Hamstring Autograft for Lateral Ligament Stabilization

Patel, Karan A.; Cabe, Taylor N.; Drakos, Mark C.

doi:10.1007/s12178-020-09623-1

Cited by 5 publications

(7 citation statements)

References 51 publications

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“…Failure rates after primary repair of the lateral ankle ligaments utilizing a modified Brostrom-Gould technique are 45.2% as opposed to 10.8% in patients without generalized ligamentous laxity 52. But, even in the setting of ligamentous laxity, the use of hamstring autograft as opposed to allograft is not contraindicated 51,54…”

Section: Discussionmentioning

confidence: 99%

“…52 But, even in the setting of ligamentous laxity, the use of hamstring autograft as opposed to allograft is not contraindicated. 51,54 Anteroposterior and lateral stress radiographs performed using protective lead gloves and manually applying anterior drawer and talar tilt stress or placing the patient in a Telos stress device 17 decanewtons of stress allow for objective measurements of ankle laxity. In patients with talar tilt > 20 degree or anterior drawer > 15 mm, reconstruction is recommended in favor of primary repair.…”

Section: Clinical Decision Makingmentioning

confidence: 99%

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Modern Surgical Techniques for Treatment of Chronic Lateral Ankle Instability

Kukadia

Murphy²,

Shah³

et al. 2022

Techniques in Foot &Amp; Ankle Surgery

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: Ankle sprains are among the most common injuries sustained during sports and physical activity. Around 2 million ankle sprains occur per year with ~85% of them being lateral ankle sprains. Lateral ankle sprains involve damage to the lateral ligamentous complex of the ankle. Patients with a history of lateral ankle sprains are at a 3.5× greater risk of re-injury than those who do not have a history of lateral ankle sprain. Repeated damage to the lateral ligamentous complex can result in the development of chronic lateral ankle instability (CLAI). CLAI can be managed conservatively or surgically. Given the frequency with which sprains occur, and the relative infrequency of symptoms requiring an operation, 80 to 85% of patients can be managed conservatively with good results and minimal disability. However, even with conservative treatment, a 56 to 74% recurrence rate of ankle sprain has been reported. Patients with CLAI who continue to display persistent symptoms after rehabilitation through conservative measures may require surgical intervention. These surgical techniques include direct ligament repair, anatomic reconstruction, and nonanatomic reconstruction. In this chapter we will discuss these procedures, along with their implications and associated risks. We offer different surgical techniques to manage CLAI and available outcome data. Level of Evidence: Diagnostic level 4, case series.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Decision Makingmentioning

confidence: 99%

Modern Surgical Techniques for Treatment of Chronic Lateral Ankle Instability

Kukadia

Murphy²,

Shah³

et al. 2022

Techniques in Foot &Amp; Ankle Surgery

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“…ankle ligament reconstruction was indicated in patients with CLAI who were refractory to non-operative treatment consisting of targeted physiotherapy focused on proprioception and peroneal strengthening for a minimum of 3 months [ 2 ] or in revision cases after failed direct ligament repair. Furthermore, for the classification as a “high-risk” case, the presence of one of the following risk factors was required: generalized ligamentous hyperlaxity, insufficient soft tissue and/or high-demand athletes (participation in pivoting sports and/or athletic activity of more than 60 min, at least 3 week) [ 37 ]. For assessment of general laxity, the Beighton score was collected, with values ≥ 4 indicating generalized hyperlaxity [ 42 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, suboptimal outcomes have been reported in patient populations especially at risk due to high intensity athletic or occupational activities [ 11 ], generalized hyperlaxity [ 47 ], high-grade instability with insufficient substance of native ligament structures [ 2 , 23 ], or in revision cases [ 19 ]. In these situations, surgical management with tendon graft-based anatomic lateral ankle ligament reconstruction has been advocated [ 37 ]. While there exists no surgical consensus to date concerning optimal fibular tunnel configuration and graft choice, both allograft- [ 5 , 7 , 8 , 16 , 21 , 31 , 34 ] as well as autograft-based techniques [ 3 , 33 ] have demonstrated to reliably restore stability.…”

