TightRope™ Fixation for Ankle Syndesmosis This technique is used to stabilize an ankle after injury. Numerous alternative procedures have been developed for the management of these injuries in the younger and more active patient. It repairs the damage caused by an injury to the LisFranc ligament. Ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol is as safe as traditional methods. It is available in stainless steel and titanium. It is not intended to be a substitute for one’s clinical decisionmaking. High Ankle Sprain (Syndesmosis Sprain) Anatomy and Biomechanics . But what exactly is this surgery and when is it necessary? In preparation for the procedure, the patient is positioned and anesthetized, and the surgeon makes an incision on the outer side of the ankle to access the joint. Secondary surgical procedures (Ankle Fracture Treatment, Deltoid Repair) and the ongoing tissue status must be considered during rehabilitation with appropriate protocol modification. Within this protocol, there are Achilles tendon repair rehab protocol. DAVID M. BELL, M.D. 1‐14 Days Postoperative Do NOT remove the surgical bandage. For the second season in a row, Alabama quarterback Tua Tagovailoa underwent a "tightrope procedure" for an ankle injury, this time for his right ankle.. Technically speaking, the procedure … Optimal management of ankle syndesmosis injuries David A Porter, Ryan R Jaggers, Adam Fitzgerald Barnes, Angela M Rund Methodist Sports Medicine/The Orthopedic Specialists, Indianapolis, IN, USA Abstract: Syndesmosis injuries occur when there is a disruption of the distal attachment of the tibia and fibula. This case series details an ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol that reduces the amount of time to return to professional rugby league in the UK. Second, the implant has to be surgeon friendly from a technical standpoint. The following post-operative rehabilitation protocol is adapted from the one used at the Brigham and Women’s Hospital and the Hospital for Special Surgery (HSS), where the modified Brostrom-Gould procedure is the preferred anatomical surgical procedure for the treatment of lateral ankle instability. Prior to … Ankle syndesmosis surgery via a double tightrope repair followed by the accelerated rehabilitation protocol is as safe as the traditional procedures. ANKLE FUSION PROTOCOL This is the fusion of the tibia and the talus for ankle joint arthritis. Detailed Physical Therapy Post Op Protocol. It can also be used to stabilize a fracture of the fibula. Among the randomized control trials and cohort study, 133 patients underwent either the syndesmotic screw or the TightRope ™ procedure. Articular cartilage transplantation to the ankle rehab protocol There are actually three joints that make up the ankle complex: the tibiotalar joint, the subtalar joint and the distal tibiofibular joint. The second screw was left in for increased stability. Progression through the protocol will depend on successful Ankle dislocation rehab protocol. Basic Expectations Following Surgery Pain and Swelling This is a procedure that can be painful during the recovery period and given the extensive nature of the surgery… ankle arthroplasty (TAA). The Tightrope technique is a modification of human procedures used in ankle surgery. For patients who are recovering from ankle or foot surgery, please refer to the following protocols as advised by your physical therapist. A device is surgically placed that stabilizes the CCL-deficient knee through bone tunnels drilled using smaller incisions. wound closure with stiches/sutures ix. The physician will make any specific changes to the protocol as appropriate for the individual patient. reduction of the syndesmosis using tightrope, anchors or screws viii. These injuries occur commonly (up to 18% of ankle sprains), and … Rehabilitation Protocol: Ankle Arthroscopy WITH Talus OCD Microfracture Phase I - Post-operative Period (Weeks 0-1) • NON-weightbearing • Splint immobilization • Daily icing, compression and elevation home program Phase II (Weeks 1-3) • Weightbearing: Contine NON … It is possible to return to spor … Design: Retrospective comparative cohort study over a two year period. View Tightrope Abstract + Paper (F).docx from HSPTS 385 at Capital University. ORTHOPAEDIC SURGERY & SPORTS MEDICINE 5924 STONERIDGE DRIVE, SUITE 202 PLEASANTON, CA 94588 925 -600 -7020 BELLSPORTMED.COM Postoperative Instructions: Ankle Syndesmosis Repair When you get home: Rest for the remainder of the day. Reduce the risks associated with the fracture, such as degenerative joint disease (arthritis), chronic pain, and disability CMC Tightrope Suspensionplasty Rehabilitation Protocol Kelly Holtkamp, M.D. Tightrope device. Grade 3 is a severe injury where the ligaments have completed ruptured, and in the case of syndesmotic injury there is associated diastasis at the ankle joint requiring surgical intervention. Tightrope’s quicker recovery has made it a very attractive procedure for surgeons and patients. The risk of complications with ankle arthroscopy and lateral ligament surgery is low. Our e-learning platform contains high resolution images and a certified CME of the Ankle fracture: Arthrex tightrope for acute syndesmotic injury and Stryker Variax plate for fibula fracture surgical procedure. Insertion of the TightRope is quick, reproducible, and without any major technical problems. 