Abstract
Purpose
To elucidate surgical outcomes in pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare.
Methods
A retrospective chart review was conducted of pediatric/adolescent patients with chronic lateral ankle instability and os subfibulare following simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active range of motion exercises for the ankle in our department between 2013 and 2017. Clinical outcomes were evaluated by comparing preoperative and final follow-up American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS) and Karlsson-Peterson ankle function scores. Intervals between surgery and return to physical education in school were determined.
Results
31 feet of 15 male and 16 female patients were examined. Mean postoperative follow-up duration was 40.7 ± 12.7 (range 24–66) months. Mean AOFAS score increased significantly from 66.3 ± 2.5 (range 62–77) preoperatively to 96.5 ± 4.9 (range 87–100) at final follow-up (p < 0.001). Mean Karlsson-Peterson score increased significantly from 51.7 ± 4.0 (range 47–70) preoperatively to 95.3 ± 6.7 (range 80–100) at final follow-up (p < 0.001). Mean interval between surgery and return to physical education in school was 11.4 ± 1.6 (range 10–18) weeks.
Conclusion
Simultaneous ossicle resection and lateral ligament repair using suture anchors with subsequent immediate full weightbearing and active ankle range of motion exercises may give excellent clinical outcomes with early return to physical activity for chronic lateral ankle instability with os subfibulare in pediatric/adolescent patients desiring an early return to physical activity.
Level of evidence
III.
Similar content being viewed by others
References
Berg EE (1991) The symptomatic os subfibulare. Avulsion fracture of the fibula associated with recurrent instability of the ankle. J Bone Joint Surg Am 73(8):1251–1254
Bowlus TH, Korman SF, Desilvio M, Climo R (1980) Accessory os fibulare avulsion secondary to the inversion ankle injury. J Am Podiatry Assoc 70(6):302–303
Cho BK, Kim YM, Shon HC, Park KJ, Cha JK, Ha YW (2015) A ligament reattachment technique for high-demand athletes with chronic ankle instability. J Foot Ankle Surg 54(1):7–12
Choi WJ, Lee JW, Han SH, Kim BS, Lee SK (2008) Chronic lateral ankle instability: the effect of intra-articular lesions on clinical outcome. Am J Sports Med 36(11):2167–2172
Chun TH, Park YS, Sung KS (2013) The effect of ossicle resection in the lateral ligament repair for treatment of chronic lateral ankle instability. Foot Ankle Int 34(8):1128–1133
Davidson RS, Mistovich RJ (2014) Operative indications and treatment for chronic symptomatic os subfibulare in children. JBJS Essent Surg Tech 4(3):e18
Dierckman BD, Ferkel RD (2015) Anatomic reconstruction with a semitendinosus allograft for chronic lateral ankle instability. Am J Sports Med 43(8):1941–1950
Ferkel RD, Chams RN (2007) Chronic lateral instability: arthroscopic findings and long-term results. Foot Ankle Int 28(1):24–31
Frank C, Amiel D, Woo SL, Akeson W (1985) Normal ligament properties and ligament healing. Clin Orthop Relat Res 196:15–25
Giza E, Nathe R, Nathe T, Anderson M, Campanelli V (2012) Strength of bone tunnel versus suture anchor and push-lock construct in Broström repair. Am J Sports Med 40(6):1419–1423
Griffiths JD, Menelaus MB (1987) Symptomatic ossicles of the lateral malleolus in children. J Bone Joint Surg Br 69(2):317–319
Guillo S, Bauer T, Lee JW, Takao M, Kong SW, Stone JW, Mangone PG, Molloy A, Perera A, Pearce CJ, Michels F, Tourné Y, Ghorbani A, Calder J (2013) Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy. Orthop Traumatol Surg Res 99(8 Suppl):S411–419
Hart DP, Dahners LE (1987) Healing of the medial collateral ligament in rats The effects of repair, motion, and secondary stabilizing ligaments. J Bone Joint Surg Am 69(8):1194–1199
