 낮아, 유용하지만 정확성은 떨어지는 검사법인 것으로 분석되었다. 기계적 불안정성이 발목 관절 스트레스 방사선검사 상 실제보다 덜 반영된다고 생각되며, 스트레스 방사선검사 소견만으로 발목 관절 외측 불안정성을 배제해서는 안 될 것으로 생각한다.

• 대한족부족관절학회지
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• 제18권3호
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• pp.108-114
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• 2014

Purpose: Ligament reattachment technique using a suture anchor appears to show satisfactory functional outcomes and mechanical stability compared with conventional bone tunnel technique. This study was prospectively conducted in order to evaluate functional outcomes of modified Brostrom procedures using the suture bridge technique for chronic ankle instability in athletes. Materials and Methods: Twenty eight athletes under 30 years of age were followed for more than two years after undergoing the modified Brostrom procedure using the suture bridge technique. Functional evaluation consisted of the foot and ankle outcome score (FAOS), foot and ankle ability measure (FAAM) score. Range of motion and time to return to exercise were evaluated using a periodic questionnaire. Talar tilt angle and anterior talar translation were measured through stress radiographs for evaluation of mechanical stability. Results: FAOS improved significantly from preoperative mean 59.4 points to 91.4 points (p<0.001). Daily living and sport activity scores of FAAM improved significantly from preoperative mean 50.5, 32.5 points to 94.8, 87.3 points, respectively (p<0.001). Talar tilt angle and anterior talar translation improved significantly from preoperative mean $16.8^{\circ}$, 13.5 mm to $4.2^{\circ}$, 4.1 mm at final follow-up (p<0.001). Times to return to exercise were as follows: mean 10.2 weeks in jogging, 15.4 weeks in spurt running, 13.1 weeks in jumping, 11.5 weeks in walking on uneven ground, 9.1 weeks in standing on one leg, 7.2 weeks in tip-toeing gait, 8.4 weeks in squatting, and 10.6 weeks in descending stairs. Conclusion: Modified Brostrom procedure using the suture bridge technique showed satisfactory functional outcomes for chronic ankle instability in athletes. Optimal indication and cost-effectiveness of the suture bridge technique will be studied in the future.

• 대한족부족관절학회지
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• 제26권1호
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• pp.40-47
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• 2022

Purpose: The modified Broström repair (BR) technique has yielded good outcomes in patients with chronic ankle instability. This study compared clinical and radiological outcomes between two groups of patients who underwent modified BR or lateral ligament augmentation using suture tapes (ST). Materials and Methods: Seventy-seven patients (ST group [n=47], BR group [n=30]; body mass index <26.61 kg/m²; mean age, 30.7±11.0 years [range, 17~39 years]; mean follow-up, 34.0±12.0 months [range, 24~59 months]) were retrospectively reviewed between January 2014 and July 2017. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS) score, and Sefton grading system were used for clinical assessment. The talar tilt angle and anterior talar translation were measured using the Telos stress device (Telos GmbH, Marburg, Germany) at 150 N for radiological evaluation. Results: FAOS, AOFAS, FAAM, and VAS scores improved in both groups at final follow-up (ST, 91.1±5.2, 93±2, 88.1±4.5, 1.5±0.7 vs. BR, 91.3±5.4, 93±3, 83.3±4.8, 1.2±0.7, respectively; p=0.854, 0.971, <0.001, 0.04, respectively). According to the FAOS, mean sports activity scores for the ST and BR groups at the final follow-up were 90.3±3.2 and 76.6±4.2, respectively, reflecting superior outcomes in the ST group (p<0.001). Sefton grading revealed satisfactory functional outcomes (ST, 91.5% vs. BR, 90.0%). There was significant improvement in the talar tilt angle and anterior talar translation in both the ST and BR groups (7.6°±1.2°, 10.5±1.8 mm vs. 4.9°±1.1°, 7.9±1.5 mm, respectively; p<0.001). Conclusion: The ST group demonstrated comparable clinical but better improvement in mechanical stability and FAOS sports scores than the BR group.

• 대한정형외과스포츠의학회지
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• 제10권2호
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• pp.69-77
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• 2011

목적: 만성 발목관절 외측 불안정성 환자에 대한 변형 Brostrom 술식에서 단일 봉합나사와 이중 봉합나사를 이용한 기법간의 임상 결과를 후향적으로 비교하고자 하였다. 대상 및 방법: 본원에서 봉합나사를 이용한 변형 Brostrom 술식을 시행받은 환자들 중 최소 1년 이상 추시가 가능하였던 37례를 대상으로 하였다. 모든 수술은 동일한 술자에 의해 이루어졌으며 단일 봉합나사를 이용한 경우가 17예, 이중 봉합나사를 이용한 경우가 20예 였다. 임상적 결과의 평가는 Karlsson 점수 및 Sefton의 평가법을 이용하였고, 발목관절의 기계적인 안정성에 대한 방사선학적 평가로 Telos 기기를 이용한 전방 전위 및 내반 스트레스 검사가 이용되었다. 결과: Karlsson 점수는 단일 봉합나사군이 술 전 평균 45.2점에서 술 후 89.4점으로, 이중 봉합나사군이 술 전 평균 46.4점에서 90.5점으로 각각 호전되었다. Sefton 평가법상 단일 봉합나사군은 우수가 7예, 양호가 8예, 보통이 2예 였고, 이중 봉합나사군은 우수 8예, 양호 10예, 보통 2예로 나타나 각각 15례(88.2%), 18례(90%)에서 만족스러운 결과를 보였다. 스트레스 방사선검사 상 거골 경사각과 거골 전방전위는 단일 봉합나사군이 술 전 평균 13.6도, 8.6 mm에서 술 후 최종 추시시 5.4도, 4.1 mm로, 이중 봉합나사군이 술 전 평균 14.1도, 8.4 mm에서 술 후 3.9도, 4 mm로 각각 호전되었으며 두 기법간에 술 후 거골 경사각의 유의한 차이를 보였다(p<0.05). 결론: 만성 발목관절 외측 불안정성에 대한 변형 Brostrom 술식에서 단일 봉합나사와 이중 봉합나사를 이용한 기법간에 술 후 임상 결과의 유의한 차이는 없었으나, 발목관절의 기계적인 안정성은 이중 봉합나사군에서 더 우수하였다. 단일 봉합나사와 이중 봉합나사를 이용한 변형 Brostrom 술식 모두 효과적인 치료 방법이라고 생각되며, 향후 운동 선수들을 대상으로 한 치료결과 및 생역학적 분석이 필요할 것으로 생각한다.

