Lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon

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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“…eReferences 2, 3, 7, 8, 12, 26 –29, 35, 36, 38, 42 –44, 46, 69, 73, 74, 86, 90, 93, 95, 97, 102, 103, 105, 107, 114, 117 –119, 132, 134, 139, 142, 151, 153, 156, 157, 166, 179, 180, 184, 189, 191, 196, 197, 199, 206, 215, 216, 226, 229, 234.…”

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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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“…[45][46][47][48] Kim ve ark., 2015 yılında yayımladıkları çalışmada, minik pencerelerden peroneus longus tendonun ön yarısını aldıktan sonra ATFL ve CFL rekonstrüksiyonunda kullanmış ve %81 mükemmel veya iyi sonuç bulmuşlardır. [49] Bu çalışmada, 34 hastanın Bu implant, dizde patella çıkıklarının tespiti veya mediyal kollateral bağ tamirinin desteklenmesi için bir süredir kullanılmaktadır. [26][27][28] Bir biyomekanik çalışmada, yazarlar InternalBrace ® kullanılarak rekonstrükte edilmiş ATFL ile doğal ATFL'yi 12 kadavra üzerinde, tibiaya iç rotasyon zorlaması yaptırarak test etmişlerdir.…”

Section: Anatomik Bağ Rekonstrüksiyonuunclassified

Sporcularda ayak bileği dış yan bağ yaralanmalarında güncel yaklaşımlar

Irgıt¹,

Topkar²

2018

TOTBID

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Türk Ortopedi ve Travmatoloji Birliği Derneği talofibular bağdan (PTFL) meydana gelir. ATFL ve CFL ana statik bağ yapılarıdır. CFL ekstrakapsüler kordon şeklinde hem tibiotalar hem de talokalkaneal eklemi stabilize eder. PTFL en kuvvetli bağ yapısıdır. ATFL, plantar fleksiyondaki ayağın inversiyon zorlamasına karşı ana engeldir. Mekanik instabilite olan hastalarda ATFL tek başına veya CFL ile birlikte yaralanmıştır. A yak bileği burkulması, ortopedi ve travmatoloji pratiğinde en sık görülen yaralanmadır ve olguların yaklaşık %85'inde dış yan bağ kompleksini ilgilendirir. [1] Çoğu yaralanma, plantar fleksiyondaki ayağa uygulanan bir inversiyon zorlaması ile meydana gelir. Dış yan bağ kompleksi, anterior talofibular bağ (ATFL), kalkaneofibular bağ (CFL) ve posterior Sporcularda ayak bileği dış yan bağ yaralanmalarında güncel yaklaşımlar Current concepts in the management of ankle lateral ligament instability in athletes

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“…22 For foot and ankle reconstruction surgeries, surgeons may prefer an autograft tendon that can be harvested around the foot and ankle. 2,13,15,34 The anterior half of the peroneus longus tendon (AHPLT) is an acceptable alternative autograft source with respect to its strength, safety, and donor site morbidity. 15,27,38 The average failure load of the AHPLT is 97.69% and 147.94% of the semitendinosus and gracilis tendons, respectively.…”

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“…2,13,15,34 The anterior half of the peroneus longus tendon (AHPLT) is an acceptable alternative autograft source with respect to its strength, safety, and donor site morbidity. 15,27,38 The average failure load of the AHPLT is 97.69% and 147.94% of the semitendinosus and gracilis tendons, respectively. 38 A study of 92 patients who underwent various knee ligament reconstructions with the AHPLT autograft revealed no significant impairment of foot and ankle function.…”

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Tendon Regeneration After Partial-Thickness Peroneus Longus Tendon Harvesting: Magnetic Resonance Imaging Evaluation and In Vivo Animal Study

et al. 2020

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Background: In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT. Hypothesis: When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting. Study Design: Case series; Level of evidence, 4; controlled laboratory study. Methods: A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups—15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting. Results: All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016). Conclusion: The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.

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Lateral ankle ligament reconstruction using the anterior half of the peroneus longus tendon

Abstract: Case-series, Level IV.

Cited by 43 publications

References 30 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

Sporcularda ayak bileği dış yan bağ yaralanmalarında güncel yaklaşımlar

Tendon Regeneration After Partial-Thickness Peroneus Longus Tendon Harvesting: Magnetic Resonance Imaging Evaluation and In Vivo Animal Study

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