Journal of Ergonomics
Open Access
ISSN: 2165-7556
ISSN: 2165-7556
Short Communication - (2022)Volume 12, Issue 3
Despite being the most frequent sports injury worldwide, ankle instability has received very little attention over the years from evidence-based medicine, a trend that has only been countered in recent years. Several papers have been published that might change the paradigm of the treatment patients in with Ankle instability, so it is paramount important that surgeons keep up to date with the best high quality available. This study intends to be an alert to that fact and a guide for the search of the newest information.
Ankle; Ankle instability; Arthroscopy; Ligament repair; Suture tape augmentation
Despite being the most frequent sports injury worldwide, ankle instability has received very little attention over the years from evidence-based medicine, a trend that has only been countered in recent years. Important papers have been published helping to understand the pathway to both dysfunction [1] and pathomechanics [2,3] of Chronic Ankle Instability (CAI). Regarding treatment, both conservative and surgical treatment had some major developments, which are going to be the scope of this study.
Starting with conservative treatment, there is no big news to report, since it has been well established the important value of rehabilitation, both as non-surgical treatment and post-operative rehabilitation. Nonetheless, there have been published three Randomized Controlled Trial (RCT), two of those that helped to cement the idea that we had already, about the importance of sensorimotor function and its rehabilitation [4,5], and another one [6], in conjunction [7], that showed that even though Virtual Reality assisted rehabilitation might be a certainty in the future, nowadays still lacks certain needed aspects to be implemented as Gold Standard.
Moving to surgical treatment, high quality studies have been published this last couple of years, that might lead to a change in paradigm. Open versus Arthroscopic ligamentous repair has been a hot topic especially since the publication of the All-Inside Technique in 2013 [8]. Some papers have been published with a penchant for arthroscopic procedure, including four Metaanalysis, two from 2020 [9,10] and two from 2021 [11,12]. In all these four papers the complication rates were equivalent or fewer than with open procedure and better AOFAS score were achieved through arthroscopy.
Regarding the structures involved in the repair, a Level I evidence paper was published by Ko, et al. [13] stating that there is no difference between repairing ATFL and CFL or ATFL alone, going along with the anatomical study published by Cordier, et al. [14]. On the same topic, the use of the Gould modification on the Arthroscopic procedure appears to have no clinical relevance one year after surgery [15] which contradicts the traditional Bostrom-Gould technique.
Another point of debate has been the use Suture Tape Augmentation (STA), both in primary and revision cases of 2022 [16] found no major clinical differences in primary cases between the groups with and without STA, although the first group appeared to have less recurrence of instability and more nerve irritation. As for revision cases, we are not aware of any high-quality study comparing the use of STA. Nonetheless, there have been published two retrospective studies reaching the same conclusion: Similar clinical outcomes after open or arthroscopic Bostrom, with or without an identifiable ATFL remnant [17,18]. It is certain that there are needs for higher evidence studies, but it could mean a paradigm change with less need of reconstructions and greater focus on repairs, even in cases of revision.
CAI is a complex topic that is often underdiagnosed and undertreated. In recent years, a great number of high evidence studies have been published and there might be some shift in the paradigm in relation to many aspects of its treatment. So, it is paramount important that foot and ankle surgeons keep up to date with this kind of knowledge so can offer the best treatment to their patients.
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Citation: Machado M, Babulal J, Amado P (2022) The Ankle Instability Treatment: A Shift in Paradigm? J Ergonomics. 12: 305.
Received: 08-Jun-2022, Manuscript No. JER-22-17854; Editor assigned: 13-Jun-2022, Pre QC No. JER-22-17854 (PQ); Reviewed: 28-Jun-2022, QC No. JER-22-17854; Revised: 08-Jul-2022, Manuscript No. JER-22-17854 (R); Published: 18-Jul-2022 , DOI: 10.35248/2165-7556.22.12.303
Copyright: © 2022 Machado M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.