Brostrom lateral ligament reconstruction using JuggerKnot soft anchor(Zimmer-Biomet) surgical technique
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It is estimated that, in the UK, there are approximately 7000 ankle sprains per day. 85% of these sprains will involve the anterior talo-fibular (ATFL) and calcaneo-fibular (CFL) ligaments which are the principal lateral ligament restraints. Most will resolve with little input other than basic remedies such as rest, ice, compression and elevation. In those cases that do not recover quickly, it is either because they have been subjected to repeated sprains or there is a concomitant pathology such as an osteochondral lesions of the talus, peroneal tendon tears or peroneal retinaculum injury.
In those cases where non-operative treatment fails, surgical intervention may be necessary with the aim of restoring ankle stability by repair of the lateral ligament complex which can be done using the Zimmer Biomet JuggerKnot soft (suture) anchor. One surgical technique that has continued good results was first described by Brostrom in 1966, whereby the ATFL and CFL are imbricated, with an additional modification by Gould in 1980 which detailed additional imbrication of the inferior extensor retinaculum (IER). This technique forms the mainstay of anatomic ankle reconstruction techniques not only because of the high success rates but also because of low rates of complication such as ankle stiffness and subtalar arthritis.
The advantage of the Zimmer Biomet JuggerKnot soft anchor system is that it offers excellent pull-out strength at the bone-anchor interface with a minimal footprint in the bone.
Author: Mark B Davies FRCS (Tr & Orth)
Institution: The Northern General Hospital, Sheffield.
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Question 1 of 13
Which one of the following statements is not true about acute lateral ankle ligament sprains?CorrectIncorrect
Question 2 of 13
Which of the following structures is not usually imbricated in a Brostrom procedure with a Gould modification?CorrectIncorrect
Question 3 of 13
Which one of the following is not associated with chronic ankle instability?CorrectIncorrect
Question 4 of 13
When performing a Brostrom procedure, which of the following anatomic structures is most at risk from the surgery?CorrectIncorrect
Question 5 of 13
After incising the skin through a curved incision lying along the anterior border of the distal fibula, which anatomic structure lies deep to the subdermal fat?CorrectIncorrect
Question 6 of 13
Before proceeding to imbricate the ATFL, which one of the following structures should be assessed?CorrectIncorrect
Question 7 of 13
When inserting the JuggerKnot anchor, which one of the following is not a recognised step in the operative technique?CorrectIncorrect
Question 8 of 13
Which one of the following anatomic structures is thought to be stabilised by the Gould modification?CorrectIncorrect
Question 9 of 13
When ordering appropriate radiological investigations for patients with painful chronic ankle instability, which one of the following imaging modalities is not commonly used?CorrectIncorrect
Question 10 of 13
Which one of the following is not an indication to proceed with an anatomic lateral ligament reconstruction with allograft technique rather than a Brostrom-Gould procedure?CorrectIncorrect
Question 11 of 13
Which one of the following is a disadvantage of positioning the patient in a lateral position for a Brostrom procedure?CorrectIncorrect
Question 12 of 13
Which one of the following complications is more likely to occur in an Evans procedure rather than a Brostrom-Gould procedure when surgically treating chronic lateral ankle instability?CorrectIncorrect
Question 13 of 13
Which one of the following statements is true regarding the open Brostrom procedure?CorrectIncorrect