Comparison of Lateral Ankle Ligamentous Reconstruction Procedures

Abstract

The static restraints of various surgical procedures for chronic lateral ankle instability were compared. Forty cadaveric ankles were divided equally into the following five groups: 1) ankles with intact anterior talofibular and calcaneofibular ligaments, 2) ankles with incised anterior talofibular and calcaneofibular ligaments, 3) ankles with Chrisman-Snook procedure, 4) ankles with Watson-Jones procedure, or 5) ankles with modified Broström procedure. All ankles were placed in a mechanical apparatus for anterior drawer stress and inversion stress tests. After each application of force, a radiograph of the ankle joint was taken, and the anterior talar displacement and the talar tilt angle were measured. All procedures reduced anterior drawer and talar tilt when compared with the ankles with incised anterior talofibular and calcaneofibular ligaments. Significant differences were found among the groups for both inversion and anterior drawer stress at all forces, except for the third and fourth groups. The modified Broström group had the least amount of anterior talar displacement and talar tilt angle at all forces. There were no significant differences between the Watson-Jones and the Chrisman-Snook procedures in anterior talar displacement and talar tilt. The modified Broström procedure produced a greater mechanical restraint than either of the other procedures.

A novel reconstruction technique for chronic lateral ankle instability: comparison to primary repair

“…The functional results in both groups were good between 2 and 4 years after surgery. These results are comparable with many previous reports [4,8,12,14,16,17].…”

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

“…The most common techniques are the non-anatomical Evans, the Watson-Jones, and the Chrisman-Snook, which make use of the tendon of peroneus brevis for reconstruction. The success rate is about 90% with these methods [13,21,24], but these techniques can be criticised as they use non-anatomical graft passage sites and are followed by residual limitation of subtalar joint movements and chronic pain. Sural nerve injury is also reported in 14 patients treated by the ChrismanSnook technique [7].…”

“…In the long-term, it seems that the results of anatomical reconstruction methods of the lateral ankle ligaments are superior to non-anatomical methods, as they achieve better stability and cause less degenerative arthritis [11,12,19,21]. 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].…”

The Broström-Gould procedure: A case presentation and review of the literature

“…[9,[13][14][15] In a cadaveric study comparing the modified Broström-Gould procedure to tendon reconstruction procedures, Liu et al found that the anatomic repair technique resulted in less loss of motion in addition to greater mechanical restraint. [17] In a retrospective review of 54 patients, Krips et al found that the modified Broström-Gould procedure was superior to tendon reconstructive procedures in terms of final stability as determined through stress radiographs and clinical outcomes. [25] While all surgical treatments should be tailored to the individual patient, the modified Broström-Gould procedure restores the native anatomy, has demonstrated efficacy both in the lab and in the clinic, and should be one of the procedures in the armamentarium of orthopaedic surgeons who treat lateral ankle instability.…”