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Lateral ligament reconstruction and augmented direct anatomical repair restore ligament laxity in patients suffering from chronic ankle instability up to 15 years from surgery

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

Abstract

Purpose

The purpose of the present study was to compare the outcomes of patients who underwent augmented direct anatomical repair using a Broström-Gould procedure with those who underwent lateral ligament reconstruction using a split peroneus brevis tendon for the treatment of chronic ankle instability.

Methods

Forty patients aged 18–40 years underwent surgical treatment for chronic lateral ankle instability between 1997 and 1998: 20 patients underwent direct anatomical repair using Broström-Gould procedure (Group A); 20 patients underwent lateral tenodesis using a split peroneus brevis tendon (Group B). Median age at surgery was 22.6 years (range 18–40). Patients were assessed pre-operatively and 15 years after surgery with functional assessment including AOFAS scale, Karlsson–Peterson score, Tegner activity level, Sefton stability scale, and objective examination comprehending ROM, anterior drawer sign and talar tilt test. Telos Stress equipment was used for pre- and post-operative radiographic laxity testing.

Results

No major complications were reported. Mean overall AOFAS, Karlsson–Peterson and Tegner scores significantly increased at follow-up compared to pre-operatory status, although no statistically significant differences concerning these variables were reported between the two groups. Sagittal ROM was full in 36 patients: 4 subjects in the Group B experienced 5 degrees dorsiflexion limitation compared to the contralateral side. Patients treated with lateral tenodesis reported a statistically significant reduction in the values of radiographic anterior talar translation (1.4 mm, SD: 0.9) compared to patients in Group A (5.7 mm, SD: 1.1, p < 0.001).

Conclusion

Augmented direct anatomical repair and lateral tenodesis provide satisfying long-term outcomes in terms of subjective and objective parameters up to 15 years from surgery in patients with chronic ankle instability without leading to significant artrhitic changes. Objectively, lateral tenodesis appears to improve more effectively restoration of laxity; the reduced ROM reported in 20% of patients did not considerably affect the overall functional outcome.

Level of evidence

Comparative case series, Level III.

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Acknowledgements

The authors wish to thank the professional medical illustrator Matilde Bongio, PhD for the assistance with the drawings.

Funding

This research was supported by the Italian Ministry of Health.

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Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, Sport Traumatology and Minimally Invasive Surgery Center, Milan, Italy

    Alberto Ventura, Claudio Legnani & Enrico Borgo

  2. ASST Gaetano Pini, 1st University Division of Orthopaedics and Traumatology, Milan, Italy

    Costantino Corradini

Authors
  1. Alberto Ventura
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  2. Claudio Legnani
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  3. Costantino Corradini
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  4. Enrico Borgo
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Corresponding author

Correspondence to Claudio Legnani.

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The authors declare that they have no competing interests.

Ethical approval

This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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All persons gave their informed consent prior to their inclusion in the study.

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Ventura, A., Legnani, C., Corradini, C. et al. Lateral ligament reconstruction and augmented direct anatomical repair restore ligament laxity in patients suffering from chronic ankle instability up to 15 years from surgery. Knee Surg Sports Traumatol Arthrosc 28, 202–207 (2020). https://doi.org/10.1007/s00167-018-5244-4

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  • DOI: https://doi.org/10.1007/s00167-018-5244-4

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