Skip to main content
Log in

Anatomical repair of lateral ligaments in patients with chronic ankle instability

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

In a prospective study, 19 patients with chronic ankle instability underwent clinical and radiographic reexaminations 36 months after anatomical reconstruction. In addition, dynamic pedography was conducted and peroneal reaction time measured on a tilting platform for an evaluation of functional aspects. Prior to this examination, 32 patients had been asked to fill in a questionnaire and make a detailed subjective evaluation of current discomfort, stability, flexibility and sporting abilities. Eighty-eight percent of the patients reported satisfactory results; only 3% complained of persistent instability. In 71% the ability to take part in sports had improved after surgery, and 85% of the patients reported unrestricted walking abilities. Supination ability was impaired in 5% of the patients at the follow-up. The radiographic examination showed restored ankle stability with a significant reduction of talar tilt and talar translation; a postoperative increase in signs and symptoms of arthrosis was not observed. Dynamic pedography showed a large degree of symmetry of plantar pressure distribution after surgery. There were no significant differences in peroneal reaction time in the repaired and intact ankles. The results of the study show that it is possible to restore ankle stability with anatomical reconstruction without impairing the range of movement in the ankle joint complex. Progressive osteoarthrosis can be prevented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bahr R, Pena F, Shine J, Lew WD, Tyrdal S, Engebretsen L (1997) Biomechanics of ankle ligament reconstruction. An in vitro comparison of the Broström repair, Watson-Jones reconstruction, and a new anatomic reconstruction technique. Am J Sports Med 25:424–432

    CAS  PubMed  Google Scholar 

  2. Barbari SG, Brevig K, Egge T (1987) Reconstruction of the lateral ligamentous structures of the ankle with a modified Watson-Jones procedure. Foot Ankle 7:362–368

    CAS  PubMed  Google Scholar 

  3. Becker HP, Rosenbaum D, Zeithammel G, Gerngross H, Claes L (1994) Gait pattern analysis after ankle ligament reconstruction (modified Evans procedure). Foot Ankle 15:477–482

    CAS  PubMed  Google Scholar 

  4. Becker HP, Zeithammel G, Danz B, Rosenbaum D, Gerngroß H (1995) Klinische und röntgenologische 5-Jahres-Ergebnisse nach modifizierter Evans-Plastik bei chronischer Außenbandinstabilität des Sprunggelenks. Unfallchirurg 98:333–337

    CAS  PubMed  Google Scholar 

  5. Becker HP, Rosenbaum D, Zeithammel G, Gnann R, Bauer G, Gerngross H, Claes L (1996) Tenodesis versus carbon fiber repair of ankle ligaments. Clin Orthop 325:194–202

    Article  PubMed  Google Scholar 

  6. Becker HP, Ebner S, Ebner D, Benesch S, Frössler H, Hayes A, Gritze G, Rosenbaum D (1999) Twelve-year-outcome after modified Watson-Jones tenodesis for ankle instability. Clin Orthop 358:194–204

    Article  PubMed  Google Scholar 

  7. Benesch S, Pütz W, Rosenbaum D, Becker HP (2000) Reliability of peroneal reaction time measurements. Clin Biomech 15:21–28

    Article  CAS  Google Scholar 

  8. Chrisman OD, Snook GA (1969) Reconstruction of lateral ligament tears of the ankle. An experimental study and clinical evaluation of seven patients treated by a new modification of the Elmslie procedure. J Bone Joint Surg 51A:904–912

    Google Scholar 

  9. Colville MR, Marder RA, Zarins B (1992) Reconstruction of the lateral ankle ligaments. Am J Sports Med 20:594–600

    CAS  PubMed  Google Scholar 

  10. Hamilton WG, Thompson FM, Snow SW (1993) The modified Brostrom procedure for lateral ankle instability. Foot Ankle 14:1–7

    CAS  PubMed  Google Scholar 

  11. Hennrikus WL, Mapes RC, Lyons PM, Lapoint JM (1996) Outcomes of the Chrisman-Snook and modified Broström procedures for chronic lateral ankle instability. Am J Sports Med 24:400–404

    CAS  PubMed  Google Scholar 

  12. Hoy GA, Henderson IJP (1994) Results of Watson-Jones ankle reconstruction for instability. The influence of articular damage. J Bone Joint Surg 76B:610–613

    Google Scholar 

  13. Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Lateral instability of the ankle treated by the Evans procedure. A long-term clinical and radiological follow-up. J Bone Joint Surg 70B:476–480

