Lateral Ligament Repair for Ankle Instability Protected With Internal Bracing. A Multicenter, Randomized Controlled Trial.
试验速览
- 阶段
- 不适用
- 发起方
- 入组人数
- 42
- 试验地点
- 4
- 主要终点
- Change from baseline Foot Ankle Outcome Score (FAOS) at 12 months
研究概览
简要总结
This study evaluates the effect of internal bracing in lateral ligament ankle surgery. Half of the patients will receive the standard Brostrom-Gould reconstruction followed by a standard revalidation protocol including 6 weeks of immobilisation, while the other half of the patients will receive the same operation augmented with internal brace followed by an accelerated rehabilitation protocol.
详细描述
Ankle inversion trauma often leads to chronic ankle instability which can severely limit the patient during daily activities, including work and sports. When conservative treatment fails, surgical treatment in which the ruptured anterior talofibular ligament (ATFL) is reconstructed can be considered. Surgical treatment for ankle instability is associated with a relatively long rehabilitation due to the initial limited strength of the reconstructed ligament. This limited strength in the first weeks after surgery makes it necessary to protect the reconstructed lateral ankle ligament with immobilization. Usually a lower leg plaster is applied for six weeks. Due to the initial limited strength of the reconstructed ligament and the immobilization period itself, return to activities after surgery for this injury usually takes up to six months or even more. Therefore, surgical intervention is only indicated for patients who suffer chronic, recurrent ankle instability.
With a new surgical technique, an internal brace is placed over the reconstructed lateral ankle ligament, thereby providing protection which makes immobilization in the postoperative weeks unnecessary. This allows an earlier start of the rehabilitation which might enhance ankle function postoperatively and allows earlier return to activities. Also, adding an internal brace to the reconstructed lateral ankle ligament might result in a lower recurrence rate of ankle instability compared to the current surgical procedure.
Objective
To evaluate if patients with chronic, recurrent lateral ankle instability who are treated with surgical lateral ankle ligament repair protected with an internal brace, have significant better ankle function after surgery compared to patients treated with standard surgical lateral ankle ligament reconstruction without internal brace. The appropriately adapted rehabilitation for each surgery procedure is applied.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 16 Years 至 60 Years（Child, Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •patients diagnosed with chronic lateral ankle instability (multiple ankle inversion trauma within 12 months and symptoms present >1 year). Lateral ankle instability is present if the patient complains of giving way of the ankle and has positive signs of ankle instability during physical exam (talar tilt score of >15 degrees compared to contralateral ankle or anterior drawer test score of >10mm compared to the contralateral ankle.
- •Conservative therapy has failed.
- •Normal foot and ankle anatomy as determined by orthopedic surgeon.
- •Patients in whom their ankle symptoms interfere with their physical activities.
- •Patients with isolated anterior talofibular ligament which is indicated for repair using the Brostrom-Gould technique.
- •Patients who are able and willing to undergo ankle surgery.
- •Patients who are able and willing to comply with the rehabilitation protocol in any of the study physiotherapy centers.
- •Patients who are able and willing to return for follow-up evaluations.
- •Patients with sufficient understanding of the Dutch language.
排除标准
- •Patients who need concomitant ankle surgery (i.e. Calcaneofibular ligament reconstruction, peroneus tendon repair, arthroscopy of the ankle, etc).
- •Patients with comorbidities, including musculoskeletal injuries or diseases in other joints than the affected ankle which limits their physical activity.
- •Ankle instability due to abnormal foot and ankle anatomy.
- •No objective or subjective ankle instability.
- •Previous ankle surgery.
- •Patients in which the contralateral ankle also shows lateral ankle instability.
结局指标
主要结局
Change from baseline Foot Ankle Outcome Score (FAOS) at 12 months
时间窗: pre-operative, post-operative at 12 months
Patient reported outcome measure, consists of 42 items, each item is scored in a 5-point likert scale
次要结局
未报告次要终点
研究者
Walter van der Weegen
Principal Investigator
St. Anna Ziekenhuis, Geldrop, Netherlands