2,3,7 Patient-reported outcome scores were measured using the American Orthopedic Foot and Ankle Society, Foot and Ankle Disability Index, or the Olerud–Molander Ankle Score. (2014) It can also be used to stabilize a fracture of the fibula. Chiodo, Cowell, Dechaves (Reviewers) Brigham and Women’s Hospital, Inc. Department of Rehabilitation Services, (2010) Sherry M. and UW Health Sports Medicine physician group: “Rehabilitation Guidelines for Lateral Ankle Reconstruction”. 1 Tightrope Ankle Syndesmosis Fixation Surgery Colin Cottrell Therapeutic Exercise: HSPTS 385-01 April 16, The Tightrope technique is a modification of human procedures used in ankle surgery. A device is surgically placed that stabilizes the CCL-deficient knee through bone tunnels drilled using smaller incisions. This new technique has the added advantage of being 1/2 the cost of the traditional TPLO. Restrictions: No heavy lifting greater than 2 lbs. It is not intended to be a substitute for clinical decision making regarding the progression of a patient’s The injury and tightrope procedure is significant as Alabama vies for … According to a hardware manufacturer, the recommended rehabilitation following tightrope placement looks very similar to a non-operative ankle sprain protocol (in the absence of a fracture) and "supports early weight-bearing and accelerated rehabilitation". If bony fragments have broken loose from the fibula, they are either removed or stabilized, and if the fibula has separated, the pieces are realigned. These are pics of the seperation of the ankle joint due to the syndesmotic rupture and high … TightRope™ Fixation for Ankle Syndesmosis This technique is used to stabilize an ankle after injury. infiltration with local anaesthetic x. back slab plaster application THE RISKS OF SURGERY All surgical procedures carry some risk. When these ligaments are overstretched, it is referred to as an ankle … It provides support for the midfoot region. It can be used to repair a high ankle sprain, which damages the soft tissue structures between the tibia and fibula and causes these bones to separate. !1 – Ankle Arthrodesis (fusion): Postoperative Protocol Above is a teen male who had an ankle injury playing football, had ankle pain and was sent for MRI which verified a tear in the long ligament of the ankle called the syndesmosis. Occasionally the subtalar joint (between the talus and calcaneus) also needs to be fused, which further stiffens the ankle. It is typically indicated in older, lower demand individuals, as the lifespan of an ankle replacement remains less certain than that for … A compression stocking worn during the day can be quite helpful. This type of injury often requires Syndesmosis surgery with TightRope fixation to restore the stability and function of the ankle. Functional Strength 4. Independent with Crutches NWB (to include all normal community barriers) Treatment: - Modalities to control inflammation Status Post Modified Brostrom Procedure Ankle Rehabilitation Protocol Preoperative Goals: 1. Full functional ROM 2. For the Clinician: The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation for the patients who undergo surgery for an ankle fracture. The accelerated rehabilitation protocol promotes early weight-bearing and has shown to expedite the return to sport for professional Rugby League players. Be Safe- stay in the care of responsible adult the first 24 hours. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. It is a severe type of foot and ankle sprain causing pain, swelling, and weakness. Your ankle will lose the majority of its up and down motion, but typically retain some side to side motion. This new technique has the added advantage of being 1/2 the cost of the traditional TPLO. are essential to optimizing the success of this procedure. Tensioning handles and a new trocar-tipped drill bit have been added to the implant system. vii. Stability of a joint is maintained by connective tissue structures and the dynamic support of the surrounding muscles. The ankle is a complex joint made up three bones: the tibia, the fibula and the talus. These three bones are connected by several ligaments that help stabilize the joint. The tightrope is a relatively new innovation in the treatment of high ankle sprains, in which ligaments and tissues around the leg bones, the