Anatomical reconstruction and Evans tenodesis of the lateral ligaments of the ankle: Clinical and radiological findings after follow-up for 15 to 30 years

Abstract

In this retrospective study, we assessed the outcome in 99 patients who underwent reconstruction of the lateral ligaments of the ankle for chronic anterolateral instability with a minimum follow-up of 15 years. Two techniques were compared: 54 patients had an anatomical reconstruction (AR group) and 45 had an Evans tenodesis (ET group). They were followed up for 19.9+/-3.6 years and 21.8+/-4.6 years, respectively. During follow-up, seven patients in the AR group and 17 in the ET group required a further operation (p = 0.004). At follow-up, significantly more patients (n = 15) in the ET group had limited dorsiflexion than in the AR group (n = 6, p = 0.007) and 18 in the ET group had a positive anterior drawer test compared with seven in the AR group (p = 0002). In the ET group 27 had tenderness on palpation of the ankle compared with 15 in the AR group (p = 0.001). Stress radiographs showed ligamentous laxity significantly more often in the ET group (n = 30) than in the AR group (n = 13, p < 0.001). The mean values for talar tilt and anterior talar translation were significantly higher in the ET group than in the AR group (p < 0.001, p = 0.007, respectively). There were degenerative changes on standard radiographs in 32 patients in the AR group and 35 in the ET group (p = 0.05). Four patients in the ET group had developed severe osteoarthritis compared with none in the AR group (p = 0.025). Assessment of functional stability revealed a mean Karlsson score of 83.7+/-10.4 points in the AR group and 67.0+/-15.8 points in the ET group (p < 0.001). According to the Good rating system, 43 patients in the AR group had good or excellent results compared with 15 in the ET group (p < 0.001). Compared with anatomical reconstruction, the Evans tenodesis does not prevent laxity in a large number of patients. Long-standing ligamentous laxity leads to degenerative change in the ankle, resulting in chronic pain, limited dorsiflexion and further operations. The functional result deteriorates more rapidly after the Evans tenodesis than after anatomical reconstruction.

Late-term reconstruction of lateral ankle ligaments using a split peroneus brevis tendon graft (Colville's technique) in patients with chronic lateral instability of the ankle

“…Krips has reported that after 30 years the Evans tenodesis did not adequately prevent laxity, thus allowing development and progression of osteoarthritis of the ankle and subtalar joints [20].…”

Quantifying the motion of Kager's fat pad

“…Dynamic US imaging was previously used to measure abnormalities and motion distances on Kager's fat pad 1,6,7,9 and other soft tissue. 14,15 Still images were extracted from video scans to measure sliding distance offline.…”

“…In some cases, the fat pad was observed extending to the soleus muscle. 5 This position means that part of Kager's fat pad may need to be excised during arthroscopic surgery to provide a clear view of the ankle joint, 6 despite the consequence of such excision currently being unclear. Recent studies have highlighted the potential biomechanical importance of the fat pad within the Achilles tendon enthesis organ.…”

“…1). 1,8,9 Kager's fat pad is still widely considered to serve predominantly as a variable space filler, 4,6 with hypothesized secondary functions providing a mechanical advantage to the Achilles tendon by moving into and out of the retrocalcaneal bursa during ankle flexion. This motion is thought to increase the lever arm of the tendon.…”

Management and prevention of acute and chronic lateral ankle instability in athletic patient populations

“…Non-anatomic reconstructions utilize tenodesis fixation to stabilize the ankle with the repair of the native ligaments. While multiple configurations have been described, most techniques involve rerouting of the peroneus brevis around the lateral ankle, and include the Watson-Jones, Evans, and Chrisman-Snook procedures (Figure 3) [74,[79][80][81][82] . Long-term outcomes of non-anatomic reconstructions are hindered by alterations in ankle and hindfoot kinematics and often, resultant loss of subtalar motion [83][84][85][86][87][88][89][90] .…”