L’instabilité latérale chronique de la cheville : résultats cliniques de la réparation selon Broström modifié Gould sous arthroscopie

Abstract : Introduction: ankle sprain incidence has a heavyweight on public health. Approximately, worldwide, one ankle sprain occurs per 10,000 person-days. Chronic ankle instability can happen even if an optimal functional treatment is a use, up to 20% at 30%. This instability leads to physical activity restriction, chronic pain and at the end stage severe osteoarthritis. Since Broström in 1966, we know that anterior talofibular ligament direct repair provides goods results. Gould modified the technic, with a retinaculum augmentation for protecting the suture and stabilized the result. For several years the “Broström-Goud” procedure became the gold standard in chronic ankle instability treatment. Purpose and Hypothesis: our study aims are to describe an arthroscopic Broström- Gould procedure using an additional lateral endoscopic portal for retinaculum reinforcement, evaluated at midterm the clinical result and the term for professional and sports activities return. Our hypothesis is this technic can improve AOFAS and Karlsson Score with a low rate of complication and an early recovery. Methods: It is an observational retrospective study between January 2015 and November 2016 with a prospective data collection. All patients complained of an ankle instability with a failure of the medical treatment. A clinical examination assessed it with a comparative anterior drawer test and a talar test. An ultrasonography and an arthoCT was performed to diagnose a lateral ligament lesion and associated injury. Then, an arthroscopic Broström-Gould was performed. An independent observer recorded preoperatively and at the final follow-up the AOFAS ankle-hindfoot scoring system, the Karlsson–Peterson score and ankle range of motion. We registered the term for professional, and sports activities return. Results: in our study 89 patients were analyzed. The average increased of AOFAS Score was 20 points (p< 0,0001). Prior to the surgery, the average Karlsson- Perterson score was 62 points, after it was 90 points (p< 0,0001). The average range of motion was 63° in the preoperative and 59° in the postoperative clinical examination. This difference exists mainly on ankle dorsiflexion with a loss of 3°; there is only a loss of 1° in plantar flexion but it is not statistically significant. The average professional return was 3,7month, and the average sport's return 4,8 month. Overall, 83% of patients were satisfied or very satisfied after the procedure. Our complication rate was 11%. The revision surgery rate was 1,1%. Conclusion: the arthroscopic Broström-Gould procedure using an additional lateral endoscopic portal improved ankle stability with a low complication rate and an early recovery.
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Master Thesis
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Johan Lebecque. L’instabilité latérale chronique de la cheville : résultats cliniques de la réparation selon Broström modifié Gould sous arthroscopie. Médecine humaine et pathologie. 2018. ⟨dumas-02073281⟩

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