1. Emergency Room: Foot and Ankle Injuries Selene G. Parekh,
MD, MBA Associate Professor of Surgery Partner, North Carolina
Orthopaedic Clinic Department of Orthopaedic Surgery Adjunct
Faculty Fuqua Business School Duke University Durham, NC
919.471.9622 http://seleneparekhmd.com Twitter:
@seleneparekhmd
2. Ankle Sprains
3. Lateral Ankle Sprains Most common specific injury in sports
Finland 16-21% of all sports injuries Basketball 45% of injuries
Soccer 31% of injuries Anatomy
4. Lateral Ankle Sprains Most common specific injury in sports
Finland 16-21% of all sports injuries Basketball 45% of injuries
Soccer 31% of injuries Anatomy
5. Lateral Ankle Sprains Most common specific injury in sports
Finland 16-21% of all sports injuries Basketball 45% of injuries
Soccer 31% of injuries Anatomy
6. Lateral Ankle Sprains Most common specific injury in sports
Finland 16-21% of all sports injuries Basketball 45% of injuries
Soccer 31% of injuries Anatomy
7. Lateral Ankle Sprains Biomechanics Dorsiflexion: ATFL loose,
CFL taut Plantarflexion: ATFL taut, CFL loose ATFL Adduction in PF,
restricts IR of talus in mortise CFL Adduction in neutral/DF PTFL
Prevents ER in DF IOL Controls rotation
8. Lateral Ankle Sprains Pathology Associated injuries Tear of
P. long/br. Talar chondral injury Medial ligament & syndesmotic
injuries Fx lateral talus & fibula, 5th metatarsal fx, anterior
process calcaneus fx Post-sprain neuritis
9. Lateral Ankle Sprains Diagnosis Immediate swelling &
pain, difficulty WB Tenderness over affected structures ROM Pain
with anterior drawer, suction sign with anterior subluxation of
talus Inversion stress- pain/instability
13. Lateral Ankle Sprains Surgical treatment Acute
Controversial Young athlete Gross instability Associated fracture
Talocrural dislocation Direct repair/fixation of bony
fragments
14. Surgical Options Modified Brostrum Imbricate using native
tissue Supplement using IER Anatomic allograft reconstructions
15. Old Technique vs New Technique Chrisman Snook / Watson
Jones Style Anatomic Secondary Procedure using Bio Tenodesis
Screws
16. Lateral Ankle Ligament Reconstruction w/ Free Graft
Overview Courtesy of Tom Clanton, MD
17. Anatomic Weave
18. Anchoring in Calcaneus
19. Talar Anchor Point
20. Talar Anchor Point
21. Knee Surg SportTram Arth 2012 Use of semitendinosus
allograft tendon for chronic lateral ankle instability
Retrospective study of n=28 ankles Reconstruction ATFL/CFL with
interference screws Mean follow-up 19 months VAS scores 62 (p