Ligamentous Injuries of the Foot and Ankle: Diagnosis, Management and Rehabilitation

Foreword: Land of Ligaments Text
Acknowledgments
Contents
Contributors
1: Introduction
Biology of Ligament Healing
Treatment Decision-Making
The Role of the Orthopedic Surgeon
The Role of the Physical Therapist
References
2: Anatomy and Biomechanics of the Foot and Ankle
Introduction
Distal Tibiofibular Syndesmosis
Lateral Collateral Ligaments of the Ankle
Medial Collateral Ligaments of the Ankle
Subtalar Joint Ligaments
Chopart Joint Ligamentous Complex
Lisfranc Ligamentous Complex
References
3: Imaging of Ligamentous Injuries in the Foot and Ankle
Introduction
Imaging Modalities
Conventional Radiography
Computed Tomography (CT)
Ultrasound
Magnetic Resonance Imaging (MRI)
MR Arthrogram (MRA) (Fig. 3.3)
Ankle
Imaging Anatomy of the Ankle Ligaments
Syndesmotic Ligaments
Lateral Ankle Ligaments
Medial Ankle Ligaments
Imaging Findings of Ligamentous Injury to the Ankle
Syndesmotic Injuries
Lateral Ankle Ligamentous Injuries
Medial Ankle Ligamentous Injuries
Foot
Imaging Anatomy of the Foot Ligaments
Lisfranc Joint Complex
Plantar Plate
Imaging Findings of Ligamentous Injury of the Foot
Lisfranc Joint Complex
Plantar Plate
Conclusion
References
4: Alignment and Instability: Managing Mechanical Contributors to Recurrent Ligament Injury and Instability
Introduction
Biomechanical Evaluation of the Foot and Ankle
Physical Examination
Imaging Studies
Nonoperative Management
Indications for Surgical Management
Operative Technique
Outcomes
Conclusion
References
5: Rehabilitating the Elite Athlete with Ligamentous Injury of the Foot and Ankle
References
6: Lateral Ankle Sprains: Injury Epidemiology and Nonoperative Treatment
Introduction
Overview and Incidence of Acute Ankle Sprains in the General Population
Incidence of Acute Ankle Sprains in the Athletic Population
Epidemiology of Ankle Sprain Reinjury Risk
Epidemiology Related to Chronic Ankle Sprains
Injury Prevention
Nonoperative Management of Acute Ankle Sprains
Conclusion
References
7: Lateral Ankle Sprains: Subtalar Instability
Introduction
Etiology of Subtalar Joint Instability
Acute Subtalar Dislocation
Clinical Assessment of Subtalar Instability
Radiographic Assessment of Subtalar Joint Instability
Conservative Treatment of SJI
Operative Treatment of Subtalar Joint Instability
Conclusions
References
8: Lateral Ankle Instability: The Modified Brostrom
Introduction
Diagnosis
Management
Modified Brostrom Surgical Technique
Rehabilitation
References
9: Lateral Ankle Instability: Arthroscopic Broström and Minimally Invasive Techniques
Introduction
Arthroscopy in Lateral Ligament Repair
Lateral Ligamentous Complex Anatomy
Arthroscopic Lateral Ligament Repair Technique
Minimally Invasive and Percutaneous Techniques
Arthroscopic Reconstruction
Percutaneous Anti-ROLL
Outcomes
Conclusions
References
10: Lateral Ankle Instability: Tendon Transfers and Grafts
Introduction
Operative Treatment
Nonanatomic Reconstruction
Anatomic Reconstruction
Rehabilitation
Outcomes
References
11: Lateral Ankle Instability: The Role of Synthetic Ligament Augmentation
Introduction
CLAI Assessment
Diagnostic Imaging
Nonsurgical Treatment
Historical Surgical Options
Brostrom Procedure Modifications and Augmentations
Brostrom with Gould Modification
Neoligament Augmentation
Additional Suture Anchor Repair Augmentation
Synthetic Augmentation
Ligament Augmentation Reconstruction System (LARS)
Leeds-Keio Artificial Ligament
Mersilene® Suture-Tape
Arthrex® Suture-Tape (InternalBrace™)
The Biomechanical Evidence
The Clinical Evidence
Modified Brostrom-Gould Repair with InternalBrace™ Augmentation
Surgical Technique
