title: The effect of ossicle resection in the lateral ligament repair for treatment of chronic lateral ankle instability.
abstract: BACKGROUND
  The management of an ossicle or avulsion fragment of the fibular tip in chronic lateral ankle instability is an open question. Some authors maintain the necessity of osteosynthesis for reconstruction of the lateral ligamentous structure if the fragment is large. We hypothesized that the modified Broström procedure with resection of the ossicle would result in good outcomes compared to that of the same procedure for chronic lateral instability patients without ossicle.
  
  
  METHODS
  Between December 2004 and December 2010, 102 patients underwent the modified Broström procedure for chronic lateral instability. Of these, 82 patients (86 ankles) were available for this study. Forty ankles had ossicles at the fibular tip (group O), 46 had no ossicle (group N). The average follow-up period was 33 months in group O and 37 months in group N. Irrespective of size, if there were ossicles we resected all fragments and performed the modified Broström procedure. To analyze the surgical outcome, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot pain and function scales and Karlsson scores were compared between the 2 groups preoperatively and postoperatively.
  
  
  RESULTS
  Preoperative scores in the 2 groups showed no significant difference, except for AOFAS pain score. There was no significant difference in postoperative AOFAS pain and function score between the groups. Postoperative Karlsson score was significantly higher in group O than in group N (P = .001). Group O was divided into 2 subgroups by the largest diameter of the ossicle (< 10 mm and ≥ 10 mm); there was no significant difference in surgical outcomes.
  
  
  CONCLUSIONS
  In the treatment of chronic lateral instability of ankle, if there are ossicles on the fibular tip, osteosynthesis of the ossicles may not be necessary, even if the size is considerable. Modified Broström procedure after resection of the ossicle was successful.
  
  
  METHODS
  Level III, retrospective case series.
authors.affiliation: Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Tae-Hwan
authors.initials: TH
authors.lastname: Chun
authors.forename: Yong-Serk
authors.initials: YS
authors.lastname: Park
authors.forename: Ki-Sun
authors.initials: KS
authors.lastname: Sung
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D017844:Lateral Ligament, Ankle / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome
keywords: avulsion fragment; chronic lateral instability; modified Broström; os subfibulare; ossicle