• 대한족부족관절학회지
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• 제21권1호
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• pp.12-16
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• 2017

Purpose: Anterior drawer and varus stress radiographs are commonly to diagnose chronic lateral ankle instability. We compared the preoperative stress radiographs with the intraoperative radiographs under anesthesia to determine the accuracy and efficacy of stress radiographs in an outpatient clinical environment. Materials and Methods: Data was collected from patients who underwent a modified $Brostr{\ddot{o}}m$ operation for painful chronic unilateral lateral ankle instability between January 2014 and June 2016. Subjects were divided into three groups-complete tear, partial tear, and instability without rupture-according to the status of preoperative MRI findings of the anterior talofibular ligament. The anterior drawer and varus stress radiographs were taken preoperatively and intraoperatively under anesthesia. Results: Ninety-six patients, with a mean age of 29.63 years, were enrolled. There were 39, 46, and 11 patients in the complete tear, partial tear, and instability without rupture groups, respectively. On the anterior drawer and varus stress radiographs of the affected limb, talar anterior translation and varus tilting were significantly increased by 2.56 mm and $2.0^{\circ}$. The gaps between the unaffected limbs were also increased by 2.47 mm and $1.32^{\circ}$ after anesthesia. Although the stress radiographs were taken under anesthesia, the results were often smaller than the diagnostic value. Conclusion: Stress radiographs for painful chronic lateral ankle instability taken at the outpatient clinic might be inaccurate for diagnosis.

• 대한족부족관절학회지
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• 제26권1호
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• pp.22-29
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• 2022

Purpose: Despite continuous updates of standard treatment guidelines for acute ankle sprain and chronic ankle instability (CAI), in practice preferred treatment protocols vary widely. Based on a Korean Foot and Ankle Society (KFAS) member survey, this study reports current trends in the management of ankle ligament injuries. Materials and Methods: A web-based questionnaire containing 34 questions was sent to all KFAS members in September 2021. Questions mainly addressed clinical experience and preferences for the diagnosis and treatment of ankle ligament injuries. Answers with a prevalence of ≥50% among respondents were considered to reflect tendencies. Results: Eighty-four of the 550 members (15.3%) responded. Answers that showed a tendency were as follows: commonest additional image study (ultrasound), conservative treatment modality (immobilization, oral medication), frequency of surgical treatment (<5 cases per annum), most important factor when deciding on surgical treatment (activity level, e.g., occupation or sport), and commonest surgical procedure (open ligament repair). Answers that showed a tendency for CAI were as follows: most important symptom (repeated sprain, giving way), radiological factors (talar tilt, osteochondral lesion, anterior talar translation), and patient factors (occupation, sports activities, recurrent instability after surgery, etc.). For decision making regarding surgical treatment and method, the most preferred surgical procedure was the modified Broström procedure, and the most common repair technique was suture anchor technique. The following were considered poor prognostic factors; generalized laxity, failed previous surgery, cavovarus, severe mechanical instability, heavy work, obesity, and dissatisfaction after surgery because of residual pain. Conclusion: This study updates information regarding current trends in the management of ankle ligament injuries in Korea, and reveals consensus opinions and variations in approaches to patients with an acute or chronic injury. The divergence of approaches identified indicates the need for further studies to determine standard guidelines and long-term results.

• 대한족부족관절학회지
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• 제11권1호
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• pp.45-50
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• 2007

Purpose: To evaluate the short-term clinical outcomes of total ankle arthroplasty for the post-traumatic osteoarthritis. Materials and Methods: Fourteen patients who had undergone total ankle arthroplasty from February 2005 to June 2006 were reviewed. Eleven patients were male and three patients were female. The mean age was 52.8 years (range, 33 to 69 years). The mean follow-up duration was 15.9 months (range, 12 to 24 months). Primary injuries were pilon fractures in eight cases, malleolar fractures in three, ankle syndesmotic injury in one, talus fracture and dislocation in one, and distal tibial physeal injury in one. Visual analogue scale (VAS), Range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and complications were evaluated. Results: The mean VAS improved from 8.6 preoperatively to 2.6 at last follow-up. The mean ROM improved from 24.6 degrees preoperatively to 33.1 degrees postoperatively. The mean AOFAS score improved from 44.5 points preoperatively to 75.1 points postoperatively. Radiographically, all components were stable, but there were component malpositions in two cases, including one varus malposition of tibial component and one increased anterior translation of talar component. Complications were deep infection in one case, intraoperative malleolar fracture in three, marginal wound necrosis in two, and heterotopic ossification in one. One prosthesis was revised because of deep infection. Conclusion: Total ankle arthroplasty for the post-traumatic osteoarthritis is believed to be an useful method for preservation of the motion, relief of the pain and high satisfaction of patients in short-term results.