Section: Introductionmentioning

confidence: 99%

High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability

Rupp

Degenhardt

Winkler

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate clinical outcomes as well as return to sports (RTS) and return to work (RTW) rates following anatomic lateral ankle ligament reconstruction with a tendon autograft for chronic lateral ankle instability (CLAI) in a high-risk population, and to compare these outcome parameters between patients having received a gracilis tendon autograft (GT) and free split peroneus brevis tendon (PBT) autograft. Methods Twenty-eight consecutive patients, who were diagnosed with CLAI, presenting with ≥ 1 risk factor (ligamentous hyperlaxity, insufficient substance of native ligament and/or high-demand athlete), who underwent ankle ligament reconstruction with a tendon autograft between January 2011 and December 2018, were included in this retrospective study. At 63.7 ± 28.0 months (24–112), 23 patients with a mean age of 29.7 ± 10.9 years were available for follow-up. The Karlsson Score, the Foot and Ankle Outcome Score (FAOS), the Tegner Activity Scale and the visual analog scale (VAS) for pain were collected at a minimum follow-up of 24 months. RTS and RTW were evaluated by questionnaire. A subgroup analysis with regard to the graft used for ankle ligament reconstruction (GT versus PBT) was performed. Results Patients reported a Karlsson score of 82.1 ± 17.5 (37–100), a FAOS score of 87.8 ± 8.4 (73–99), a median Tegner activity scale of 5.0 (IQR 4–6) and a VAS for pain of 0.5 ± 0.9 (0–4) at rest and of 2.0 ± 2.1 (0–7) during activities at final follow-up. Postoperatively, 96% of patients had returned to sports after 8.3 ± 6.2 months. All patients (100%) had returned to work at 3.5 ± 5.7 (0–24) months, with 87% reporting an equal or improved working ability compared to that preoperatively. Postoperatively, exercise hours per week were significantly reduced compared to preoperatively in patients with a split PBT (n = 12; 13.0 ± 12.9 to 5.6 ± 6.4 h, p = 0.038) autograft as opposed to patients with a GT autograft (n = 11; 13.1 ± 8.7 to 12.4 ± 7.1 h, n.s.). No other group differences were observed. Conclusion Good patient-reported outcomes as well as excellent RTS and RTW rates can be achieved in high-risk patients undergoing ankle ligament reconstruction with a tendon autograft for CLAI. These results may be helpful in preoperatively managing patients’ expectations regarding sports- and work-related outcomes and provide tangible data on the expectable time frame of the individual return to sports and work trajectory. Level of evidence IV.

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“…Reconstruction of the anterior talo bular ligament and calcaneo bular ligament is considered critical in the treatment of lateral ankle injuries because the lateral collateral ligaments are di cult to suture during long-term disease progression or the soft tissues used for strengthening and repair are di cult to utilize. Currently, arthroscopic reconstruction of the anterior talo bular ligament and calcaneo bular ligament is an important modality for the treatment of chronic ankle instability, and has been used with good clinical results since [3].Many studies have found that the tibio bular anterior ligament has a rich distribution of proprioceptors [4,5],and it has been reported that reconstruction using autologous tendon grafts can achieve good results [6][7][8].Because the distal bula is thin and there is a risk of fracture of the distal bula during reconstruction, the establishment of the bone tract should also be a consideration for the surgeon. Anatomic reconstruction of the ligament has also been proposed in recent years [9], but the question of whether the stump of the anterior tibio bular ligament should be preserved intraoperatively is still inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of arthroscopic reconstruction of the anterior talofibular ligament with preservation of the stump

Liu¹,

Wu²,

Zhang³

et al. 2021

Preprint

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Background The purpose of this study was to investigate the clinical efficacy of anatomic reconstruction of the anterior talofbular ligament with preservation of the stump. Methods This retrospective study included 42 patients who underwent an endoscopic lateral ligament reconstruction between from June 2015 to June 2019.Fourteen consecutive patients (10 [71.4%] males and 4 [28.6%] female, mean age 27.79 ± 4.56[range 26 to 36] years) with preserved anterior tibiofibular ligament stump were enrolled in this study.On the other side ,there were 18 patients with unpreserved tibiofibular ligament stumps (unpreserved stump group), 12 males and 6 females, aged 20–36 years, mean (28.56 ± 5.67) years.The functional evaluation was carried out according to the Ankle-Hindfoot Score by the American Orthopaedic Foot and Ankle Society.The Tegner system was used to evaluate range of motion after the index procedure. Ankle proprioception was assessed using the visual analogue scale (VAS) to assess the degree of subjective pain symptoms. Operative time, fever time and wound healing time were also recorded. Results There were no statistically significant differences in postoperative outcomes such as postoperative fever time and wound healing time between the two groups (P > 0.05). The operative time was slightly longer in the stump-preserving group than in the non-stump-preserving group (94.14 ± 11.59 vs. 82.94 ± 15.61 P < 0.05). There were no statistically significant differences in preoperative AOFAS ankle-hindfoot scores, Tegner motor level scores, and VAS scores between patients in the retained-stump group and the non-reserved-stump group (P > 0.05). At 1 year after surgery, the AOFAS ankle-hindfoot scores and Tegner motor level scores improved and the VAS pain scores decreased in both the presurgical and non-presurgical groups. The AOFAS ankle-hindfoot scores and Tegner motion level scores 1 year after surgery were higher in the group with preserved stump than in the group without preserved stump (P < 0.05). Conclusion Arthroscopic reconstruction of the anterior talofibular ligament with and without preservation of the stump can achieve good clinical outcomes. Although arthroscopic anterior talofibular ligament reconstruction with preserved stump prolonged the operative time compared with surgery without preserved stump, it could better improve the subjective ankle function and motion status of patients and improve the prognosis.

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Hamstring Autograft for Lateral Ligament Stabilization

Cited by 5 publications

References 51 publications

Modern Surgical Techniques for Treatment of Chronic Lateral Ankle Instability

Modern Surgical Techniques for Treatment of Chronic Lateral Ankle Instability

High return to sports and return to work rates after anatomic lateral ankle ligament reconstruction with tendon autograft for isolated chronic lateral ankle instability

Clinical efficacy of arthroscopic reconstruction of the anterior talofibular ligament with preservation of the stump

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