No abstract

Two anatomic reconstructions for correction of chronic lateral ankle joint instability were compared. In a prospective, randomized study, 60 patients were allocated to one of two treatment groups: reconstruction of the ligaments as described by Karlsson et al. (Group I) or with the modification of the Broström procedure as described by Gould et al. (Group II). The functional results were evaluated with a scoring scale, and the mechanical stability with standardized stress radiographs. The minimum follow-up period was 2 years. The functional results were satisfactory in 27 of 30 (90%) patients in Group I and 25 of 30 (83%) in Group II. There was no significant difference between the groups regarding mechanical stability. The mean anterior talar translation in Group I was 7.1 mm (range, 4 to 10) at followup, compared with 6.7 mm (range, 3 to 9) in Group II. The corresponding values for talar tilt were 4.9 degrees (range, 0 degree to 8 degrees) in Group I and 4.4 degrees (range, 0 degree to 8 degrees) in Group II. The duration of operation time was significantly longer in Group II and surgical complications were more frequent, probably due to the more extensive surgical exposure. This study showed that the majority of patients with chronic ankle instability can be successfully treated with anatomic reconstruction of the lateral ankle ligaments. Mechanical stability was restored with both methods.

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

Early range of motion training after ligament reconstruction of the ankle ligaments for chronic ankle joint instability was evaluated. Forty patients were operated on with anatomic reconstruction of the lateral ankle ligaments, i.e. shortening, imbrication and reinsertion. The patients were randomized postoperatively between two groups: (1) immobilization for 6 weeks in a plaster cast and (2) early range of motion training, in a Walker-Boot. Both groups underwent an identical rehabilitation program, with peroneal strengthening and co-ordination training after 6 weeks. The functional results were evaluated using a scoring scale and the mechanical stability with standardized stress radiographs. The minimum follow-up was 2 years. The functional results were satisfactory in 16 (80%) of the patients in group I, and 19 (95%) in group II. The mean values of anterior talar translation and talar tilt were not significantly different between the groups preoperatively nor at follow-up. The mean time period for sick leave was significantly shorter for group II, 6.5 +/- 1.6 weeks compared with 8.5 +/- 1.8 weeks for group I. The mean time period for return to sports activity was significantly shorter for group II, 9.5 +/- 2.2 weeks, compared with 12.5 +/- 2.6 weeks for group I. Early range of motion training is recommended after ligament reconstruction of the ankle, as it will enable earlier return to sports activities, shorter sick leave and preserved mechanical stability.