    Google Scholar 

  14. Karlsson J, Bergsten T, Lansinger O, Peterson L (1988) Reconstruction of the lateral ligaments of the ankle for chronic instability. J Bone Joint Surg 70A:581–588

    Google Scholar 

  15. Karlsson J, Bergsten T, Lansinger O, Peterson L (1989) Surgical treatment of chronic lateral instability of the ankle joint. Am J Sports Med 17:268–274

    CAS  PubMed  Google Scholar 

  16. Karlsson J, Eriksson BI, Bergsten T, Rudholm O, Swärd L (1997) Comparison of two anatomic reconstructions for chronic lateral instability of the ankle joint. Am J Sports Med 25:48–53

    CAS  PubMed  Google Scholar 

  17. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M (1994) Clinical rating systems for the ankle-hindfoot, midfoot, hallux and lesser toes. Foot Ankle 15:349–353

    CAS  PubMed  Google Scholar 

  18. Konradsen L, Voigt M, Hojsgaard C (1997) Ankle inversion injuries. The role of the dynamic defense mechanism. Am J Sports Med 25:54–58

    CAS  PubMed  Google Scholar 

  19. Krips R, van Dijk CN, Halasi T, Lehtonen H, Moyen B, Lanzetta A, Farkas T, Karlsson J (2000) Anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter study. Knee Surg Sports Traumatol Arthrosc 8(3):173–179

    Google Scholar 

  20. Löfvenberg R, Kärrholm J, Sundelin G (1996) Die propriozeptive Reaktion beim gesunden und beim chronisch instabilen Sprunggelenk. Sportverl Sportschad 10:79–83

    Google Scholar 

  21. Liu SH, Baker CL (1994) Comparison of lateral ankle ligamentous reconstruction procedures. Am J Sports Med 22:313–317

    CAS  PubMed  Google Scholar 

  22. van der Rijt AJ, Evans GA (1984) The long-term results of Watson-Jones tenodesis. J Bone Joint Surg 66B:371–375

    Google Scholar 

  23. Rosenbaum D, Becker HP, Sterk J, Gerngroß H, Claes L (1996) Long-term results of the modified Evans repair for chronic ankle instability. Orthopedics 19:451–455

    CAS  PubMed  Google Scholar 

  24. Rosenbaum D, Bertsch C, Claes L (1997) Tenodeses do not fully restore ankle joint loading characteristics: a biomechanical in vitro investigation in the hind foot. Clin Biomech 12(3):202–209

    Article  Google Scholar 

  25. Rosenbaum D, Becker HP, Sterk J, Gerngross H, Claes L (1997) Functional evaluation of the 10-year outcome after modified Evans repair for chronic ankle instability. Foot Ankle 18:765–771

    CAS  PubMed  Google Scholar 

  26. Rudert M, Wülker N, Wirth CJ (1997) Reconstruction of the lateral ligaments of the ankle using a regional periostal flap. J Bone Joint Surg 79B:446–451

    Article  Google Scholar 

  27. Smith PA, Miller SJ, Berni AJ (1995) A modified Chrisman-Snook procedure for reconstruction of the lateral ligaments of the ankle: review of 18 cases. Foot Ankle 16:259–266

    CAS  PubMed  Google Scholar 

  28. Snook GA, Chrisman OD, Wilson TC (1985) Long term results of the Chrisman-Snook operation for reconstruction of the lateral ligaments of the ankle. J Bone Joint Surg 67A:1–7

    CAS  PubMed  Google Scholar 

  29. Takahashi T, Nakahira M, Kaho K, Kawakami T (2003) Anatomical reconstruction of chronic lateral ligament injury of the ankle using pedicle tendon of the extensor digitorum longus. Arch Orthop Trauma Surg 123(4):175–179

    PubMed  Google Scholar 

  30. Trevino SG, Davis P, Hecht PJ (1994) Management of acute and chronic lateral ligament injuries of the ankle. Orthop Clin North Am 25:1–16

    CAS  PubMed  Google Scholar 

  31. Verhagen RAW, de Keizer G, van Dijk CN (1995) Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg 114:92–96

    CAS  PubMed  Google Scholar 

  32. Wirth CJ, Küsswetter W, Jäger M (1978) Biomechanik und Pathomechanik des oberen Sprunggelenkes. Hefte Unfallheilkd 177:10–22

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R. Schmidt.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmidt, R., Benesch, S., Friemert, B. et al. Anatomical repair of lateral ligaments in patients with chronic ankle instability. Knee Surg Sports Traumatol Arthrosc 13, 231–237 (2005). https://doi.org/10.1007/s00167-004-0562-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-004-0562-0

Keywords

Navigation