Anatomical reconstruction of the lateral ligaments using Gracillis tendon in chronic ankle instability; a new technique

Background: The surgical management of chronic lateral ankle instability (CLAI) has evolved since the 1930s, but for the past 50 years, the modified Broström technique of ligament repair has been the gold standard. However, with the development of arthroscopic techniques, significant variation remains regarding when and how CLAI is treated operatively, which graft is the optimal choice, and which other controversial factors should be considered. Purpose: To develop clinical guidelines on the surgical treatment of CLAI and provide standardized guidelines for indications, surgical techniques, rehabilitation strategies, and assessment measures for patients with CLAI. Study Design: A consensus statement of the Chinese Society of Sports Medicine. Methods: A total of 14 physicians were queried for their input on guidelines for the surgical management of CLAI. After 9 clinical topics were proposed, a comprehensive systematic search of the literature published since 1980 was performed for each topic through use of China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Web of Science, EMBASE, and the Cochrane Library. The recommendations and statements were drafted, discussed, and finalized by all authors. The recommendations were graded as grade 1 (strong) or 2 (weak) based on the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Based on the input from 28 external specialists independent from the authors, the clinical guidelines were modified and finalized. Results: A total of 9 topics were covered with regard to the following clinical areas: surgical indications, surgical techniques, whether to address intra-articular lesions, rehabilitation strategies, and assessments. Among the 9 topics, 6 recommendations were rated as strong and 3 recommendations were rated as weak. Each topic included a statement about how the recommendation was graded. Conclusion: This guideline provides recommendations for the surgical management of CLAI based on the evidence. We believe that this guideline will provide a useful tool for physicians in the decision-making process for the surgical treatment of patients with CLAI.

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“…References 2 –4, 6 –13, 15 –17, 19, 20, 24 –33, 35 –37, 40 –46, 51, 53, 54, 56 –58, 64, 67, 69, 72 –81, 85 –87, 90 –97, 99, 102 –…”

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confidence: 99%

“…cReferences 2, 4, 6 –9, 12, 13, 15 –17, 19, 20, 25, 28, 35, 40 –45, 51, 57, 58, 64, 67, 69, 72, 73, 76, 77, 79 –81, 85, 86, 96, 98, 109 –111, 114, 117 –119, 132, 136, 142, 144 –146, 154, 156, 164, 166, 168, 170, 174, 179, 180, 185, 191, 194, 196 –…”

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confidence: 99%

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Song

Liu

Sun

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Two other case series have since been published with similar results in terms of their patient-reported outcome scores. No failures are noted in any group [49,50].…”

Section: Clinical Outcomesmentioning

confidence: 82%

Hamstring Autograft for Lateral Ligament Stabilization

Patel

Cabe

Drakos

2020

Curr Rev Musculoskelet Med

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Purpose of Review This paper seeks to review the current literature and trends regarding use of hamstring autograft for lateral ankle instability. Recent Findings Reconstruction of the lateral ankle ligaments using hamstring autograft has been found to be an effective method to treat ankle instability in terms of patient-reported outcomes and objective measures. Biomechanically, reconstruction has been shown to be stronger (load to failure) when compared with the Broström procedure. Clinical studies have demonstrated noninferiority when compared with the Broström procedure, with one synthetic reconstruction technique demonstrating superior outcomes. Summary Reconstruction of the lateral ankle ligaments using hamstring autograft is especially useful in patients who are at high risk of failure (insufficient soft tissue available for repair, ligamentous laxity, previous failed ligament repair, ossicle > 1 cm, or in the heavier, high-demand athletes). Keywords Lateral ankle instability. Hamstring autograft. Broström procedure This article is part of the Topical Collection on Management of Ankle Instability

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“…Anatomical reconstruction of the lateral ankle ligament complex is a well-recognized procedure to restore stability. [1][2][3] We modified the talar insertion of the anterior talofibular ligament a little medially to the talar neck close to the talar body because of the following concerns. First, if the bone tunnel is made in the talar body, the cartilage and posterior tibial neurovascular bundle may have higher risks to be damaged.…”

Section: Discussionmentioning

confidence: 99%

“…A nkle lateral ligament complex reconstruction is a well-proven procedure both to restore stability and to prevent traumatic arthritis. [1][2][3] Open procedures have the advantages of accurate portal placement and anatomical reconstruction, but larger incision, extensive dissection and slower rehabilitation are the main disadvantages. [4][5][6] Arthroscopic ankle ligament reconstruction has been advocated recently.…”

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confidence: 99%

All Arthroscopic Remnant-Preserving Technique to Reconstruct the Lateral Ankle Ligament Complex

Gui

Jiang

et al. 2017

Arthroscopy Techniques

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Arthroscopic lateral ankle ligament reconstruction has been recently advocated. But this technique has not been popularized because of the technical complexity and potential iatrogenic injury. Because the talocalcaneal and calcaneofibular ligaments are extra-articular structures, how to efficiently view and address them is a difficult task. Limited dissection outside the capsule to form a working space is required, but aggressive dissection is harmful for tissue healing although it is helpful for visualization and instrumentation. Because almost the entire talar body is covered by articular cartilage, it is very difficult to safely make a bone tunnel without damaging the cartilage. The remnants of the lateral ankle ligament have proprioceptive sensors that are important for functional stability, but it is difficult to perform anatomical reconstruction arthroscopically while preserving them because of the narrow working space. Furthermore, how to properly tension the reconstructed ligaments in such a narrow working space is also a very difficult task. We have designed a technique that preserves the remnants of lateral ankle ligaments, and all of the above-mentioned problems have been successfully addressed. We have used this technique clinically, and only minor complications occurred.

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Anatomical reconstruction of the lateral ligaments using Gracillis tendon in chronic ankle instability; a new technique

Cited by 41 publications

References 27 publications

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Clinical Guidelines for the Surgical Management of Chronic Lateral Ankle Instability: A Consensus Reached by Systematic Review of the Available Data

Hamstring Autograft for Lateral Ligament Stabilization

All Arthroscopic Remnant-Preserving Technique to Reconstruct the Lateral Ankle Ligament Complex

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