Anatomic reconstruction of lateral ankle ligaments: is there an optimal graft option?

Abstract

Purpose Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle. Methods A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient’s subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures. Results Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes. Conclusions The systematic analysis of validated CAI outcome measures and the patient’s subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson–Peterson score superior to 80 points and to a similar rate of patient’s subjective satisfaction. Level of evidence Level IV.

Progress in diagnosis and treatment of acute injury to the anterior talofibular ligament

“…For non-anatomical ligament reconstruction, the surgical method will replace reconstruction with grafts. Studies have shown that regardless of the grafts used (autograft or allograft), the Karlson-Peterson score is always over 80 with good or excellent outcomes[ 69 ]. Evans, Chrisman-Snook, and Watson-Jones surgeries are commonly used for non-anatomic reconstruction.…”

Incidence of Septic Arthritis After Vancomycin Soaking of the Graft During Arthroscopic Anatomic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction

“…29 After appropriate nonoperative management, ankle stabilization can be obtained with an anatomic surgical reconstruction technique of both bundles of the lateral ligament complex. 7,15,26 This anatomic reconstruction technique, particularly by mini-invasive arthroscopy, results in good clinical results and a rapid return to sports (RTS). 8,[18][19] The infection rate in the ligament reconstruction of the ankle could be higher than that of other joints because of the superficial location of this joint and the graft.…”

“… 29 After appropriate nonoperative management, ankle stabilization can be obtained with an anatomic surgical reconstruction technique of both bundles of the lateral ligament complex. 7 , 15 , 26 This anatomic reconstruction technique, particularly by mini-invasive arthroscopy, results in good clinical results and a rapid return to sports (RTS). 8 , 18 - 19 …”