Lateral Ankle Sprain Anatomy ¢â‚¬â€œ Can the Bifurcate Ligament ... Lateral Ankle Sprain Anatomy ¢â‚¬â€œCan

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  • Lateral Ankle Sprain Anatomy – Can the Bifurcate Ligament be Consistently

    Identified with Ultrasound on Cadavers Lyman Wood, 1st Year Medical Student

  • Overview • Objective

    • Bifurcate ligament anatomy

    • Understanding lateral ankle injury

    • Methods & Materials

    • Results and clinical significance

    • Conclusion

  • Objective

    • Investigate whether the bifurcate ligament could be identified using ultrasound on cadavers as a training exercise for anatomy education, clinical training, and assessment

  • Introduction • The bifurcate ligament (BFL) is under

    appreciated regarding lateral ankle injuries

    • Similar orientation to the anterior talofibular ligament (ATFL)

    • The BFL supports the joints between the calcaneous, cuboid and naviculus bones

  • Understanding Lateral Ankle Sprians • Typical Mechanism

    – Plantar flexion

    – Inversion

    • High Recurrence – A survey of 380 athletes

    revealed 73.5% of 563 ankle sprains had been previously injured

    • Variable Recovery Time – Average non-surgical complete

    rehabilitation 36-72 days

    Fallat, Grimm, Saracco, 1998

  • Methods • Literature Search – current imaging text and

    online journals

    • Dissection – 58 cadavers to identify BFL

    – 55 (n=110 sides; 55R:55L) Carolina solution

    – 3 (n=6; 3R:3L) Freedom Art solution

  • Methods • Evaluate Structural Relationships – Digital caliper

    measurements between:

    – Apex distal fibula (ADF), 5th metatarsal tuberosity (5MT)

    – ADF, Proximal aspect of BFL ligament (PBFL)

  • Methods

    • Surface Anatomy Template - developed using palpable bony landmarks for proper probe placement

    • Ultrasound – 31 donor cadaver patients (n=61 30R:31L) utilizing surface anatomy template

  • Materials

    • Ultrasound systems used

    – Sonosite M-Turbo – Classic probe

    – Fukuda-Denshi AG760 machines - SonicEye finger probe

    Sonosite M-Turbo Fukuda-Denshi AG760

  • Results

    • Literature Search – Revealed no studies of ultrasound (US) identification of BFL on cadavers

    – Study of 19 patients revealed 95% positive I.D. by US of ATFL damage (confirmation by Arthroscopy)

    • Dissection & Measurements

    – ADF – 5MT 60.22mm ± 0.43

    – ADF – PBFL 42.18mm ± 0.51

    Ratio ADF-PBFL:ADF-5MT = 1/3 from ADF

    1/3

    2/3

  • Results

    • Surface Anatomy Template

    – Revealed 76.27% positive BFL I.D. with 1st probe placement

    – Modified 2nd attempt revealed 92.86% positive I.D. with slight transducer adjustment

    Ultrasound Probe Placement Accuracy

    Accuracy of 61 US probe placements utilizing surface anatomy template and palpable landmarks

  • Results

    Caveric tissue

    In vivo

  • Results

    Caveric tissue

    In Vivo

  • Conclusion & Discussion

    • The bifurcate ligament can be positively identified using ultrasound on cadavers

    • Utilizing the surface anatomy template provides accurate and efficient I.D. with multiple different ultrasound systems and transducers

    • Ultrasound provides cost effective, quality imaging of affected anatomy regarding lateral ankle injuries

    • Accurate identification of ALL injured structures can reduce recurrence, recovery time, and improve overall patient care

  • Acknowledgements

    Bryan Beall 4th Year Medical Student Brion Benninger, MD MSc

  • References • Anagnostopoulos, D., Bali, N., Alo, K., & McKenzie, J. (2014). (iii) Arthroscopy of the foot and ankle. Orthopaedics and Trauma,

    28(1), 18-26. • Anderson, S. J. (2002). Acute ankle sprains. Physician and sportsmedicine, 30(12). • Ansede, G., Lee, J. C., & Healy, J. C. (2010). Musculoskeletal sonography of the normal foot. Skeletal radiology, 39(3), 225-42. • Clanton, T. O., & Porter, D. A. (1997). Primary care of foot and ankle injuries in the athlete. Clinics in sports medicine, 16(3), 435-

    66. • Croy, T., Saliba, S., Saliba, E., Anderson, M. W., & Hertel, J. (2012). Differences in lateral ankle laxity measured via stress

    ultrasonography in individuals with chronic ankle instability, ankle sprain copers, and healthy individuals. Journal of orthopaedic & sports physical therapy, 42(7), 593-600.

    • Fallat, L., Grimm, D. J., & Saracco, J. A. (1998). Sprained ankle syndrome: prevalence and analysis of 639 acute injuries. The journal of foot and ankle surgery, 37(4), 280-5.

    • Golanó, P., Vega, J., De Leeuw, P. A., Malagelada, F., Manzanares, M. C., Götzens, V., & Van Dijk, C. N. (2010). Anatomy of the ankle ligaments: a pictorial essay. Knee Surgery, Sports Traumatology, Arthroscopy, 18(5), 557-69.

    • Hertel, J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of athletic training, 37(4), 364.

    • Hodge, J. C. (1999). Anterior process fracture or calcaneus secundarius: a case report. The Journal of emergency medicine, 17(2), 305-9.

    • Hua, Y., Yang, Y., Chen, S., & Cai, Y. (2012). Ultrasound examination for the diagnosis of chronic anterior talofibular ligament injury. Acta Radiologica, 51(10), 1142-5.

    • Hubbard, T. J., & Hicks-Little, C. A. (2008). Ankle ligament healing after an acute ankle sprain: an evidence-based approach. Journal of athletic training, 43(5), 523.

    • Mei-Dan, O., Kots, E., barchilon, v., Massarwe, S., Nyska, M., & Mann, g. (2009). A dynamic ultrasound examination for the diagnosis of ankle syndesmotic injury in professional athletes a preliminary study. The American journal of sports medicine, 37(5), 1009-1016.

    • Oae, K., Takao, M., Uchio, Y., & Ochi, M. (2010). Evaluation of anterior talofibular ligament injury with stress radiography, ultrasonography and MR imaging. Skeletal Radiology, 39(1), 41-7.

    • Robbins, M. I., Wilson, M. G., & Sella, E. J. (1999). MR imaging of anterosuperior calcaneal fractures. AJR. American journal of roentgenology, 172(2), 475-9.

    • Seybold, J. D., J. R., & Myerson, M. S. (2014) Hindfoot fusions in the flatfood deformity: when and what techniques to use in late stage II and stage III deformities. techniques in foot & ankel surgery, 13(1), 29-38.

    • Yeung, M. S., Chan, K. M., So, C. H., & Yuan, W. Y. (1994). An epidemiological survey on ankle sprain. British journal of sports medicine, 28(2), 112-6.

    • Weiss, D. B., Jacobson, J. A., & Karunakar, M. A. (2005). The use of ultrasound in evaluating orthopaedic trauma patients. Journal of the American Academy of Orthopaedic Surgeons, 13(8), 525-33.