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Anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation for chronic lateral ankle instability with poor remnant quality: results and complications

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

A Correction to this article was published on 24 November 2022

This article has been updated

Abstract

Purpose

Treatment of chronic lateral ankle instability (CLAI) with poor remnant quality is challenging. The aim of the present study was to evaluate clinical results and complications of anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation in the treatment of such patients.

Methods

One hundred and eight patients with CLAI, who were treated surgically using anatomic reconstruction with allograft tendon and suspensory fixation between April 2016 and January 2018 at our hospital, were retrospectively analysed. None of the patients had sufficient ligament remnants for the modified Broström procedure during the intraoperative evaluation. Eighteen patients were excluded. Seventeen patients were lost to follow-up and 73 patients completed the study. The mean duration of instability symptoms was 39.1 months (range, 6–480 months). The mean follow-up time was 57.5 months (range, 48–69 months). Clinical results were evaluated using the Karlsson scoring scale, American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) score, visual analogue scale (VAS), patients’ subjective satisfaction, and incidence of complications. Mechanical stability was evaluated using the varus talar tilt angle (TTA) and anterior talar displacement (ATD).

Results

The AOFAS-AH scores significantly improved from 67.7 ± 8.5 points to 89.8 ± 9.5 (p < 0.001). The Karlsson scoring scales evolved from 58.8 ± 16.5 to 88.4 ± 11.2 (p < 0.001). VAS scores significantly decreased from 2.9 ± 1.3 to 1.1 ± 1.0 (p < 0.001). On stress radiographs, TTA decreased from 15.1 ± 2.5 degrees to 5.8 ± 2.1 degrees (p < 0.001), whereas ATD reduced from 13.4 ± 2.9 mm to 5.7 ± 1.5 mm (p < 0.001). Patients' subjective satisfaction indicated 46 excellent, 20 good, 5 fair, and 2 bad results. Postoperatively, 15 cases (20.5%) did not achieve complete relief of discomfort or swelling, 9 cases (12.3%) experienced joint stiffness or decreased range of motion, and 6 cases (8.2%) had soft tissue irritation. Residual instability and reoperation are rare. Allograft rejection or wound infection was not observed.

Conclusion

For the CLAI patients with poor remnant quality, anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation is an effective procedure, while the top three complications in incidence were residual discomfort, joint stiffness, and soft tissue irritation.

Levels of evidence

Level IV, retrospective case series.

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Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This work was supported by the Shanghai Municipal Health Commission (No. 201940339) and the National Natural Science Foundation of China (No. 81772372).

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Authors and Affiliations

  1. Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Rd., 200025, Shanghai, China

    Yongxing Cao, Chonglin Yang, Yang Xu, Yuan Hong & Xiangyang Xu

Authors
  1. Yongxing Cao
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  2. Chonglin Yang
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  3. Yang Xu
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  4. Yuan Hong
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  5. Xiangyang Xu
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Contributions

YC and XX contributed to conception and design. YC, CY, YX, and YH contributed to acquisition of data. CY and YX contributed to analysis and interpretation of data. YC and YH contributed to writing—original draft preparation; XX contributed to writing—review and editing; YC and XX contributed to funding acquisition. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiangyang Xu.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

The study was approved by the Ethics Committee of Shanghai Ruijin Hospital.

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The original online version of this article was revised: In the “Data availability” section, the final two words “reasonable request” were missing.

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Cao, Y., Yang, C., Xu, Y. et al. Anatomic reconstruction of the lateral ligaments using allograft tendon and suspensory fixation for chronic lateral ankle instability with poor remnant quality: results and complications. Arch Orthop Trauma Surg 143, 3231–3237 (2023). https://doi.org/10.1007/s00402-022-04680-2

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