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Sixty patients with chronic lateral functional and mechanical instability of the ankle joint were treated with shortening and reinsertion of the lateral ankle ligaments. All patients were followed prospectively for 2 to 5 years (mean, 3 years 6 months). We found the functional results to be excellent or good in 53 patients (88%). Patients with unsatisfactory results had either generalized joint hypermobility or long-standing ligament insufficiency. Anterior talar translation (ATT) and talar tilt (TT) were measured radiologically on standardized radiographs. Patients with excellent and good functional results had better mechanical stability, both ATT and TT, than those with fair and poor functional results. A good correlation was found between clinical, functional, and radiological results. In conclusion we found that reconstruction of the ankle stability by shortening and reinsertion of the lateral ankle ligaments is a safe and simple method and is a good alternative to other more complex methods of ligament reconstruction. The method should, however, be used with great care in patients with generalized joint hypermobility or in patients with long-standing ligament insufficiency.

We have reviewed 42 of 52 consecutive patients at an average of 14 years after a tenodesis based on Evans' operation performed for chronic lateral instability of the ankle. Only 21 patients (50%) had satisfactory long-term functional results, and 12 patients with satisfactory early results had deteriorated after three to six years. Stress radiographs were used to measure anterior talar translation and talar tilt, and a good correlation was found between function and mechanical stabifity. Talar tilt had been controlled more successfully than anterior translation. Marginal osteophytes were found in most ankles, and were larger and more numerous in

Acute lateral ligament injuries of the ankle are best treated nonsurgically, with peroneal strengthening and neuromuscular training. At least 80 to 90% of patients will regain satisfactory ankle stability after functional treatment. Chronic ankle instability occurs in approximately 10 to 20% of patients after acute ligament injuries, irrespective of primary treatment. Surgical reconstruction may be necessary, especially in athletes with high demands on ankle joint stability. Numerous different surgical procedures have been described many with some kind of a tenodesis. The classic tenodeses, Evans, Watson-Jones and Chrisman-Snook, have all been used with good short term results. Anatomical ligament reconstruction using the remnants of the ruptured and elongated ligaments, with shortening, reinsertion and duplication, have been shown to be simple, effective and free from complications. As the results of anatomical reconstruction are satisfactory both in the short and the long term, this reconstruction is recommended for correction of lateral ankle instability.