Hasegawa A, Kimura M, Tomizawa S, Shirakura K (1996) Separated ossicles of the lateral malleolus. Clin Orthop Relat Res 330:157–165
Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic lateral instability. J Bone Joint Surg Am 70(4):581–588
Karlsson J, Lundin O, Lind K, Styf J (1999) Early mobilization versus immobilization after ankle ligament stabilization. Scand J Med Sci Sports 9(5):299–303
Karlsson J, Peterson L (1991) Evaluation of ankle joint function; the use of a scoring scale. Foot 1(1):15–19
Karlsson J, Rudholm O, Bergsten T, Faxén E, Styf J (1995) Early range of motion training after ligament reconstruction of the ankle joint. Knee Surg Sports Traumatol Arthrosc 3(3):173–177
Kim BS, Choi WJ, Kim YS, Lee JW (2010) The effect of an ossicle of the lateral malleolus on ligament reconstruction of chronic lateral ankle instability. Foot Ankle Int 31(3):191–196
Kim HN, Jeon JY, Dong Q, Noh KC, Chung KJ, Kim HK, Hwang JH, Park YW (2015) Lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon. Knee Surg Sports Traumatol Arthrosc 23(6):1877–1885
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 15(7):349–353
Kocher MS, Fabricant PD, Nasreddine AY, Stenquist N, Kramer DE, Lee JT (2017) Efficacy of the modified Broström procedure for adolescent patients with chronic lateral ankle instability. J Pediatr Orthop 37(8):537–542
Maffulli N, Ferran NA (2008) Management of acute and chronic ankle instability. J Am Acad Orthop Surg 16(10):608–615
Matsui K, Oliva XM, Takao M, Pereira BS, Gomes TM, Lozano JM; ESSKA AFAS Ankle Instability Group, Glazebrook M (2017) Bony landmarks available for minimally invasive lateral ankle stabilization surgery: a cadaveric anatomical study. Knee Surg Sports Traumatol Arthrosc 25(6):1916–1924
Miyamoto W, Takao M, Yamada K, Matsushita T (2014) Accelerated versus traditional rehabilitation after anterior talofibular ligament reconstruction for chronic lateral instability of the ankle in athletes. Am J Sports Med 42(6):1441–1447
Ogden JA, Lee J (1990) Accessory ossification patterns and injuries of the malleoli. J Pediatr Orthop 10(3):306–316
Petrera M, Dwyer T, Theodoropoulos JS, Ogilvie-Harris DJ (2014) Short- to-medium-term outcomes after a modified Broström repair for lateral ankle instability with immediate postoperative weightbearing. Am J Sports Med 42(7):1542–1548
Pill SG, Hatch M, Linton JM, Davidson RS (2013) Chronic symptomatic os subfibulare in children. J Bone Joint Surg Am 95(16):115
Ponce BA, Hosemann CD, Raghava P, Tate JP, Eberhardt AW, Lafosse L (2011) Biomechanical evaluation of 3 arthroscopic self-cinching stitches for shoulder arthroscopy: the lasso-loop, lasso-mattress, and double-cinch stitches. Am J Sports Med 39(1):188–194
SooHoo NF, Shuler M, Fleming LL (2003) Evaluation of the validity of the AOFAS Clinical Rating Systems by correlation to the SF-36. Foot Ankle Int 24(1):50–55
Strauss JE, Forsberg JA, Lippert FG 3rd (2007) Chronic lateral ankle instability and associated conditions: a rationale for treatment. Foot Ankle Int 28(10):1041–1044
Yasui Y, Shimozono Y, Kennedy JG (2018) Surgical procedures for chronic lateral ankle instability. J Am Acad Orthop Surg 26(7):223–230
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Funding
No funding has been provided for this research.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of Teikyo University (No: 16-063) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kubo, M., Yasui, Y., Sasahara, J. et al. Simultaneous ossicle resection and lateral ligament repair give excellent clinical results with an early return to physical activity in pediatric and adolescent patients with chronic lateral ankle instability and os subfibulare. Knee Surg Sports Traumatol Arthrosc 28, 298–304 (2020). https://doi.org/10.1007/s00167-019-05718-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-019-05718-6