tibia and fibula, are loosened and become unstable. The accelerated rehabilitation protocol promotes early weight-bearing resulting in an effective and quick route to return to sport for professional Rugby League players. In his defense, when you search this topic in PubMed, Google or even resources from other reliable medical institutions, there are very few evidence based protocols established. Learn the Ankle fracture: Arthrex tightrope for acute syndesmotic injury and Stryker Variax plate for fibula fracture surgical technique with step by step instructions on OrthOracle. Objective: To analyse whether early post-operative full weight bearing following syndesmotic ankle fixation affected radiographic outcomes suggestive of diastasis. This important ligament connects the medial cuneiform to the second metatarsal. The goal of this procedure is to restore daily function and allow return to an active, healthy lifestyle. In some cases, the tibia and fibula may draw apart (diastasis) resulting in ankle instability. 0-minimmal inflammation 3. Once the oblong button emerges, the surgeon flips it parallel to the bone surface and exerts lateral tension to hold it flush. The first surgery is 2 syndesmotic screws. The aim of this study was to describe players’ journey from injury, through diagnosis to surgery, rehabilitation and return to participation, The “TightRope” in his ankle is doing the job of his ligaments while they heal, allowing him to stably move around the turf. ANKLE/ HINDFOOT PROCEDURES Ankle Arthrodesis/ Tibio-talo-Calcaneal Arthrodesis Postop: Below knee backslab Foot elevation 7 to 10 days Non-weight bearing (NWB) 2 weeks DVT prophylaxis for 2 weeks - LMWH Follow-up: 2 weeks Wound check & ROS at plaster room Wednesday P.M. clinic Below knee cast PWB to FWB depending on fixation This surgical procedure stabilizes the bones of your foot. an ankle syndesmosis tightrope repair and an accelerated rehabilitation protocol that reduces the amount of time to return to professional rugby league in the UK. Ankle instability rehab protocol. The TightRope has allowed me to achieve immediate rotational stability of the ankle and lets me push earlier weight-bearing. The plan of care should be based upon the patients clinical exam and individual goals. A higher incidence of syndesmosis injuries occurs in the athletic population, with a majority of those injuries occurring in football. It can be used to repair a high ankle sprain, which damages the soft tissue structures between the tibia and fibula and causes these bones to separate. Introduction: Ankle replacement is performed as a treatment for end-stage ankle arthritis (See Figure 1). After 12 weeks, the proximal screw was removed and a tight rope was applied. Rehab protocol created with help by: Braidy Solie, DPT, CSCS, EMR Tightrope Procedure (Isolated Syndesmotic Repair) The intent of this protocol is to provide a general framework for an isolated syndesmotic repair utilizing a Tightrope device. Secondary surgical procedures (Ankle Fracture Treatment, Deltoid Repair) and the ongoing Tightrope surgery has become more popular in the last year or so due to some cases of famous athletes having the procedure and subsequent features on ESPN. A tightrope device provides greater mobility within the ankle joint and a quicker return to sport. This procedure can cause a lot of swelling. It is normal for the foot and ankle to be swollen for up to 6-12 months after surgery. ANKLE/SYNDESMOSIS ORIF PHYSICAL THERAPY Philosophy This protocol is to be utilized as a guideline. A series of unfortunate events (but thank goodness the nachos were saved) resulted in an ankle syndesmosis repair and early referral to therapy by a trusting surgeon.Just minus a protocol. Lateral Ankle Reconstruction The ankle is a very complex joint. Please fax initial evaluation and progress notes to 815‐381‐7498. Quote or Evaluation The Syndesmosis TightRope ® XP implant system features a unique delivery mechanism that allows surgeons to insert the implant without pulling a needle through the medial skin. After suffering another ankle injury against Tennessee on October 19, he had an innovative procedure called “tightrope,” which has been used to accelerate recovery from ankle sprains. There will always be individual differences amongst patients regarding progression and tolerance of specific activities. TREATMENT FOR ANKLE TIGHTROPE After drilling through all four cortices in the transmalleolar axis, the surgeon pulls the needle, with its tightrope and oblong button, from the lateral to the medial side. The AC Tightrope (Arthrex) reconstruction was developed originally as an arthroscopic technique by Mr Duncan Tennent (St George’s Hospital, London). McKenzie MJ : “Modified Brostrom-Gould Repair for Chronic Lateral Ankle Instability”.

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