Anatomical Arthroscopic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction Using an Autogenic Hamstring Tendon: Safe Creation of Anatomical Fibular Tunnel

Higashiyama, Reiji; Aikawa, Jun; Iwase, Dai; Takamori, Yasuyuki; Watanabe, Eiichiro; Takaso, Masashi

doi:10.1016/j.eats.2018.10.016

Cited by 13 publications

(37 citation statements)

References 22 publications

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“…The foot is suspended from the distal edge of the bed, and the contralateral leg is slightly lowered to provide a wide working space ( Fig 1A). 8 Step 2: Graft Preparation…”

Section: Surgical Techniquementioning

confidence: 99%

“…The ankle is positioned neutrally. The AM portal is created medial to the anterior tibial tendon 8 and slightly proximal to the joint line. A 30 2.7-or 4.0-mm-diameter arthroscope is introduced through the AM portal.…”

Section: Graft Fixationmentioning

confidence: 99%

“…If it does not reach the opposite cortex, the drill wire is inserted anteriorly from the anterior edge of the tunnel inlet to the posterior and proximal end to penetrate the posterior cortical wall of the fibula. 8 A 2.9-mm JuggerKnot Soft Anchor (Zimmer Biomet, Warsaw, IN), which has 2 sets of threads, is placed at the fibular cortex behind the fibular tunnel. The first set of threads is used to grasp the ATFL remnant via a lasso-loop technique.…”

Section: Step 4: Tunnel Creationmentioning

confidence: 99%

“…If the screw is not firmly fixed, the screw size is changed to a larger size or the cancellous bone tips are grafted to the space between the tunnel and the tendon graft. 8…”

Section: Step 6: Tendon Graft Introduction and Fixationmentioning

confidence: 99%

“…A ligament reconstruction method using a free tendon is indicated in such cases. 3,4 A few technical reports [5][6][7][8][9] and short-term clinical results [10][11][12][13] of arthroscopic lateral ankle ligament reconstruction have been published. Recently, remnant-preserved anterior cruciate ligament (ACL) reconstruction has gained popularity because the remnant-preservation effect may be advantageous for graft remodeling, proprioceptive recovery, and clinical outcomes.…”

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confidence: 99%

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Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Higashiyama

Sekiguchi

Takata

et al. 2020

Arthroscopy Techniques

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Arthroscopic techniques for anterior talofibular ligament (ATFL) repair and reconstruction have been developed in recent years. We simultaneously performed anatomical arthroscopic ATFL repair and reconstruction using a free tendon graft. The ATFL remnant is carefully dissected only at the footprint of the superior limb of the ATFL, and a bone tunnel is created on each side of the fibula and talus. A soft suture anchor with 2 sets of threads is inserted into the fibular tunnel. One set of threads is used to grab the ATFL remnant via a lasso-loop technique, whereas the other set of threads is used to introduce the ATFL graft. The graft is first fixed with a screw in the talar tunnel. Subsequently, the ATFL remnant and the graft are tightened simultaneously by pulling the 2 sets of suture anchor threads at the fibular tunnel and are fixed with a screw. This technique provides the possible advantages of remnant preservation and promotion of load sharing by the repaired ATFL remnant and the reconstructed ATFL graft.

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“…The foot is suspended from the distal edge of the bed, and the contralateral leg is slightly lowered to provide a wide working space ( Fig 1A). 8 Step 2: Graft Preparation…”

Section: Surgical Techniquementioning

confidence: 99%

Section: Graft Fixationmentioning

confidence: 99%

Section: Step 4: Tunnel Creationmentioning

confidence: 99%

“…If the screw is not firmly fixed, the screw size is changed to a larger size or the cancellous bone tips are grafted to the space between the tunnel and the tendon graft. 8…”

Section: Step 6: Tendon Graft Introduction and Fixationmentioning

confidence: 99%

mentioning

confidence: 99%

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Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Higashiyama

Sekiguchi

Takata

et al. 2020

Arthroscopy Techniques

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An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL

Michels

Matricali

Guillo

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose A bone tunnel is often used during the reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL). The purpose of this study is to compare proposed directions for drilling this fibular tunnel and to assess potential tunnel length, using a 5-mm-diameter tunnel and surrounding bone. Methods Anonymous DICOM data from spiral CT-scan images of the ankle were obtained from 12 Caucasian patients: 6 females and 6 males. Virtual tunnels were generated in a 3D bone model with angles of 30°, 45°, 60° and 90° in relation to the fibular long axis. Several measurements were performed: distance from entrance to perforation of opposing cortex, shortening of the tunnel, distance from tunnel centre to bone surface. Results A tunnel in a perpendicular direction resulted in an average possible tunnel length of 16.8 (± 2.7) mm in the female group and 20.3 (± 3.4) mm in the male group. A tunnel directed at 30° offered the longest length: 30.9 (± 2.5) mm in the female group and 34.4 (± 2.9) mm in the male group. The use of a 5-mm-diameter tunnel in a perpendicular direction caused important shortening of the tunnel at the entrance in some cases. The perpendicular tunnel was very near to the digital fossa while the most obliquely directed tunnels avoided this region. Conclusion An oblique tunnel allows for a longer tunnel and avoids the region of the digital fossa, thereby retaining more surrounding bone. In addition, absolute values of tunnel length are given, which can be useful when considering the use of certain implants. We recommend drilling an oblique fibular tunnel when reconstructing the ATFL and CFL.

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The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction

Jiang

Hou

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo compare the mid‐ to long‐term clinical and radiological outcomes of the confluent L‐shaped tunnel technique with the Y‐graft technique for anatomic lateral ankle ligament reconstruction. MethodsThis retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L‐shaped tunnel group and 24 patients in the Y‐graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow‐up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared. ResultsThe mean follow‐up times were 72 and 42 months for the L‐shaped group and Y‐graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L‐shaped group vs. 2.53 ± 1.29 in the Y‐graft group, p = 0.035). The incidence of flexion–extension ROM restriction (≥ 5°) was significantly higher in the Y‐graft group (41.2%) than in the L‐shaped group (12.5%) (p = 0.035). ConclusionsBoth the confluent L‐shaped tunnel technique and the Y‐graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid‐ to long‐term follow‐up. The confluent L‐shaped tunnel technique resulted in lower rates of flexion–extension ROM restriction, while the Y‐graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI. Level of evidenceIII.

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Anatomical Arthroscopic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction Using an Autogenic Hamstring Tendon: Safe Creation of Anatomical Fibular Tunnel

Cited by 13 publications

References 22 publications

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

Anatomical Arthroscopic Anterior Talofibular Ligament Repair and Reconstruction Using a Free Tendon

An oblique fibular tunnel is recommended when reconstructing the ATFL and CFL

The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction

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