august 2008

LATERAL ANKLE INSTABILITY

Have you ever been out in the yard and stepped in a hole or stepped off a curb and all of the sudden your foot twists and you feel a pop and sudden sharp pain in your ankle? Well this inversion or twisting motion of your foot has caused an ankle sprain. Now that these ligaments have been injured they are more susceptible to recurrent or continuous sprains leading to instability of the lateral or outside portion of your ankle. There are three collateral ligaments found in this area but it is the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) that we are concerned with since these are the primary restraints and ligaments most commonly associated with in inversion type injury. A preferred method of repair is a Brostrom procedure where one or both of the ligaments are sutured in an end to end fashion and reported with CPT codes 27695 for one collateral ligament and 27696 for both collateral ligaments. The Brostrom repair can also be over sewn with the adjacent retinaculum to supplement and strengthen the repair is what’s called a Gould modification. Per the AAOS advancement of the retinaculum is considered part of the Global Service and not additionally reported. With CPT code 27698 for a secondary repair the CPT manual gives you an example of a Watson-Jones while the Coder’s Desk Reference mentions an Evans or Chrisman-Snook procedure. All of these types of procedures read more like a reconstruction instead of a repair in that the peroneus brevis tendon is transected at a more proximal location up the leg and left attached to its distal point on the fifth metatarsal tuberosity. In an Evans procedure the tendon is passed through drill holes in the fibula and secured, for the Chrisman-Snook the tendon follows the same path as the Evans but then it is brought down through drill holes in the calcaneus and then sewn back onto itself in the area of the talus. The objective of these procedures is to try and anatomically replicate the position and function of the ATFL and CFL collateral ligaments. So next time, you may not know exactly how you stepped down and twisted your ankle but you’ll know how it can be repaired!

 

 

 

 

 

 

 

 

 

 

 

 







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