References
12: Lateral Ankle Instability: Rehab and Return to Sport
Background
Anatomy and Biomechanics
History and Physical Exam
Imaging
Concomitant Pathology
Nonoperative Management
Manual Therapy
Exercise Interventions
Ankle Supportive Devices and Taping
Recommendations for Return to Activity and Sports with CAI
Operative Management
Conclusion
References
13: Syndesmosis Injury: Classification, Evaluation, and Prevention
Introduction
Anatomy
Biomechanics
Mechanism of Injury
Stable Versus Unstable Syndesmosis Injuries
The Deltoid Ligament Dilemma
Clinical Evaluation
Imaging
X-Rays
Ultrasound
Weight-Bearing Computed Tomography
Magnetic Resonance Imaging
Functional Intraoperative Tests
Arthroscopy
Classification Systems
Treatment
Conservative Treatment
Surgical Treatment
Conclusion
References
14: Syndesmosis Injuries: Surgical Indications, Techniques, and Outcomes
Introduction
Indications for Surgical Treatment
Surgical Techniques
Reduction Techniques
Fixation Techniques
Flexible Fixation
Screw Fixation
Anatomic Reconstruction
Syndesmosis Fusion
Surgical Outcomes
Reduction Techniques
Fixation Techniques: Outcomes
Management of Complications
Postoperative Rehabilitation
Postoperative Protocol
Return to Sport
Conclusion
References
15: Syndesmotic Injuries in Athletes: Return to Play and Rehabilitation
Introduction
Return to Play Protocol/Survey Results
Return to Play
Global Perspective
Rehabilitation
Background on Guidelines
First Phase (0–2 Weeks)
Second Phase (2–3 Weeks)
Third Phase (3–5 Weeks)
Last Phase (5 Weeks +)
Tests to Include Prior to RTP
Conclusion
References
16: Deltoid Ligament Injury: When to Repair, Reconstruct, or Let It Heal
Introduction
Clinical Presentation
Deltoid Ligament Injury and Ankle Arthroscopy
Treatment of Deltoid Ligament Injury
Conservative Treatment
Open Treatment
Arthroscopic Treatment
Conclusion
References
17: Spring Ligament Injuries and Instability: Repair/Reconstruction Indications and Techniques
Introduction
Anatomy of the Spring Ligament
Talocalcaneonavicular Joint Complex (Fig. 17.1)
Components of the Spring Ligament
Functions of the Spring Ligament
Injury to the Spring Ligament
Clinical Features of Spring Ligament/Instability
Classification of Spring Ligament Injuries
Imaging of the Spring Ligament
Plain X-Ray
Ultrasound
MRI
Conservative Treatment for Spring Ligament Injury and Instability
Surgical Treatment for Spring Ligament Injury and Instability
Spring Ligament Repair
Spring Ligament Reconstruction
Cadaver Studies
Clinical Studies
Autograft Transfers
Synthetic Materials
Combined Spring and Deltoid Ligament Repair
Additional Procedures
Post-Operative Rehabilitation
Conclusions
References
18: Posterior Ankle Ligaments: The Role of Posterior Talofibular Ligament, Flexor Retinaculum, Posterior Talocalcaneal Ligament, and Fibulotalocalcaneal Ligament in Posterior Ankle Impingement
Introduction
Ligamentous Sources of Posterior Ankle Impingement
Posterior Talofibular Ligament
Flexor Retinaculum
Posterior Talocalcaneal Ligament
Rouvière Ligament or Fibulotalocalcaneal Ligament
Conclusions
References
19: Lisfranc Injuries of the Foot and Ankle: Diagnosis and Treatment Indications
Anatomy
Mechanism of Injury
Classification
Clinical Evaluation
Imaging Studies
Radiographs
Stress Radiographs
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Authors’ Diagnostic Algorithm (Fig. 19.9)
Treatment
References
20: Lisfranc Injuries in Athletes: Surgical Treatment Techniques
Introduction
Historical Perspective on Treatment/Procedures
Epidemiology and Injury Patterns
Evaluation
Presentation/Examination
Imaging
Treatment Principle
The Argument of Fixation Versus Fusion in the Athlete
