Revision Surgery for Lateral Ankle Instability

Abstract

Chronic ankle instability can develop in 20–40% of patients who suffer an ankle sprain with damage to the lateral ligaments (ATFL, PTFL, and CFL). Radiographic indicators for lateral ankle instability diagnosis are 10 degrees or greater talar tilt, 10 mm or greater anterior drawer, or 5 degrees/5 mm difference from the contralateral side. While the modified Brostrom-Gould repair is the gold standard for lateral ankle instability, confounding factors can present challenges which may lead to stabilization failure and necessarily dictate revision surgery and use of an alternative technique. Pathologies often mitigating failed repair include generalized ligamentous laxity, larger patients, more active patients, or underlying deformities (i.e., cavovarus setting). Our described revision technique can be utilized in patients presenting with these conditions as well as who experience a previous graft failure during repair. The technique involves anatomic ligament reconstruction using the harvested semitendinosus, gracilis, or both tendons as an autograft woven through three tunnels in the calcaneus, fibula, and talus. It has produced successful and significant results thus far, at least 1 year postoperatively with improvements in radiographic and clinical outcome scores.