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Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability

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

Abstract

Purpose

To compare the return-to-activity and long-term clinical outcomes between anatomic lateral ligament reconstruction using the autologous gracilis tendon and modified Broström-Gould (MBG) procedure in chronic lateral ankle instability (CLAI). It was hypothesised that there was no difference between the two techniques.

Methods

From 2013 to 2018, 30 CLAI patients with grade III joint instability confirmed by anterior drawer test underwent anatomic reconstruction of lateral ankle ligament with the autologous gracilis tendon (reconstruction group) in our institute. Another 30 patients undergoing MBG procedure (MBG group) were matched in a 1:1 ratio based on demographic parameters. The post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner activity score, Karlsson–Peterson score, surgical complications, return-to-activities and work were retrospectively evaluated and compared between the two groups.

Results

All subjective scores significantly improved after the operation (all with p < 0.001) without difference between the two groups (all n.s.). The MBG group showed a significantly higher proportion of postoperative sprain recurrence than the reconstruction group (26.7% vs. 0, p = 0.002). The reconstruction group showed a significantly longer period to start walking with full weight-bearing (10.5 ± 6.9 vs. 7.0 ± 3.1 weeks, p = 0.015), jogging (17.1 ± 8.9 vs. 12.7 ± 6.9 weeks, p = 0.043) and return-to-work (13.5 ± 12.6 vs. 8.0 ± 4.7 weeks, p = 0.039) than the MBG group.

Conclusions

Both anatomic reconstruction using the autologous gracilis tendon and MBG procedure could equally achieved reliable long-term clinical outcomes and the tendon reconstruction showed a relatively lower incidence of postoperative sprain recurrence but delayed recovery to walking, jogging and return-to-work. The MBG procedure was still the first choice with rapid recovery but the tendon reconstruction was recommended for patients with higher strength demand.

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), Beijing Natural Science Foundation (7212132), 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 Yi-chuan Zhu have contributed equally to this manuscript.

Authors and Affiliations

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

    Tong Su, Yi-chuan Zhu, Ming-ze Du, Yan-fang Jiang, Qin-wei Guo, Yue-lin Hu, Chen Jiao & Dong Jiang

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Contributions

TS and YZ have contributed equally to this work. DJ and CJ have contributed equally to this work. (1) Conception and design of the study: DJ and CJ. (2) Acquisition of data: TS, YZ, MD and YJ. Analyses of data: TS and YZ. Drafting the work: TS and YZ. Revising it critically for important intellectual content: QG, YH, CJ and DJ. (3) Final approval of the version to be published: TS, YZ, MD, YJ, QG, YH, DJ, CJ.

Corresponding authors

Correspondence to Chen Jiao or Dong Jiang.

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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., Zhu, Yc., Du, Mz. et al. Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 30, 4181–4188 (2022). https://doi.org/10.1007/s00167-022-07011-5

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