Results of Anatomic Lateral Ankle Ligament Reconstruction with Tendon Allograft

Abstract

Chronic ankle instability can be addressed surgically through direct lateral ligament repair, nonanatomic reconstruction, or anatomic reconstruction. The goal of this study was to assess the radiographic, functional, and clinical results of patients undergoing an anatomic lateral ankle ligament reconstruction using an anterior tibial tendon allograft. Eleven patients (12 feet; mean age, 48.9 ± 11.4 years) undergoing lateral ankle ligament reconstruction were followed at a mean of 3.5 ± 1.7 years after surgery (range, 1.2 to 5.0 years). Indications for surgery were previous failed repair (i.e., Broström; one case), hyperlaxity (seven cases), and high-demand patients (four cases). Subjective outcomes including the Foot and Ankle Outcome Score (FAOS), SF-36, and activity level were assessed. Mortise and lateral ankle stress radiographs were performed. The FAOS daily activity and sports activity subscores were 93.4 (range, 77.9 to 100) and 78.6 (range, 30 to 100), respectively. The SF-36v2 physical health and mental health components were 50.4 (range, 30.6 to 65.7) and 45.0 (range, 24.8 to 68.0), respectively. Four patients (five feet) reported no restriction; six patients reported mild restrictions, and one patient reported moderate activity restrictions. Tibiotalar tilt improved significantly from 20.2°to 4.6°after surgery (p<0.01). The radiographic anterior displacement of the talus from the tibia was 6.5 mm postoperatively. The technique described restores mechanical stability in patients with chronic lateral ankle instability and may be considered in a select group of patients.

Treatment algorithm for chronic lateral ankle instability

“…The only case that complained a limitation of more than 10 degrees in S. Giannini et al plantar-flexion treated with anatomic reconstruction using the plantar gracilis tendon, was anyhow able to resume sport activity. At final follow-up we didn't observe any case of recurrence of instability even if the delayed failure due to the insufficient strength of the reconstruction is the major drawback of anatomic repair techniques described in literature 24,25 . Return to sports was highly satisfactory in this series both in recreational athletes and in professional players.…”

Erratum zu: Das instabile Sprunggelenk

“…Aufgrund der individuellen, an die Patientenanatomie anpassbaren Technik werden v. a. anatomische Rekonstruktionsverfahren präferiert [2,3,22]. Als Goldstandard gelten hierbei die Broström-Gould-oder Karlsson-Verfahren modifiziert in Ankertechnik [3,[22][23][24]. Langzeitergebnisse zeigten auch nach Jahrzehnten bei über 90 % der Patienten ein gutes bis exzellentes Operationsergebnis nach durchgeführter Broström-Bandrekonstruktion [25].…”

“…Nicht anatomische Verfahren des Tenodese-Typs, wie beispielsweise Rekonstruktionsverfahren nach ChrismanSnook, Watson-Jones oder auch die Evans-Technik, führen zu einer absoluten Stabilisierung im Sprunggelenk, die jedoch Komplikationen wie eine Reduktion der Eversionskraft aufgrund eines Funktionsverlustes der Peronealsehnen oder auch sekundäre Bewegungseinschränkungen aufgrund der nicht isometrischen Insertion provoziert [3,22,23]. Zudem kann die Entwicklung von Arthrose im Bereich des Subtalargelenks und im oberen Sprunggelenk beobachtet werden [3].…”

Allografts in Foot and Ankle Surgery

“…Twenty-one (88%) of twenty-four ankles were rated as satisfactory or very satisfactory by patients. Ellis et al 38 performed a similar retrospective study of eleven patients (twelve ankles) who underwent lateral ankle ligament reconstruction with use of anterior tibial tendon allografts. After a mean duration of follow-up of 3.5 years, ten of the eleven patients rated the outcome as good or excellent.…”