Chronic instability of the ankle

Abstract

Cowlipht 0 Mwrkrgaard 1993 -a< MEDICINE I SCIENCE IN SPORTS ISSN 0905-7188 Long-term results after modified Evans reconstruction Raatikainen ' I: Puranen J. Chronic instability of the ankle. Long-term results after modified Evans reconstruction. Scand J Med Sci Sports 1993: 3: 122-126.0 M d g W d 1993.Evans tenodesis is one of the techniques used much for correcting the chronic lateral instability of the ankle. Long-term results (average follow-up 8 years) are reported for U operations on 109 patients. It is concluded that the method used gives a good functional result when the major complaint is recurrent sprains of the ankle. Functional stability does not n d y correlate w i t h mechanical stability when tested clinically or by radiographs.An acute rupture of the lateral ligaments of the ankle, when not treated adequately, can lead to chronic disability with recurrent sprains, pain and swelling (1-'7), and arthrosis of the ankle joint may even develop (8-lo), even though it is not frequent. A number of techniques for lateral stabilizing of the ankle have been d e s c r i i . Nilsonne in 1932 (11) was the first to use the peroneus brevis tendon to stabilize a previously injured ankle, although the same method had been used earlier by Gallie (12) in cases of infantile paralysis. Evans in 1953 (13) modified this method by re-routing the peroneus brevis tendon through the lateral malleolus, and his method and its modifications have been used later by many authors. We have been using a modified Evans operation (14) routinely for years and we report here our long term-results. Materlal and methodsA total of 1w ankles of 109 patients were operated on at Oulu University Hospital in 1972-1984 on account of recurrent sprains after a traumatic inversion injury of the ankle. Fifty-three of the patients were men and 56 women, their age ranging from 13 to 60 years (average 28.2 years). The left ankle was involved in 54 cases and the right in 59. Sixty-six of the patients were sports participants (23 competitive, 43 recreational) and 50 of the primary injuries that later led to recurrent sprains had occurred during sport (16 during running, 11 in volleyball, 6 in soccer, 6 during orienteering, 5 in gymnastics, 2 in basketball and one in long jump, high jump, ice hockey and skiing). The most common mechanisms in the non-sport injuries were spraining of the ankle during walking (29 ankles) and falling from stairs or from a high level (17 ankles). Four patients had compression injuries, 3 had sustained a traffic accident and 2 patients had sprained the ankle when dancing. Eight patients did not remember the first sprain any more.During the first sprain 27 patients had not sought any treatment at all, and 86 ankles had been treated conservatively with a bandage (68 ankles) or plaster cast (18 ankles). In 22 cases an arthrography was performed at the acute stage, and a rupture of the anterior fibulotalar ligament was diagnosed in 11 cases and a combined rupture of the anterior fibulotalar and the fibulocalcanear ligament in ll cas...