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

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

Abstract

Purpose

To 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.

Methods

This 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.

Results

The 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).

Conclusions

Both 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 evidence

III.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Funding

The author(s) report funding from National Key R&D Program of China (2019YFB1706900, 2018YFF0301100), National Natural Science Foundation of China (82072428), Peking University Medicine Seed Fund for Interdisciplinary Research (BMU2020MX020) and Key Clinical Projects of Peking University Third Hospital (Y72484-02).

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Author notes

  1. Tong Su and Yan-fang Jiang equally contributed to this manuscript.

Authors and Affiliations

  1. Department of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine of Peking University, No. 49 North Garden Road, Beijing, 100191, China

    Tong Su, Yan-fang Jiang, Zong-chen Hou, Yue-lin Hu, Qin-wei Guo, Dong Jiang & Chen Jiao

  2. Department of Radiology, Peking University Third Hospital, No. 49 North Garden Road, Beijing, China

    Yu-qing Zhao & Wen Chen

Authors
  1. Tong Su
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Contributions

TS and YJ have contributed equally to this work. CJ and DJ have contributed equally to this work. Conception and design of the study: DJ and CJ. Acquisition of data: TS, YJ, ZH, YZ and WC. Analyses of data: TS and YJ. Drafting the work: TS and YJ. Revising it critically for important intellectual content: QG, YH, CJ and DJ. Final approval of the version to be published: TS, YJ, ZH, YZ, WC, QG, YH, CJ and DJ.

Corresponding authors

Correspondence to Dong Jiang or Chen Jiao.

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The author(s) declared no potential conflict of interest with respect to the research, authorship, and/or publication of this article.

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IRB Medical Committee of Peking University Third Hospital, IRB00006761-M2019035.

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Su, T., Jiang, Yf., Hou, Zc. et al. The L-shaped tunnel technique showed favourable outcomes similar to those of the Y-graft technique in anatomic lateral ankle ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 30, 2166–2173 (2022). https://doi.org/10.1007/s00167-022-06880-0

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