Treatment Options: Acute
The Principles and Techniques for Open Reduction and Internal Fixation (ORIF) with Rigid Hardware
Technique No. 1: ORIF (Video 20.1)
Technique
Intercuneiform ORIF
Second TMT ORIF
First Tarsometatarsal ORIF
The Principles of Fixation and Technique for PRIF (Percutaneous)
Technique No. 2: Percutaneous Lisfranc Fixation (Video 20.2)
The Principles of Fixation and Technique for Suture Button Flexible Fixation for Isolated Lisfranc Ligament Injury
Technique No. 3: Primary Open Flexible Fixation with Suture Button(s) by Cho et al. [32]
The Principles of Fixation and Technique for Primary Arthrodeses
Technique No. 4: Primary Arthrodesis Principles of Coetzee and Ly [27] and Technique of Kuhn [33]
Additional Considerations for Primary-Hybrid Arthrodeses
Technique No. 4: Hybrid-Primary Arthrodesis (Stødle Technique [25])
Treatment Options: Chronic
Chronic Lisfranc Dislocation (>4 Weeks After Injury)
Chronic Lisfranc Injury Without Collapse (4–12 Weeks Post Injury)
Technique No. 1: Fixation (ORIF with Suture Button Augmentation)
Technique No. 2: Fixation (ORIF Chronic Lisfranc with Suture Button – Charlton [34])
Technique No. 3: Use of Free Tendon Graft for Chronic Lisfranc Ligament Reconstruction
Miyamoto Technique [36]
De los Santos-Real Technique [35]
Zwipp Technique [37]
Technique No. 4: Secondary Arthrodeses for Chronic Lisfranc
Hardware Removal
Rehabilitation
Expected Outcomes
Complications
Authors’ Preferred Approach
Conclusions
References
21: Lisfranc Injury in Athletes: Return to Play and Rehabilitation
Return to Play Following Lisfranc Injury
Introduction
Anatomical Characteristics of the Injury and Return to Play Parameters
Does Management Strategy Impact RTP Parameters?
Operative vs. Non-operative
ORIF vs. PA Is Still Controversial
Anatomical Reduction and Residual Displacement Matter the Most
The Players’ Position Does Matter
So What Matters?
Conclusion
Rehabilitation of Lisfranc Injuries
Introduction
Protocol Depends on the Management
Non-operative Rehabilitation
Postoperative Rehabilitation
LERC Milestones Program [7]
Lorenz and Beauchamp [27]
Return to Play Criteria and Testing
Conclusion
References
22: Management of Turf Toe and Sesamoid Injuries
Introduction
Epidemiology
Anatomy
Metatarsophalangeal and Metatarsal-Sesamoidal Articulations
Plantar Plate and Other Capsuloligamentous Structures
Dynamic Stabilizers
Biomechanics
Mechanism of Injury and Pathoanatomy
Diagnosis and Classification
Management/Rehabilitation
Nonoperative
Operative
Postoperative Rehabilitation
References
23: Lesser Toe Plantar Plate Injuries and Angular Deformities: Indications, Techniques, and Outcomes
Lesser Toe Plantar Plate Tears
Introduction
Pathophysiology and Anatomy
History and Exam
Imaging
Classification
Treatment
Plantar Plate Repair [2, 10] (Fig. 23.2)
Outcomes
Toe Deformities
Introduction
Anatomy
Hammertoes
FDL Tendon Transfer [26]
PIP Joint Arthrodesis [24, 27] (Fig. 23.3)
Claw Toes
MTP Joint Contracture Release
Mallet Toe
DIP Joint Resection Arthroplasty [29] (Fig. 23.5)
References
24: Returning to Sport: Tips and Techniques for Safe Transition to Sports Participation
Returning to Sport: Introduction
Phases of Rehabilitation
Phase I
Phase II
Phase III
Range of Motion/Mobilization
Strengthening
Functional Progression
Return to Play
Dorsiflexion Lunge Test: Range of Motion (Fig. 24.1) [13]
Star Excursion Balance Test (SEBT): Balance and Proprioception (Fig. 24.2) [13].
Agility T-Test: Agility (Fig. 24.3) [13]
Vertical Jump Test: Strength (Fig. 24.4) [13]
Achilles Tendon Injuries
Lateral Ankle Instability
Syndesmosis Injuries
Special Considerations
Conclusion
References
Index