Biomechanical Properties of Commonly Used Autogenous Transplants in the Surgical Treatment of Chronic Lateral Ankle Instability

Abstract

The purpose of this study was to evaluate the biomechanical properties of commonly used autogenous transplants for the surgical stabilization of chronic lateral ankle instability. We dissected the transplants (peroneus longus, peroneus brevis, Achilles and plantaris tendon, periosteal flap, fascia, corium) and the anterior talofibular ligament from 13 fresh anatomic specimens. After laser-assisted measurement of the transplant diameter, we assessed their biomechanical properties with a universal testing device. Biomechanical stability of the peroneus longus, peroneus brevis, and Achilles tendons was significantly higher than the other transplants. The stability parameters of the periosteal flap were in the range of the anterior talofibular ligament but inferior to the tendons. The application of a transplant with low biomechanical stability, such as the periostal flap, requires more postoperative immobilization as in a strong orthosis or cast.

The peroneus brevis tendon at its insertion site on fifth metatarsal bone

“…In previous studies it was reported that the length of the PB tendon was important in tendon transplantations and the rotational grafts needed in orthopedic surgical procedures [1,2]. In our study, the mean tendon length of the PB tendon was found to be 79.57 AE 15.40 mm on the right and 81.48 AE 14.31 mm on the left side.…”

“…The anatomy of the PB tendon at its insertion site on the base of fifth metatarsal bone (MB) is important in terms of surgeries involving lateral side of the foot [1,2]. Peroneal (fibular) muscles are the ones running in the evertion motion of the foot.…”

Lateral Ankle Ligament Reconstruction With Free Plantaris Tendon Graft

“…32 The plantaris tendon should be the first choice because it involves no donor site morbidity and has the highest tensile strength. 13 In addition, the plantaris tendon is frequently more sufficient and more often found when harvesting at the proximal calf. Finally, there are no significant differences and few studies comparing different anatomic routing procedures.…”

“…The direction of collagen fibers, which are located longitudinal to withstand axial forces, is crucial, which is not the case for periosteal or fascia lata strips. 13 …”

“…We prefer the doubled plantaris tendon as a free graft because it has the highest tensile strength (N/mm 2 ) compared to other commonly used tissues like the peroneal tendons, fascia, etc. 13 In addition, no crucial function is reduced, which is not the case with the use of peroneal tendons, as they act as the major dynamic stabilizer of the lateral ankle and foot arches. 14 If chronic instability reoccurrs after failed surgical ligament repair, we indicate a more generous augmentation or reconstruction of the ATFL and CFL with a free plantaris tendon.…”