The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction

Abstract

PurposeTo compare the mid‐ to long‐term clinical and radiological outcomes of the confluent L‐shaped tunnel technique with the Y‐graft technique for anatomic lateral ankle ligament reconstruction. MethodsThis retrospective study involved 41 patients who underwent lateral ankle ligament reconstruction between 2013 and 2018. Based on the tunnel direction and tendon fixation method at the fibula side, patients were divided into two groups, with 17 patients in the L‐shaped tunnel group and 24 patients in the Y‐graft group. The American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner score, and Karlsson score were evaluated and compared preoperatively and at follow‐up. Anterior talar translation and talar tilt at stress radiographs, postoperative sprain recurrence, range of motion (ROM) restriction, sensory disturbance, etc., were also collected and compared. ResultsThe mean follow‐up times were 72 and 42 months for the L‐shaped group and Y‐graft group, respectively. The median VAS pain score, Tegner score, AOFAS score, Karlsson score significantly improved from a preoperative level in both groups (all with p < 0.01). No significant difference was found between the two groups regarding the changes from preoperatively to postoperatively except for the VAS pain score reduction (1.58 ± 1.58 in the L‐shaped group vs. 2.53 ± 1.29 in the Y‐graft group, p = 0.035). The incidence of flexion–extension ROM restriction (≥ 5°) was significantly higher in the Y‐graft group (41.2%) than in the L‐shaped group (12.5%) (p = 0.035). ConclusionsBoth the confluent L‐shaped tunnel technique and the Y‐graft technique significantly improved symptoms, ankle function, and radiographic outcomes in patients with chronic lateral ankle instability (CLAI) at mid‐ to long‐term follow‐up. The confluent L‐shaped tunnel technique resulted in lower rates of flexion–extension ROM restriction, while the Y‐graft technique showed better VAS pain reduction. This result could provide further evidence for the surgical treatment of CLAI. Level of evidenceIII.

Clinical Outcomes and Return to Preinjury Sports After Anatomic Reconstruction With a Gracilis Autograft Versus the Modified Broström Procedure in Patients With Generalized Joint Laxity

“…Ellis et al 6 reported that 6 patients (54.5%) had ROM restrictions, and 1 complained of moderate activity restrictions. Su et al 26 reported a 12.5% ROM restriction rate after anatomic reconstruction with the Y-graft technique. This might be due to the greater tension of graft reconstruction than repair.…”

“…The open modified Broström procedure or open anatomic reconstruction with a gracilis autograft was performed according to previous studies. 26 , 27 …”

“…Passive ROM of the ankle joint was measured using a goniometer with the patients seated at follow-up, and ROM restriction was defined as a deficit of ≥5° on the operated side compared with the contralateral nonoperated side. 26 All the assessments were performed by 2 independent reviewers.…”

“…The open modified Brostro ¨m procedure or open anatomic reconstruction with a gracilis autograft was performed according to previous studies. 26,27 For the modified Brostro ¨m procedure, an arc-shaped incision of 4 cm was made along the lower edge of the lateral malleolus. The remnant of the ATFL and the CFL was identified and anatomically repaired with 2 or 3 suture anchors (Mitek Mini-GII; Johnson & Johnson).…”

The precision of technical aspects in the minimally invasive Broström-Gould procedure：A Cadaveric Anatomical Study

“…In clinical practice, conservative treatment is initially recommended for CLAI, with surgery being considered if symptoms do not improve or worsen after 3-6 months of conservative treatment. The surgical techniques include anatomical repair [8][9] , anatomical reconstruction [10][11] , and non-anatomical reconstruction [12][13] . Anatomic repair of the ATFL offers advantages such as minimal surgical trauma, simplicity in operation, and favorable postoperative recovery; thus it is currently regarded as the preferred choice for repairing the ligament.…”